Evaluating case studies of community-oriented integrated care.

This paper summarises a ten-year conversation within London Journal of Primary Care about the nature of community-oriented integrated care (COIC) and how to develop and evaluate it. COIC means integration of efforts for combined disease-treatment and health-enhancement at local, community level. COIC is similar to the World Health Organisation concept of a Community-Based Coordinating Hub - both require a local geographic area where different organisations align their activities for whole system integration and develop local communities for health. COIC is a necessary part of an integrated system for health and care because it enables multiple insights into 'wicked problems', and multiple services to integrate their activities for people with complex conditions, at the same time helping everyone to collaborate for the health of the local population. The conversation concludes seven aspects of COIC that warrant further attention

Shaping the future for primary care education and training project. Finding the evidence for education & training to deliver integrated health and social care: the primary care workforce perspective

This report is one of a series of outputs from the Shaping the Future in Primary Care Education and Training project (www.pcet.org.uk) funded by the North West Development Agency (NWDA). It is the result of a collaborative initiative between the NWDA, the North West Universities Association and seven Higher Education Institutions in the North West of England. The report presents an evidence base drawn from the analysis of the experiences and aspirations of integrated health and social care, as reported by members of the current primary health and social care workforce working in or with Primary Care Trusts (PCTs) in the North West region

Healthcare professionals' perspectives on mental health service provision : a pilot focus group study in six European countries

Background: The mental healthcare treatment gap (mhcGAP) in adult populations has been substantiated across Europe. This study formed part of MentALLY, a research project funded by the European Commission, which aimed to gather qualitative empirical evidence to support the provision of European mental healthcare that provides effective treatment to all adults who need it. Methods: Seven focus groups were conducted with 49 health professionals (HPs), including psychologists, psychiatrists, social workers, general practitioners, and psychiatric nurses who worked in health services in Belgium, Cyprus, Greece, the Netherlands, Norway and Sweden. The focus group discussions centered on the barriers and facilitators to providing quality care to people with mild, medium, and severe mental health problems. Analyses included deductively and inductively driven coding procedures. Cross-country consensus was obtained by summarizing findings in the form of a fact sheet which was shared for triangulation by all the MentALLY partners. Results: The results converged into two overarching themes: (1) Minding the treatment gap: the availability and accessibility of Mental Health Services (MHS). The mhcGAP gap identified is composed of different elements that constitute the barriers to care, including bridging divides in care provision, obstacles in facilitating access via referrals and creating a collaborative 'chain of care'. (2) Making therapeutic practice relevant by providing a broad-spectrum of integrated and comprehensive services that value person-centered care comprised of authenticity, flexibility and congruence. Conclusions: The mhcGAP is comprised of the following barriers: a lack of funding, insufficient capacity of human resources, inaccessibility to comprehensive services and a lack of availability of relevant treatments. The facilitators to the provision of MHC include using collaborative models of primary, secondary and prevention-oriented mental healthcare. Teamwork in providing care was considered to be a more effective and efficient use of resources. HPs believe that the use of e-mental health and emerging digital technologies can enhance care provision. Facilitating access to a relevant continuum of community-based care that is responsive coordinated and in line with people's needs throughout their lives is an essential aspect of optimal care provision

Shaping the future for primary care education and training project. Best practise in education and training strategies for integrated health and social care: development of a benchmarking tool

Collaboration and partnership working between Higher Education and the NHS is an essential requirement for effective delivery of care (Universities UK 2003). The North West Universities Association (NWUA) and the North West Development Agency (NWDA) are two organisations at the forefront of creating such alliances. The research project, Shaping the Future for Primary Care Education and Training Project is a collaborative partnership between both these organisations and seven North West Higher Education Institutions. In addition, the project brings together for the first time all the key partners in the health, social care and education sectors who are involved in supporting the delivery of integrated health and social care in the North West Region

How will the Internet of Things enable Augmented Personalized Health?

Internet-of-Things (IoT) is profoundly redefining the way we create, consume, and share information. Health aficionados and citizens are increasingly using IoT technologies to track their sleep, food intake, activity, vital body signals, and other physiological observations. This is complemented by IoT systems that continuously collect health-related data from the environment and inside the living quarters. Together, these have created an opportunity for a new generation of healthcare solutions. However, interpreting data to understand an individual's health is challenging. It is usually necessary to look at that individual's clinical record and behavioral information, as well as social and environmental information affecting that individual. Interpreting how well a patient is doing also requires looking at his adherence to respective health objectives, application of relevant clinical knowledge and the desired outcomes. We resort to the vision of Augmented Personalized Healthcare (APH) to exploit the extensive variety of relevant data and medical knowledge using Artificial Intelligence (AI) techniques to extend and enhance human health to presents various stages of augmented health management strategies: self-monitoring, self-appraisal, self-management, intervention, and disease progress tracking and prediction. kHealth technology, a specific incarnation of APH, and its application to Asthma and other diseases are used to provide illustrations and discuss alternatives for technology-assisted health management. Several prominent efforts involving IoT and patient-generated health data (PGHD) with respect converting multimodal data into actionable information (big data to smart data) are also identified. Roles of three components in an evidence-based semantic perception approach- Contextualization, Abstraction, and Personalization are discussed

