Would you care for some integrated care in your fragmented health system? A participatory action research to improve integration between levels of care in a Belgian urban setting.

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Context

Weak integration between levels of care

Increasing demand for integration

No gatekeeping

Few integrated care pathways Weak functional & normative integration

No territorial planification

Ageing population and multimorbidity

Financial pressure on hospital

Model: Local Health System

Integration between levels of care

for a defined population

supported by a coordination team

Method:

Participatory Action Research

Research through Action

Deming’s Spiral: plan/do/check/act

Participative at all stages Justified for

•  comprehensive approach in complex situation •  implementation

Results

Choices for action: local secondary care hospital

and local GP representatives

Professional and organizational interests for integrated care:

§  Internal improvement: information flow

§  Increased interprofessional and interorganizational

knowledges and relationships

Supported by concertation platform of

organizational representatives

§  No financial incentive

§  Extension of process to other hospitals and

other primary health care organizations

Coordination mechanisms implemeted locally

§  Information flows between levels of care

§  Direct contact between professionals

§  Integrated care pathways for complex situations

(a specified stage of one disease)

Highlights

Concertation platform of organizational representatives from the 2 levels of care = necessary link in a fragmented health system (like Belgium)

Bottom-Up approach built on:

•  immaterial incentives (e.g.mutual recognition)

•  participativ approach

•  self-defined territory

Time consuming: to gain voluntary adhesion

Difficulty to represent weakly structured Primary Health Care

Input of researchers:

•  raising local representative‘s awarness,

•  supporting boundary spanner’s activities

•  bringing technical competencies (primary care, public health)

Limited scope: doctor-centered

single disease approach

difficulty to gather several hospitals

(marked-based organization of secondary care)

Conclusions

• Potentialization

of

BOTTOM-UP

and

TOP-DOWN

Adapted to the local context

Incentives for action

•  Policy

•  (weak) Financial

investement Sustainability

• Increased integration of care

From normative (cultural framework) to functional (support) dimensions Between levels of care and inside each levels

(vertical/horinzontal) From organizational to professional level

Would you care for some INTEGRATED CARE

in your FRAGMENTED health system?

A particpatory action research

to improve integration between levels of care in a Belgian urban setting

JL.Belche, C.Duchesnes, C.Darras, J. Van der Vennet, F.Monet, JP. Unger, D.Giet. DSP IMT Antwerpen/DUMLG ULg

Contact: JeanLuc Belche [email protected] Département Médecine Générale - Université de Liége

CHU Sart Tilman Bât B23 Tour 3 4000 Liège Tel: (+32)4/366.40.50 Fax: (+32)4/366.42.77

Urban setting

Several Hospitals; ≅ 300 GP’s

From Grodos D, Mercenier P. Health systems research: a clearer methodology for more effective action. Antwerpen: ITGPress, 2000: 107 pp. (Studies in Health Services Organisation & Policy; 15). [ITM Library: SOCA /16535] [Available from: http:// www.itg.be/]

Primary health care:

Self-employed GP mainly in solo practice

Pr im ar y' he al th 'c ar e' Se co nd ar y' he al th ' car e' Po pu la3 on 'o f' re sp on sab ili ty ' In te gr a3 on 'o f'c ar e' Co or di na3 on : catal ys t' Chie f'Me di cal ' offi ce r' O rg an iza3 on al ' dim ension.' Decision' Mo del' Running'3me…' Providing'technical'and'scien3fic'skills' Managing'group'dynamics' Extending'involvement'inside'hospital' Improving'inter'professional'knowledges'of'representa3ves' Including'other'local'hospitals'in' thema3c'project' Concerta3on'with'other' local'hospitals'' Improving'inter'professional'knowledges'of'healthcare'providers' Managing'integrated'care'projects' Improving'representa3ve'func3on'inside'GP'circle' Including'other'GP’s'organiza3ons' Extending'to'other'Primary'Care'professions' Defining'the'territory'for'Primary'and'Secondary'health'care'Integra3on' Sub: working' groups' Concerta3on' plateform' Improving'inter' organiza3onal' knowledges' Lo cal ' re pr es en ta3 ve s'of' GP:'GP' ci rcl e' Po pu la3 on 'o f' re sp on sab ili ty 'for ' GP' ci rcl e' Link 'func3on ' Raising'interest'' September'2011'' May' 2016'' Coordina3ng'the'groups'