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Integrated care: easy in theory, harder in practice?

Abstract

Integrated care (IC) is a term now commonly adopted across the world, which implies a positive attitude towards addressing fragmentation of service provision inside health systems. While the principles of IC are simple, their implementation is more controversial. The ever growing number of IC definitions is related to the increasing domains of applications, which reflect the increasing demand induced by ageing multi-morbid patients. An exhaustive definition of IC should now enclose the coordination of health and social services useful to deliver seamless care across organizational boundaries. The current debate on IC is largely fueled by the modern mismatch between the growing burden of health needs for chronic conditions from the demand side and the design of health systems still largely centered on acute care from the supply side. The major reasons of persisting IC weakness in Western European nations stem from arguable choices of health policy taken in a quite recent past. The political creed in ‘market competition’ is likely to be the most emblematic. All initiatives encouraging healthcare providers to compete with each other are likely to discourage IC. Another historically rooted reason of IC weakness is the occupational status of European general practitioners (GPs). While single large-scale organizations have become a pressing priority for a modern primary care, most GPs are still selfemployed professionals working in their own cabinets. It is time to reconsider the anachronistic status of GPs so as to enhance IC in the future.

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References

  1. Shaw S, Rosen R, Rumbold B (2011) What is integrated care? An overview of integrated care in NHS. London, Nuffield Trust. www.nuffieldtrust.org.uk/sites/files/nuffield/publication/what_is_integrated_care_research_report_. Accessed 1 June 2021

  2. Goddard M, Mason AR (2017) Integrated care: a pill for all ills? Int J Health Policy Manag 6(1):1–3

    Article  Google Scholar 

  3. Goodwin N (2016) Understanding integrated care. Int J Integr Care 16(4):6

    Article  Google Scholar 

  4. Armitage GD, Suter E, Oelke ND, Adair C (2009) Health systems integration: state of the evidence. Int J Integr Care 9(17):1–11

    Google Scholar 

  5. Briggs AM, Valentijn PP, Thiyagarajan JA, de Carvalho IA (2018) Elements of integrated care approaches for older people: a review of reviews. BMJ Open 8(4):e021194

    Article  Google Scholar 

  6. Janse B, Huijsman R, de Kuyper RD, Fabbricotti IN (2016) Do integrated care structures foster processes of integration? A quasi-experimental study in frail elderly care from the professional perspective. Int J Qual Health Care 28(3):376–383

    Article  Google Scholar 

  7. Stoop A, de Bruin SR, Wistow G, Billings J, Ruppe G, Leichsenring K, Obermann K, Baan CA, Nijpels G (2019) Exploring improvement plans of fourteen European integrated care sites for older people with complex needs. Health Policy 123(12):1135–1154

    Article  Google Scholar 

  8. Stokes J, Riste L, Cheraghi-Sohi S (2018) Targeting the “right” patients for integrated care: stakeholder perspectives from a qualitative study. J Health Serv Res Policy 23(4):243–251

    Article  Google Scholar 

  9. van der Heide I, Snoeijs S, Quattrini S, Struckmann V, Hujala A, Schellevis F, Rijken M (2018) Patient-centeredness of integrated care programs for people with multimorbidity. Results from the European ICARE4EU project. Health Policy 122(1):36–43

    Article  Google Scholar 

  10. Baxter S, Johnson M, Chambers D et al (2018) The effects of integrated care: a systematic review of UK and international evidence. BMC Health Serv Res 18(1):350

    Article  Google Scholar 

  11. Mur-Veeman I, Hardy B, Steenbergen M, Wistow G (2003) Development of integrated care in England and the Netherlands: managing across public-private boundaries. Health Policy 65(3):227–241

    Article  Google Scholar 

  12. Garattini L, Padula A (2019) Competition in health markets: is something rotten? J R Soc Med 112(1):6–10

    Article  Google Scholar 

  13. Connelly LB, Fiorentini G (2021) Structural factors and integrated care interventions: is there a role for economists in the policy debate? Eur J Health Econ. https://doi.org/10.1007/s10198-020-01253-1 (Epub ahead of print)

    Article  PubMed  Google Scholar 

  14. Garattini L, Padula A, Mannucci PM (2021) Community and hospital pharmacists in Europe: encroaching on medicine? Intern Emerg Med 16(1):7–10

    Article  Google Scholar 

  15. Ham C (2003) Improving the performance of health services: the role of clinical leadership. Lancet 361(9373):1978–1980

    Article  Google Scholar 

  16. Alderwick H, Dunn P, Gardner T, Mays N, Dixon J (2021) Will a new NHS structure in England help recovery from the pandemic? BMJ 372:n248

    Article  Google Scholar 

  17. Gilburt H (2016) Supporting integration through new roles and working across boundaries. London: King’s Fund. www.kingsfund.org.uk/publications/supporting-integration-new-roles-boundaries. Accessed 1 June 2021

  18. Garattini L, Padula A, Mannucci PM (2020) Defensive medicine: Everything and its opposite. Eur J Intern Med 74:117–118

    Article  Google Scholar 

  19. Garattini L, Badinella Martini M, Mannucci PM (2021) Improving primary care in Europe beyond COVID-19: from telemedicine to organizational reforms. Intern Emerg Med 16(2):255–258

    Article  Google Scholar 

  20. Das P, Naylor C, Majeed A (2016) Bringing together physical and mental health within primary care: a new frontier for integrated care. J R Soc Med 109(10):364–366

    Article  Google Scholar 

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Correspondence to Livio Garattini.

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Livio Garattini, Marco Badinella Martini and Pier Mannuccio Mannucci have no conflicts of interest directly relevant to this article.

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Garattini, L., Badinella Martini, M. & Mannucci, P.M. Integrated care: easy in theory, harder in practice?. Intern Emerg Med 17, 3–6 (2022). https://doi.org/10.1007/s11739-021-02830-9

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Keywords

  • European union
  • Integrated care
  • National health service