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Models of integrated primary and community health service delivery

Outline. History

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Models of integrated primary and community health service delivery

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    1. Models of integrated primary and community health service delivery Learning from the evidence

    2. Outline History & context Integrated service delivery models Common infrastructure requirements The next challenge

    3. Reforms: history & context matter Differing cultures Health system organisation, payment systems Evolutionary approach

    4. Impact of context Scope of reform influenced by: Who’s engaged The authority of the primary care organisation Incentives/funding to support elements of new approaches & behaviours

    5. Integrated service delivery models Multidisciplinary approaches Changing provider roles Sharing care Outreach Early supported discharge/PAC

    6. Evidence for integrated service delivery models Improved: access & referral patient satisfaction clinical, functional, self reported outcomes quality of care Reduced costs/health service utilisation

    7. Common infrastructure supports Workforce Organisational structures Communication systems Funding/resources Leadership/governance

    8. Next challenge…… Organisational structures for integrated service planning: Population responsibility Population and equity based performance and accountability requirements Levers to influence local service delivery

    9. Levers to influence local service delivery Most Commissioning/contracting: Primary Care Trusts Primary Health Organisations Limited contracting: Divisions of General Practice No contracting: Primary Care Partnerships/ Networks Least Evidence that they all to some extent: Improve the organisation of services: egs Commissioning/contracting Drive service delivery changes: improved quality & access to a broader range of PHC services to meet population needs Limited contracting Influence some changes through contracting/provision of services Persuasion No contracting Persuasion Improved coordination amongst members Evidence that they all to some extent: Improve the organisation of services: egs Commissioning/contracting Drive service delivery changes: improved quality & access to a broader range of PHC services to meet population needs Limited contracting Influence some changes through contracting/provision of services Persuasion No contracting Persuasion Improved coordination amongst members

    10. Contact details Julie McDonald Centre for Primary Health Care & Equity The University of New South Wales Australia Tel: +61 2 4226 7052 Email: j.mcdonald@unsw.edu.au

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