integrated primary care, the search for coherence
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Integrated primary care, the search for coherence. EFPC congres 2012 Gothenburg. Msc Pim P. Valentijn; Bruijnzeels , Marc A; Opheij, Wilfrid. Jan van Es Institute, Dutch Expert Centre Integrated Primary Care. Content: . The fragmentation of primary care - PowerPoint PPT PresentationTRANSCRIPT
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Integrated primary care, the search for coherence
Msc Pim P. Valentijn; Bruijnzeels, Marc A; Opheij, Wilfrid
Jan van Es Institute, Dutch Expert Centre Integrated Primary Care
EFPC congres 2012 Gothenburg
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Content:
• The fragmentation of primary care
• Integration and inter-organisational collaboration
• The search for theoretical guidance
• Conceptualisation of integrated primary care
• From idea to reality
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The fragmentation of primary care
From mono disciplinary small scale enterprises to complex inter-organisational relationships
The ‘Primary focus’ program (2009-2013):
• Stimulate integration through inter-organisational collaboration
• By subsidizing 70 collaboration initiatives
• What hampers or facilitates inter-organisational collaboration?
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The search for theoretical coherence
There is a lack of conceptual clarity regarding integration through inter-organisational collaboration that hampers a systematic evaluation
Identify an overarching framework based on the theoretical concepts of integrated- and primary care that enables us to understand the inter-organisational collaboration processes
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Some theoretical guidance
Primary care: • A broad societal strategy requires inter-sectorial collaboration (WHO, 1978) • Precise definition of the functions (Starfield, 1992) Integrated care: • Lack of an uniform definition• Multidimensional construct (Kodner, 1999)
Inter-organisational relationship: • Lack of an uniform definition (Cropper et al, 2008)
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Conceptualisation of integrated primary care
A. Perfect primary care: • Person-focused and population based • Provided as: accessible, comprehensive, and coordinated services (Starfield, 2009)
• Critical hub in a health system (Nasmith, 2010)
B. Integrated care: Micro, meso and macro integration processes…….
Linking primary care with the macro level: system integration• Comprehensive services that address the needs of people and populations (Suter, 2009)
• Streamlining services: Vertical- and horizontal integration through partnerships
(Kodner, 2009, Shortell 1996)
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Macro level: System integration and primary care
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Micro level: Clinical and service integration
- Clinical integration is disease-focused instead of person-focused care
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Meso level: Professional integration
- Inter-professional partnerships with a collective responsibility towards a defined population
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Meso level: Functional integration
− The aligning mechanism between the service-, professional and organisational layers within a system
- Back-office functions that support professionals and management in their decisions
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Meso level: Organisational integration
- Inter-organisational relationships, including common governance mechanisms to deliver comprehensive services to a defined population
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Meso level: Organisational integration
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All levels: Normative integration
- A common frame of reference (e.g. shared values, culture, mission and vision) across all the levels of an integrated system
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Integrated primary care, connecting the dots
The proposed conceptual framework provides directions to evaluate the integration the 70 collaboration initiatives
The patterns of successful integration and collaboration….
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From idea to reality?
Methodological implications……− Lack of standardized, validated tools and indicators to measure integration
Further work:Developing a comprehensive measurement approach……….
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Guidance for further research
What is your opinion?
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Thank you very much for your attention
Email: [email protected]
Dutch Expert Center for Integrated Primary Care