Integration of social and health services: 3 issues and 3 solutions

Aging population has many interpretations, some of them very positive such as the fact that more and more people are fortunate that they live for longer with a fairly healthy life. The other side of the coin is that there are also problems such as increased multiple combined chronic diseases, social deprivation and the fact that many people reach an advanced stage of geriatric frailty. And this is where service delivery models that have been consolidated in recent decades are still struggling to give satisfactory answers. Governments know it and, for this reason, are launching initiatives to address chronic disease and frailty in a more effective manner but these programs often face political difficulties, resistance to change and difficult to overcome bureaucracies.

From everything I've seen in this issue, I think the British are the most daring, so I chose the report of the "Commission on the future of health and social care in England" published by King's Fund, because it synthesizes very well what the problems of current models are and what are the solutions to be put on the table.

First problem: the current model is unfair. The health system is universal and free, while access to social services is restricted. Let's say two examples: people affected by cancer enjoy global coverage, regardless of process costs and economic level of the patient, while Alzheimer's patients suffer from limited access to services, especially in more advanced stages when their needs are more social than medical.

Second problem: funding sources are different. The health system feeds directly from the public budget, while social funding source is hybrid, with participation of different administrations, including the local, and with a variety of complex management copayments.

Precision medicine, personalized medicine and person-centred medicine

Cristina Roure

In recent years we have frequently heard about personalized medicine referring to the use of our growing understanding of genetic variability in medicine for prevention strategies, more accurate and safer diagnoses and more effective treatments for each individual.

I must confess that the use of the "personalized" adjective referring to the individualization of treatments based on the genetic characteristics of each person has always caused me some discomfort, because I think that a person is much more than a set of genetic information, however accurate it may be.

For this reason I was happy to hear the term precision medicine in relation to the new initiative of the Obama Administration announced in his discourse of State of the Nation on January 20th, 2015.

Population’s health beyond service integration

All health systems in the world are immersed in service integration projects aiming to meet the challenge posed by the increased chronic disease and geriatric frailty. Based on this circumstance, King's Fund has published a document, "Population health systems. Going beyond integrated care" wondering how difficult could the integration of public health services be, given that improving health determinants  and risk prevention can most effectively affect the way in which many people grow older and healthier. 

The King's Fund document selects 5 experiences from different countries, that beyond the integration of services, are reaching community action: a) Kaiser Permanente, USA, focused on promoting physical activity and healthy eating; b) Nuka System of Care, Alaska, focused on community work to reduce domestic violence; c) Gesund Kinzigtal, Germany, focused on community groups that promote sport and health; d) Manukau Counties, New Zealand, created programs that emphasize healthy improvements in social housing; and e) Jönköping County Council, Sweden, formed discussion groups to promote health (life cafés, learning cafés, etc.)

Basic instruments for clinical management

In preparing this post I have chosen nine references which, in my opinion, have been milestones in the development of methodologies and tools that have shaped clinical management as we understand it today. To make it more understandable, I have framed these milestones in 5 relevant periods: the introduction of the concepts of quality in the 60s, the protocols in the 70s, the consensus in the 80s, the evidence of 90s and the safety of patients in the first decade of this century.