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Health problems of the elderly : Do we need more integration ?

Health problems of the elderly : Do we need more integration ?. Prof. Güzel Dişçigil , Adnan Menderes Univ , Medical School, Family Medicine Department Asistant Prof. Serap Çifçili , Marmara Univ , Medical School, Family Medicine D epartment. Program

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Health problems of the elderly : Do we need more integration ?

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  1. Health problems of the elderly: Do we need more integration? Prof. GüzelDişçigil, Adnan Menderes Univ, Medical School, Family Medicine Department Asistant Prof. Serap Çifçili, Marmara Univ, Medical School, Family Medicine Department EFPC Conference, İstanbul, 2013

  2. Program 15:00-15:20Wellcome and introduction 15:20-15:40  Presentation: Current health services and status of the elderly in Turkey. (GüzelDişçigil) 15:40-15:50  Brain storming: Challenges of primary care in terms of care for the elderly focusing on integration and co-ordination of care. 15:50-16:20  Coffee Break and formation of the groups 16:20-16:40  Presentation: Care for the elderly: Integration of care across Europe (Serap Çifçili) 16:40-17:00  Group discussions about solutions to our problems 17:00-17:15  Sharing ideas that came up in the groups. WELLCOME EFPC Conference, İstanbul, 2013

  3. Care for the elderly: Integration of care across Europe Serap Çifçili Marmara University Medical School EFPC Conference, İstanbul, 2013

  4. What is integration of care1? “the purposeful working together of independent elements in the belief that the resulting whole is greater than the sum of the individual parts” (Woods, 2001). 1. MacAdamM. Frameworks of IntegratedcarefortheElderly: A SystematicReview. CPRN Research Report, April 2008 (http://www.insp.mx/geriatria/acervo/pdf/60%2049813_EN.pdf) EFPC Conference, İstanbul, 2013

  5. What is integration of care1? “a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion”.(WHO European Office for Integrated Health Care Services). “a means to improve the services in relation to access, quality, user satisfaction and efficiency” (Gröne and Garcia- Barbero, 2001). EFPC Conference, İstanbul, 2013

  6. Why is it needed1? Poor quality of care being delivered to those with chronic conditions. Episodic, short-term intervention tolong-term, comprehensive care EFPC Conference, İstanbul, 2013

  7. Why is it needed1? Toimproveintegration of continuingcareservices. Care of the elderly has been a particular focus with one or more chronic conditions, their high use of health care services EFPC Conference, İstanbul, 2013

  8. TheGoal: Toimprove accessibility, quality of care and financial sustainability EFPC Conference, İstanbul, 2013

  9. Terminology1 (Leutz 1999) Linkage;allows individuals with mild to moderate health care needs to be cared for in systems that serve the whole population without requiring any special arrangements. Coordination;requires that explicit structures be put in place to coordinate care across acute and other health care sectors. While coordination is a more structured form of integration than linkage, it still operates through separate structures of current systems. EFPC Conference, İstanbul, 2013

  10. Terminology1 (Leutz 1999) Full integration creates new programs or entities where resources from multiple systems are pooled. EFPC Conference, İstanbul, 2013

  11. Does it workandwhatkind? Bird et. al. (2007) IntegratedCareFacilitationforOlderPatientswithComplexNeedsReducesHospitalDemand, Australia Intervention: Case management, facilitatedaccesstohealthandsocailservices, self-managementeducation Outcome: %21 reduction in ER visits %28 reduction in admissions Cost-effectiveovertheexistingsystem (1M$) EFPC Conference, İstanbul, 2013

  12. Does it workandwhatkind? Beland et. al. (SystemIntegratedCareforOlderPersons, Canada) SIPA Intervention: Case management, multidisciplinaryteams, homesupportservices, clinicalprotocols, intensivehomecare, 24 hour on-call Outcome: No additionalcost, increasedclientsatisfaction, nocostsavings. EFPC Conference, İstanbul, 2013

  13. Does it workandwhatkind? US department of Healthand Human Services. Program forAll-InclusiveCare of theElderley (PACE). Intervention: Case management, interdisciplinaryteam, adultdaycare, accesstosupportivehealthandsocialservices, capitationpayment Outcome: Lowerrates of hospitaluse, NH and ER visits, lowermortality, betterhealthstastusandquality of life. No costsavings. EFPC Conference, İstanbul, 2013

  14. Does it workandwhatkind? Barnabelet.al. (1998, Italy). Integratedcare. Intervention: casemanagemnt, geriatricevaluation, involvement of GPs, coordianedhealthandsocial service delivery. Outcome: Reduceduse of hospialandnursinghome, improvedphysicalandcognitivefunction. Cost-effective. EFPC Conference, İstanbul, 2013

