Drivers of successful implementation of integrated care for multi-morbidity: Mechanisms identified in 17 case studies from 8 European countries

Looman, Willemijn; Struckmann, Verena; Köppen, Julia; Baltaxe, Erik; Czypionka, Thomas; Huić, Mirjana; Pitter, J; Ruths, Sabine; Stokes, Jonathan; Bal, Roland; Mölken, Maureen Rutten-van

doi:10.1016/j.socscimed.2021.113728

Cited by 41 publications

(64 citation statements)

References 21 publications

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“…Staff at the operative level should be included in the team to be able to be a part of building a mutual understanding of each other’s roles. Moreover, the development of new roles and competencies for integrated care has to be initiated by the management [ 39 ]. The results from the present study will form the basis of a longitudinal study between organisations of the implementation of an ICP from the staff’s understanding, commitment and ability to change their work procedures.…”

Section: Discussionmentioning

confidence: 99%

Barriers for Inter-Organisational Collaboration: What Matters for an Integrated Care Programme?

Bångsbo

Dunér

Dahlin‐Ivanoff

et al. 2022

International Journal of Integrated Care

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Introduction: Inter-organisational collaboration is challenging but essential in managing the complex and comprehensive needs of frail older people. Therefore, there is a need to investigate the influence of different barriers to inter-organisational collaboration when implementing an integrated care programme. The aim of this study was to investigate both inpatient and outpatient staff views on the factors they deemed to be influential to inter-organisational collaboration for an integrated care programme. Methods: The study was a cross-sectional study and included staff from hospitals, primary care and municipal health and social care. Results: There were no significant differences between staff from inpatient and outpatient care in measuring factors that may cause difficulties for inter-organisational collaboration. Staff views diverged significantly on all factors, such as educational level at long physical distances, laws and regulations, knowledge of each others work settings, experience from inter-organisational collaboration, different professions, variations in professional status and power, psychosocial factors such as positive work environment and interpersonal chemistry. Discussion: A multidisciplinary team culture and avenues for inter-organisational collaboration need to be developed for improved care continuity. Conclusion: The staffs’ educational level influenced what was perceived as barriers to inter-organisational collaboration, and may guide future development of integrated care programmes.

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Section: Discussionmentioning

confidence: 99%

Barriers for Inter-Organisational Collaboration: What Matters for an Integrated Care Programme?

Bångsbo

Dunér

Dahlin‐Ivanoff

et al. 2022

International Journal of Integrated Care

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“…Growing literature on champions and leaders in primary care supports their important role in facilitating implementation of AMS strategies [ 43 , 48 ] and other initiatives (e.g. [ 49 , 50 ]). However, a qualitative study with Norwegian GPs showed a need for leadership training and tensions between GPs’ clinical and leadership roles [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

Development of an intervention to support the implementation of evidence-based strategies for optimising antibiotic prescribing in general practice

Borek

Campbell

Dent

et al. 2021

Implement Sci Commun

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Background Trials show that antimicrobial stewardship (AMS) strategies, including communication skills training, point-of-care C-reactive protein testing (POC-CRPT) and delayed prescriptions, help optimise antibiotic prescribing and use in primary care. However, the use of these strategies in general practice is limited and inconsistent. We aimed to develop an intervention to enhance uptake and implementation of these strategies in primary care. Methods We drew on the Person-Based Approach to develop an implementation intervention in two stages. (1) Planning and design: We defined the problem in behavioural terms drawing on existing literature and conducting primary qualitative research (nine focus groups) in high-prescribing general practices. We identified ‘guiding principles’ with intervention objectives and key features and developed logic models representing intended mechanisms of action. (2) Developing the intervention: We created prototype intervention materials and discussed and refined these with input from 13 health professionals and 14 citizens in two sets of design workshops. We further refined the intervention materials following think-aloud interviews with 22 health professionals. Results Focus groups highlighted uncertainties about how strategies could be used. Health professionals in the workshops suggested having practice champions, brief summaries of each AMS strategy and evidence supporting the AMS strategies, and they and citizens gave examples of helpful communication strategies/phrases. Think-aloud interviews helped clarify and shorten the text and user journey of the intervention materials. The intervention comprised components to support practice-level implementation: antibiotic champions, practice meetings with slides provided, and an ‘implementation support’ website section, and components to support individual-level uptake: website sections on each AMS strategy (with evidence, instructions, links to electronic resources) and material resources (patient leaflets, POC-CRPT equipment, clinician handouts). Conclusions We used a systematic, user-focussed process of developing a behavioural intervention, illustrating how it can be used in an implementation context. This resulted in a multicomponent intervention to facilitate practice-wide implementation of evidence-based strategies which now requires implementing and evaluating. Focusing on supporting the uptake and implementation of evidence-based strategies to optimise antibiotic use in general practice is critical to further support appropriate antibiotic use and mitigate antimicrobial resistance.

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“…The experiences of these two sites reflect the common complexity of implementation and the many factors that can lead to a promising intervention not being well received in a local context [56]. The findings reveal the detailed learning about the implementation of asset based approaches to integrated care, through what was successful and challenging in both sites, whilst highlighting the differences between their approaches to implementation of the same intervention.…”

Section: Discussionmentioning

confidence: 85%

Implementing Asset-Based Integrated Care: A Tale of Two Localities

Duggal

Miller

Tanner

2021

International Journal of Integrated Care

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Drivers of successful implementation of integrated care for multi-morbidity: Mechanisms identified in 17 case studies from 8 European countries

Cited by 41 publications

References 21 publications

Barriers for Inter-Organisational Collaboration: What Matters for an Integrated Care Programme?

Barriers for Inter-Organisational Collaboration: What Matters for an Integrated Care Programme?

Development of an intervention to support the implementation of evidence-based strategies for optimising antibiotic prescribing in general practice

Implementing Asset-Based Integrated Care: A Tale of Two Localities

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