Editorial

Citation

Miller, R., Glasby, J. and White, S. (2016), "Editorial", Journal of Integrated Care, Vol. 24 No. 4. https://doi.org/10.1108/JICA-06-2016-0024

Editorial

Article Type: Editorial From: Journal of Integrated Care, Volume 24, Issue 4.

It often seems that integrated care is focused on a particular group of the population (older people), a particular interface (acute to primary/adult social care), and a particular outcome (saving resources through greater efficiency …). It can also feel at times that there are a particular set of interventions that are promoted as being the most effective response, with risk stratification, multi-disciplinary teams and financial incentives being current leaders in this regard. Whilst all these are important, integration has and will continue to be, much more than this limited set of people and responses. In this edition of the Journal of Integrated Care we therefore draw on work with different populations (including older people), but which have insights that can applicable to other contexts and challenges. The articles highlight both the complexity of factors that lead to fragmentation, and the multiplicity of outcomes that fragmentation can negatively influence. Furthermore, there are a range of potential interventions that can be deployed, with opportunity for creativity alongside more process based responses.

Jessica Langston reports on an innovative project seeking to improve the relationship that fathers who are incarcerated in prison have with their children. Despite recognition in research and policy of the negative impact to all concerned that can be caused through the imprisonment, this vital aspect of family life often continues to be unsupported. As the paper states one contributory factor is fragmentation in the system – “there is a need for professionals to transcend departmental barriers, not simply to share information, but to unite the conflicting agendas and strike a balance between punishment and empowerment”. The Mellow Dads Parenting Programme runs weekly over 14 weeks and provides contact between father and child(ren), reflection on their interactions and input on key parenting related topics. Overall it seeks to increase self-awareness, parent and child well-being and parent-child interactions. The study found that the integrated approach to service delivery was fundamental to creating a staff culture that recognised participant’s strengths within the context of their families.

Kathy Rush and colleagues have researched the support of older people with atrial fibrillation within rural communities of Canada. Previous work has demonstrated that uncoordinated care in low-resourced rural communities compromises care quality, putting older adults with this condition at greater risk of negative outcomes. Part of a larger mixed methods study, the paper is based on focus groups and six-month individual patient journeys involving face-to-face and telephone interviews. The study found that professionals did not always recognise risks perceived by older people due to delays in access to services, poor communication affected co-ordination between professionals, and ineffective team working led to the potential benefits of multi-disciplinary teams being diluted or lost. They recommend that further “development, implementation, and evaluation of patient-focused primary care models is required to determine the impacts relative to integration and risk at patient, provider and system levels”.

Catherine Mangan and colleagues share the use of a peer review approach to identifying and addressing the causes of inappropriate admissions from hospital to nursing homes. Peer review is being promoted as a process to enable improvement across services even though the evidence base to support it is not yet well developed. Data suggested that the case study locality had higher than average levels of admission to nursing homes and a process to understand this was therefore introduced. This began with a case audit in which local care professionals would discuss a representative sample of the needs and circumstances of people who have been admitted to nursing homes to consider whether appropriate decisions had been made. This was then followed by a review of four people’s care by an independent panel of practice experts working outside of the case study area. The combination of case audit and peer review highlighted weaknesses in the assessment processes and recommended changes to address the issues. The authors suggests that the process is a robust and effective one, but only if senior managers have confidence in the peer reviewers and their own managers and elected members that the findings from the review will be used as learning rather than blame for failure.

Godfred Boahen explores the role of social workers within community learning disability teams. A key issue within such multi-disciplinary services is the balance between the specialist roles held by many team members and their generic responsibilities as integrated team members. Learning disability services have long recognised the importance of integration (or partnership working as it was commonly referred to in the 2000s) to supporting people holistically and in facilitating their access to mainstream community resources as citizens. Through ethnographic research, social work in the service in question could be categorised along five domains of practice: case management, safeguarding, assessments, mental health practice, and duty work. The study concludes with the interesting conclusion that whilst social workers do make a unique contribution this was not (as one would commonly assume) that this was due to unique expertise, but rather “their knowledge about several services and ability to accomplish different and sometimes unrelated tasks that makes the profession indispensable”. In essence, their “specialism” was that of “generalism”.

Finally, Carolina Day and colleagues have investigated that key transition from hospital into the community but in the less researched context of Brazil. They gathered the views of professionals from the acute and primary health care elements of the local system and found that acute services were unaware (and indeed surprised) by the breadth of support that could be provided in the community and that communication was a, if not the, key enabler of better care for the patient experiencing this transition. Accompanying the view of the professions that better integration “facilitated greater appreciation of shared vision and values of organisations and the health system as a whole resulting in trust and collaborative decision making” was their perception that this vision was yet to be firmly endorses and supported by policy makers.

Along with Rome, integration “is not built in a day, and uses a multiplicity of materials”.