Data-driven, integrated primary and secondary care for children: moving from policy to practice

Hassanzadeh, Roya; Klaber, Robert; Watson, Mando; Holden, Ben; Majeed, Azeem; Hargreaves, Dougal

doi:10.1177/0141076820968781

Cited by 8 publications

(5 citation statements)

References 14 publications

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“…174 Global healthcare systems already have a problem of large amounts of data being produced without frictionless accessibility between services. 175,176 Poor integration of digital healthcare apps in an already fractured system could just provide another silo of data which may not necessarily be easily interservice accessible. Current digital health approaches in COPD mostly add a digital complexity to already established conventional pathways, rather than reinventing care through adaptive solutions, which may be required.…”

Section: Ensuring Digital Healthcare Safety and Creating A High-quali...mentioning

confidence: 99%

Digital healthcare in COPD management: a narrative review on the advantages, pitfalls, and need for further research

Wilkinson

2022

Ther Adv Respir Dis

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Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality despite current treatment strategies which focus on smoking cessation, pulmonary rehabilitation, and symptomatic relief. A focus of COPD care is to encourage self-management, particularly during COVID-19, where much face-to-face care has been reduced or ceased. Digital health solutions may offer affordable and scalable solutions to support COPD patient education and self-management, such solutions could improve clinical outcomes and expand service reach for limited additional cost. However, optimal ways to deliver digital medicine are still in development, and there are a number of important considerations for clinicians, commissioners, and patients to ensure successful implementation of digitally augmented care. In this narrative review, we discuss advantages, pitfalls, and future prospects of digital healthcare, which offer a variety of tools including self-management plans, education videos, inhaler training videos, feedback to patients and healthcare professionals (HCPs), exacerbation monitoring, and pulmonary rehabilitation. We discuss the key issues with sustaining patient and HCP engagement and limiting attrition of use, interoperability with devices, integration into healthcare systems, and ensuring inclusivity and accessibility. We explore the essential areas of research beyond determining safety and efficacy to understand the acceptability of digital healthcare solutions to patients, clinicians, and healthcare systems, and hence ways to improve this and sustain engagement. Finally, we explore the regulatory challenges to ensure quality and engagement and effective integration into current healthcare systems and care pathways, while maintaining patients’ autonomy and privacy. Understanding and addressing these issues and successful incorporation of an acceptable, simple, scalable, affordable, and future-proof digital solution into healthcare systems could help remodel global chronic disease management and fractured healthcare systems to provide best patient care and optimisation of healthcare resources to meet the global burden and unmet clinical need of COPD.

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Section: Ensuring Digital Healthcare Safety and Creating A High-quali...mentioning

confidence: 99%

Digital healthcare in COPD management: a narrative review on the advantages, pitfalls, and need for further research

Wilkinson

2022

Ther Adv Respir Dis

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“…For example, technology may allow delivery of virtual clinics; rapid collaboration between professionals via email, phone or the e-referral system; easy participation in virtual multidisciplinary team meetings; and collaborative case finding via population level data streams such as the Whole Systems Integrated Care (WSIC) platform in north-west London. 60 However, efficiency gains from technology will be incremental, and no substitute for addressing the systemic workforce shortages described earlier.…”

Section: The Future Of Integrated Child Health Servicesmentioning

confidence: 99%

Back to the future? Lessons from the history of integrated child health services in England

Maile

Singh²,

Black

et al. 2022

Future Healthcare Journal

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The UK has a long history of attempts to integrate child health services to improve outcomes, an ambition renewed in the recent The NHS Long Term Plan. It's therefore timely to review the history of integration to inform future initiatives. Key milestones include the Platt report (1959), Court report (1976), Sure Start (1999), National service framework (2004) and Facing the future report (2015). These stand against a backdrop of national NHS policy changes, with a myriad of local integration initiatives and research efforts in parallel. We suggest lessons for future integration initiatives: integration may support the quadruple aim; integration depends on addressing divides between primary and secondary care; workforce and funding challenges need to be resolved before integration can thrive; high-quality research and evaluation of integrated interventions is required; strong relationships between professional groups are key to integration; and integration can help address health inequalities.

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“…Like secondary care, it is usually provided in hospital settings (NICE, 2022). Over recent decades secondary and tertiary healthcare models have become increasingly specialised to focus on specific conditions, leading to fragmentation that impedes the ability of practitioners to respond effectively to the comorbidities or complex needs of many CYP (Hassanzadeh et al., 2021).…”

Section: Introductionmentioning

confidence: 99%

“…Integrating healthcare services is an increasingly explored solution to improve access, quality of care and health outcomes of CYP with comorbidities, including chronic physical and mental health conditions (Arango, 2011; Baxter et al., 2018; Burkhart, Asogwa, Muzaffar, & Gabriel, 2020; de Voursney & Huang, 2016; Fazel et al., 2021; Hassanzadeh et al., 2021; Platt et al., 2018; Wolfe, Satherley, Scotney, Newham, & Lingam, 2020). Yet, despite the growing application of integrated care models for adults in both primary and secondary care settings, studies evaluating its effectiveness in paediatric populations are scarce (Burkhart et al., 2020; Cohen, Jovcevska, Kuo, & Mahant, 2011; Platt et al., 2018; Wolfe et al., 2020).…”

Section: Introductionmentioning

confidence: 99%

Research Review: Integrated healthcare for children and young people in secondary/tertiary care – a systematic review

Pygott

Hartley

Seregni

et al. 2023

Child Psychology Psychiatry

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Background: Children and young people (CYP) with comorbid physical and/or mental health conditions often struggle to receive a timely diagnosis, access specialist mental health care, and more likely to report unmet healthcare needs. Integrated healthcare is an increasingly explored model to support timely access, quality of care and better outcomes for CYP with comorbid conditions. Yet, studies evaluating the effectiveness of integrated care for paediatric populations are scarce. Aim and Methods: This systematic review synthesises and evaluates the evidence for effectiveness and cost-effectiveness of integrated care for CYP in secondary and tertiary healthcare settings. Studies were identified through systematic searches of electronic databases: Medline, Embase, PsychINFO, Child Development and Adolescent Studies, ERIC, ASSIA and British Education Index. Findings: A total of 77 papers describing 67 unique studies met inclusion criteria. The findings suggest that integrated care models, particularly system of care and care coordination, improve access and user experience of care. The results on improving clinical outcomes and acute resource utilisation are mixed, largely due to the heterogeneity of studied interventions and outcome measures used. No definitive conclusion can be drawn on cost-effectiveness since studies focused mainly on costs of service delivery. The majority of studies were rated as weak by the quality appraisal tool used. Conclusions: The evidence of on clinical effectiveness of integrated healthcare models for paediatric populations is limited and of moderate quality. Available evidence is tentatively encouraging, particularly in regard to access and user experience of care. Given the lack of specificity by medical groups, however, the precise model of integration should be undertaken on a best-practice basis taking the specific parameters and contexts of the health and care environment into account. Agreed practical definitions of integrated care and associated key terms, and cost-effectiveness evaluations are a priority for future research.

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Data-driven, integrated primary and secondary care for children: moving from policy to practice

Cited by 8 publications

References 14 publications

Digital healthcare in COPD management: a narrative review on the advantages, pitfalls, and need for further research

Digital healthcare in COPD management: a narrative review on the advantages, pitfalls, and need for further research

Back to the future? Lessons from the history of integrated child health services in England

Research Review: Integrated healthcare for children and young people in secondary/tertiary care – a systematic review

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