Explicating the role of partnerships in changing the health and well-being of local communities in urban regeneration areas: evaluation of the Warnwarth conceptual framework for partnership evaluation

This literature review is one of three outputs from a project: Explicating the role of partnerships in changing the health and well-being of local communities, one of a number of projects in a larger Higher Education Funding Council Strategic Development Fund project (HEFCE) entitled: Urban Regeneration: Making a Difference. This was a collaborative venture between Manchester Metropolitan University, Northumbria University, University of Salford and University of Central Lancashire. Bradford University was an affiliated partner

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Social exclusion and care for the elderly: Theoretical concepts and changing realities in European welfare states

How approaches in elderly care should be structured to counteract processes of social marginalisation in old age is in the focus of this discussion paper. On a theoretical basis the paper draws on concepts of social exclusion developed in international comparative welfare state research. For the analysis of processes of social exclusion in old age, the ageing process is defined on a wide basis ranging from genetic, social, cultural to environmental components. The term inclusive care describes characteristics of approaches in elderly care, which enable processes of social exclusion to be counteracted. Approaches in elderly care have been re-structured in most member countries of the European Union since the beginning of the 1990s. With the background of the defined characteristics of inclusive care modes of financing, access criteria and procedures, diversification and integration of service facilities and offers as well as the combination with informal care are investigated. The characteristics decisive for inclusive care are defined such as universal accessibility related to social rights, a diversified and integrated care system, a social model of care delivery and the acknowledgement, support and cooperation with informal carers. The findings prove the difficulties and obstacles encountered by certain EU-member countries to fulfil the criteria. Furthermore, according to their risk of experiencing processes of social exclusion, inequalities among different groups of elderly people have become apparent. -- Im Zentrum des Discussion Papers steht die Frage nach adäquaten Ansätzen in der Alten-betreuung zur Verhinderung von sozialer Marginalisierung älterer Menschen. Konzeptionell wird auf Ansätze der international vergleichenden Wohlfahrtsstaatsforschung zur Debatte um soziale Ausgrenzung (social exclusion) zurückgegriffen, die auf die beiden Bereiche Altern und Betreuung älterer Menschen zugespitzt werden. Die Analyse sozialer Aus-grenzung erfordert eine Definition des Alterns-Prozesses, der neben genetischen insbesondere soziale, kulturelle und umweltbezogene Komponenten einschließt. Der Begriff Inclusive Care benennt Charakteristika der Altenbetreuung, die es ermöglichen, Prozessen sozialer Ausgrenzung im Alter entgegenzuwirken. Seit den 1990er Jahren wurden in den meisten Mitgliedsländern der Europäischen Union die Ansätze in der Altenbetreuung restrukturiert. Vor dem Hintergrund der Definition der Charakteristika von Inclusive Care werden Finanzierung, Zugangskriterien, Diversifikation und Integration von Dienstleistungen sowie die Verbindung zur informellen Pflege untersucht. Dabei erweisen sich ein universeller Zugang zu Dienstleistungen verbunden mit sozialen Rechten, ein ausdifferenziertes aber integriertes Versorgungssystem, ein soziales Modell der Versorgung und die Anerkennung, Unterstützung sowie die Kooperation mit informell Pflegenden als entscheidend. Die Ergebnisse zeigen aber auch die Schwierigkeiten in unterschiedlichen europäischen Ländern auf, die Anforderungen zu erfüllen. Deutlich werden zudem Ungleichheiten zwischen verschiedenen Gruppen älterer Menschen, die in unterschiedlicher Art und Weise und Ausmaß von dem Risiko sozialer Ausgrenzung bedroht sind.

Health and mobility: Current status and future paradigms

The movement of telemedicine to the wireless and mobile Internetable applications is imminent in the next few years. This migration from the desktop platforms to the wireless and mobile configurations will have significant impact on the future health care delivery system and their globalisation. The recent telecommunications and biomedical computing advances will significantly enhance the current methodologies of telemedicine and telecare systems. This editorial will present some of the evolutionary issues and important aspects that have to be considered in the developing technologies for the next generation of Internet and Third Generation of Mobile Systems (3G), geared for future telemedical applications. These will provide new dimensions to existing medical services and areas of outreach, that are not possible in the current generation and will have tremendous impact on how the health care delivery will be shaped for the 21 Century