The effects of integrated care: a systematic review of UK and international evidence

BACKGROUND: Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. METHODS: The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. RESULTS: One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. CONCLUSIONS: Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand. TRIAL REGISTRATION: Prospero registration number: 42016037725

Gluttony, excess, and the fall of the planter class in the British Caribbean

Food and rituals around eating are a fundamental part of human existence. They can also be heavily politicized and socially significant. In the British Caribbean, white slaveholders were renowned for their hospitality towards one another and towards white visitors. This was no simple quirk of local character. Hospitality and sociability played a crucial role in binding the white minority together. This solidarity helped a small number of whites to dominate and control the enslaved majority. By the end of the eighteenth century, British metropolitan observers had an entrenched opinion of Caribbean whites as gluttons. Travelers reported on the sumptuous meals and excessive drinking of the planter class. Abolitionists associated these features of local society with the corrupting influences of slavery. Excessive consumption and lack of self-control were seen as symptoms of white creole failure. This article explores how local cuisine and white creole eating rituals developed as part of slave societies and examines the ways in which ideas about hospitality and gluttony fed into the debates over slavery that led to the dismantling of slavery and the fall of the planter class

A letter of the abolition of the slave trade : addressed to the freeholders and other inhabitants of Yorkshire

ColofónSignaturizadoAntepTexto con reclamos tipAcompañado de: "New Works in the press / by T. Cadell, & W. Davies, 1806" (4 p.

A new system of measures, weights, and money : entitled the Linn-base decimal system; and designed for the adoption of all civilized nations, as the one common system /

Mode of access: Internet