Integrated primary care, the search for coherence

1. Integrated primary care, the search for coherence EFPC congres 2012 Gothenburg Msc Pim P. Valentijn; Bruijnzeels, Marc A; Opheij, Wilfrid • Jan van Es Institute, Dutch Expert Centre Integrated Primary Care

2. Content: • The fragmentation of primary care • Integration and inter-organisational collaboration • The search for theoretical guidance • Conceptualisation of integrated primary care • From idea to reality

3. The fragmentation of primary care • From mono disciplinary small scale enterprises to complex inter-organisational relationships • The ‘Primary focus’ program (2009-2013): • Stimulate integration through inter-organisational collaboration • By subsidizing 70 collaboration initiatives • What hampers or facilitates inter-organisational collaboration?

4. The search for theoretical coherence • There is a lack of conceptual clarity regarding integration through inter-organisational collaboration that hampers a systematic evaluation • Identify an overarching framework based on the theoretical concepts of integrated- and primary care that enables us to understand the inter-organisational collaboration processes

5. Some theoretical guidance • Primary care: • A broad societal strategy requires inter-sectorial collaboration(WHO, 1978) • Precise definition of the functions (Starfield, 1992) • Integrated care: • Lack of an uniform definition • Multidimensional construct (Kodner, 1999) • Inter-organisational relationship: • Lack of an uniform definition(Cropper et al, 2008)

6. Conceptualisation of integrated primary care • Perfect primary care: • Person-focused and population based • Provided as: accessible, comprehensive, and coordinated services (Starfield, 2009) • Critical hub in a health system (Nasmith, 2010) • Integrated care: • Micro, meso and macro integration processes……. • Linking primary care with the macro level: system integration • Comprehensive services that address the needs of people and populations • (Suter, 2009) • Streamlining services: Vertical- and horizontal integration through partnerships (Kodner, 2009, Shortell 1996)

7. Macro level: System integration and primary care

8. Micro level: Clinical and service integration • Clinical integration is disease-focused instead of person-focused care

9. Meso level: Professional integration • Inter-professional partnerships with a collective responsibility towards a defined population

10. Meso level: Functional integration • The aligning mechanism between the service-, professional and organisational layers within a system • Back-office functions that support professionals and management in their decisions

11. Meso level: Organisational integration • - Inter-organisationalrelationships, including common governance mechanisms to deliver comprehensive services to a defined population

12. Meso level: Organisational integration

13. All levels: Normative integration • A common frame of reference (e.g. shared values, culture, mission and vision) across all the levels of an integrated system

14. Integrated primary care, connecting the dots • The proposed conceptual framework provides directions to evaluate the integration the 70 collaboration initiatives • The patterns of successful integration and collaboration….

15. From idea to reality? • Methodological implications…… • Lack of standardized, validated tools and indicators to measure integration • Further work: • Developing a comprehensive measurement approach……….

16. Guidance for further research • What is your opinion?

17. Thank you very much for your attention Email: p.valentijn@jvei.nl • Dutch Expert Center for Integrated Primary Care