Designing and Governing Responsive Local Care Systems – Insights from a Scoping Review of Paramedics in Integrated Models of Care

Allana, Amir; Tavares, Walter; Pinto, Andrew D.; Kuluski, Kerry

doi:10.5334/ijic.6418

Cited by 13 publications

(11 citation statements)

References 130 publications

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“…It has been suggested that bureaucratic, command-and-control approaches to management and policy are partly why efforts to integrate services fail. Instead, the fostering of an enabling environment (Theme 2) would allow a more organic collaboration between professions and organisations [ 20 – 22 ]. It has long been maintained that co-ordinated service delivery relies on the integration of services at multiple levels [ 23 , 24 ], but the research is still evolving on how to do this in a way that would enable integration from the ground-up rather than imposing it from the top-down.…”

Section: Discussionmentioning

confidence: 99%

Lessons learnt while integrating services for children: qualitative interviews with professional stakeholders

Baxter

Speed

Ioakimidis

et al. 2023

BMC Health Serv Res

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Background In the English NHS, integrated care is seen as an opportunity to deliver joined-up care for children and families. This paper examines the lessons learnt by professional stakeholders in the process of developing different examples of integrated models of care/frameworks for children’s services. Methods Initial desk research was undertaken to identify different examples of integrated care models and systems/frameworks for children’s services. This identified forty-three examples in England. Of these, twelve examples were shortlisted after consultation with the senior managers within the Health and Care Partnership that had commissioned the research, and a more detailed online search for published documents was undertaken. Semi-structured qualitative interviews were then conducted with sixteen professional stakeholders in eight of these examples, ranging from one to four interviewees per example. Interviews focused on the lessons learnt from integrating and transforming services. Data were analysed using framework analysis. Results The eight examples vary in their design but have several broad commonalities. A number of common themes and learning have emerged, of which two were identified within all eight examples: the first is about focusing on children and young people; the second is about focusing on partner engagement and collaboration and the importance of building trust and relationships between partners. A number of other important themes also emerged together with several challenges. Conclusions A number of common factors were identified that are essential to success in integrating health and care systems. Common across all localities were being child-centric and focusing on child outcomes plus the importance of building trust, engagement and relationships with partners. The findings can help health and care system leaders transform services to ensure efficiency, improvement in services and integration.

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Section: Discussionmentioning

confidence: 99%

Lessons learnt while integrating services for children: qualitative interviews with professional stakeholders

Baxter

Speed

Ioakimidis

et al. 2023

BMC Health Serv Res

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“…There is also a burgeoning evidence base for the role that community paramedics play in integrated, community care despite ongoing challenges with wider health system recognition of this expanded role 23. A recent scoping review examining factors that could support paramedics’ role within a responsive, local healthcare system noted the need for a cross-cutting service organisation 24. In our study, community paramedics were seen as connectors, linking residents with services and connecting themselves with other healthcare organisations in the community.…”

Section: Discussionmentioning

confidence: 99%

Perceived value and benefits of the Community Paramedicine at Clinic (CP@clinic) programme: a descriptive qualitative study

Marzanek,

Nair,

Ziesmann

et al. 2023

BMJ Open

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ObjectivesCommunity Paramedicine (CP) is increasingly being used to provide chronic disease management for vulnerable populations in the community. CP@clinic took place in social housing buildings to support cardiovascular health and diabetes management for older adults. The purpose of this study was to examine participant perceptions of their experience with CP@clinic as well as potential ongoing programme benefits.DesignThis descriptive qualitative study used focus groups to understand resident experiences of the CP@clinic programme. Groups were facilitated by experienced moderators using a semistructured guide. An inductive coding approach was used with at least two researchers taking part in each step of the analysis process.SettingCommunity-based social housing buildings in Ontario, Canada.ParticipantsForty-one participants from four CP@clinic sites took part in a focus group. Convenience sampling was used with anyone having taken part in a CP@clinic session being eligible to attend the focus group.ResultsAnalysis yielded six themes across two broad areas: timely access to health information and services, support to achieve personal health goals, better understanding of healthcare system (Personal Benefits); and sense of community, comfortable and familiar place to talk about health, facilitated communication between healthcare professionals (Programme Structure). Participants experienced discernible health changes that motivated their participation. CP@clinic was viewed as a programme that created connections within the building and outside of it. Participants were enthusiastic for the continuation of the programme and appreciated the consistent support to meet their health goals.ConclusionsCP@clinic was successful in creating a supportive and friendly environment to facilitate health behavioural changes. Ongoing implementation of CP@clinic would allow residents to continue to build their chronic disease management knowledge and skills.Trial registration numberTrial registration number:NCT02152891, Clinicaltrials.gov.

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“…Integrated care and mental health were ranked highly. A recent scoping review of paramedics in integrated models of care 56 found that paramedics are often the link between acute and chronic care, play a key role in case finding within health systems, and can make considerable contributions to public health initiatives. Of the 137 documents included in the review, only eight originated from Australia and two from New Zealand, reiterating the need for research on the features, approaches, and outcomes of integration in pathways and models of care where Australian and New Zealand paramedics are involved.…”

Section: Clinical Pathways and Models Of Carementioning

confidence: 99%

Research agenda and priorities for Australian and New Zealand paramedicine: A Delphi consensus study

Pap,

Barr,

Hutchison

et al. 2024

Paramedicine

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Introduction: The systematic development of a research agenda is essential for coordinated, collaborative, and efficient research endeavours in any discipline. The aim of this study was to create and prioritise a stakeholder-informed, consensus-derived paramedicine research agenda for Australia and New Zealand. Methods: The study utilised a modified Delphi consensus method consisting of three phases. Phase 1, the findings of which were previously published, consisted of a survey of Australian and New Zealand paramedicine stakeholders to inform the subsequent consensus process. Phase 2 contained three Delphi rounds involving key paramedicine profession stakeholders to generate a research agenda. Panellists were asked to rate their agreement with the inclusion of each item using a 5-point Likert scale. Consensus was defined as 80% agreement signalled by ‘ Strongly Agree’ and ‘ Agree’ responses. Phase 3 involved one additional round of voting to determine the importance and thus establish priorities amongst the final list of agenda items. Results: There were 341 responses to the survey in Phase 1 and thematic analysis produced a provisional agenda consisting of 109 perceived research priorities. Sixty-three key paramedicine profession stakeholders were invited to Phases 2 and 3, of which 56 (88.9%) completed all three rounds in Phase 2, and 43 (68.3%) completed the final Phase 3. Thirty-seven items achieved consensus and were subsequently prioritised constituting the final research agenda. Panellists gave the highest priority to ‘Paramedics role in broader healthcare system’, ‘New and emerging roles in for paramedics’, ‘Patient safety’, ‘System improvement’, and ‘Clinical reasoning processes and models’. Conclusion: Using a modified Delphi consensus method and drawing from a broad range of stakeholders, a 37-item Australian and New Zealand paramedicine research agenda with item prioritisation was developed. The agenda serves to inform industry and other key stakeholders to guide their research endeavours ultimately leading to meaningful and tangible impact within the paramedicine profession.

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Designing and Governing Responsive Local Care Systems – Insights from a Scoping Review of Paramedics in Integrated Models of Care

Cited by 13 publications

References 130 publications

Lessons learnt while integrating services for children: qualitative interviews with professional stakeholders

Lessons learnt while integrating services for children: qualitative interviews with professional stakeholders

Perceived value and benefits of the Community Paramedicine at Clinic (CP@clinic) programme: a descriptive qualitative study

Research agenda and priorities for Australian and New Zealand paramedicine: A Delphi consensus study

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