  15. Does it workandwhatkind? Department of HealthandAgeing. CoordinatedhealthTrials(Australia 2001, 2007). Intervention: Assessmentandcareplanning, Enhancement of GP roles in somelocations. Outcome: • Round-1; No impact on healthandwell-being, increaseduse of communityservices, expendituresweregreater. • Round-2; Improvedhealthandwell-beingandaccesstohealthservices, indications of cost-effectiveness. EFPC Conference, İstanbul, 2013

  16. Does it workandwhatkind2? Darlington (UK) Challis D, Hughes J. Intervention: Case finding and screening, Assessment, Care planning, Monitoring and review, Case closure Outcome: Reduced the rates of institutionalization (50% at home after 12 months), increased the number of days at home (137 days versus 12 days), Increased the use and appropriateness of community services, increased morale, patient satisfaction and depression; limited generalizability due to the requirement for extensive social support or only moderate dependency EFPC Conference, İstanbul, 2013

  17. Primarycareforolderpersons in Europe 3 Quality of careforolderpersons (professionals’ opinion, France) 1- Inadequateneedsassessmentprocesswithinprimarycare 2- Inadequate coordination of primary care services 3- Inadequate coordination of primary and secondary care 4- Perceived consequences for patients and families EFPC Conference, İstanbul, 2013

  18. Primarycareforolderpersons in Europe 2 EFPC Conference, İstanbul, 2013

  19. Unmet needs3 • Healthneeds, mobilityneeds, personalneeds, houseworkneeds • 6 countries; Greece, Italy, Poland, UK, Germany, Sweden. Higheruse of socialcareandintegratedservices 3. BienB, McKee KJ, Döhner H, Triantafillou J, Lamura G, Doroszkiewicz H, Krevers B, Kofahl C. Disabledpeople’suse of healthandsocialservicesandtheirunmetcareneeds in sixEuropeancountries. TheEuropeanJournal of publicHealth 2013;1-7. EFPC Conference, İstanbul, 2013

  20. Patent’s perspective2 • Patientcenteredandindividualised • Easyaccsesstoproviders (telephone, internet, in person) • Clearcommunication of individualisedcareplans • Supportfrom a singlecoordinator • Continuity of relationships EFPC Conference, İstanbul, 2013

  21. ComprehensiveCare • Practiceguidelines, DiseaseOrientedprograms • Differentguidelines, multipleproviders Multi-dimensionalgeriatricassessments STEP, EASY-care; outcome? EFPC Conference, İstanbul, 2013

  22. ComprehensiveCare • Integrating Services • Multidisciplinaryteam-work; communitynurses, pharmacists, socialworkers Singlecoordination of care (generally GP) GPsare not wellpositionedto do thefullclinicalcoordination EFPC Conference, İstanbul, 2013

  23. Integrating services • Single entry point in Italy (SEPs), GP is a proactive actor • Case management by community matrons, UK • Coordination of Professional Care for the elderly (COPA), GP and manager work together, targets old persons living alone. • a single entry point; reinforced the role played by the GP, • integrated health professionals into a multidisciplinary primary care team that includes case managers, • introducing geriatricians into the community who intervene upon a GP request. EFPC Conference, İstanbul, 2013

  24. References • MacAdam M. Frameworks of IntegratedcarefortheElderly: A SystematicReview. CPRN Research Report, April 2008. • JohriM, Beland F, Bergman H . International experiments in integratedcarefortheelderly: a synthesis of theevidence. Int J GeriatrPsychiatry. 2003 Mar;18(3):222-3. • Boeckzstaens P, De Graaf P. Primarycareandcareforolderpersons: PositionPaper of theEuropean Forum forPrimary Car. Quality in PrimaryCare 2011;19: 369-89. European Forum for Primary Care, Almere, The Netherlands. On behalf of the Position Paper Working Group: Aggie Paulus, Arno Van Raak, Peter Groenewegen (The Netherlands), Carmen de la Cuesta (Spain), DanicaRotar (Slovenia), Hanna Kaduskiewicz, Martina Hasseler, Ulrike Junius Walker (Germany), Isabelle Vedel (Canada), Jan De Lepeleire, JannekeRonse, Jean- Pierre Baeyens (Belgium), ModestaVisca (Italy), Steve Illife (UK) • Bien B, McKee KJ, Döhner H, Triantafillou J, Lamura G, Doroszkiewicz H, Krevers B, Kofahl C. Disabledpeople’suse of healthandsocialservicesandtheirunmetcareneeds in sixEuropeancountries. TheEuropeanJournal of publicHealth 2013;1-7. EFPC Conference, İstanbul, 2013

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