Implementation of integrated services networks in Quebec and nursing practice transformation: convergence or divergence?

Longpré, Caroline; Dubois, Carl-Ardy

doi:10.1186/s12913-015-0720-8

Cited by 18 publications

(24 citation statements)

References 24 publications

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“…These findings have been consistently reported in other studies [10] and are internationally recognized [11]. While, in theory, this knowledge can contribute to making health care utilization easier for patients with chronic or complex illnesses, the integration of care in daily practice is complicated by differences in organizational goals, funding streams and stakeholders or care providers.…”

Section: Transparent Entrepreneurship (7 Elements)supporting

confidence: 76%

In pursuit of integrated care: the contribution of patient portals (Preprint)

Zwikker¹,

Scheepers²,

Smit³

et al. 2018

Preprint

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Background: Advocates of patient portals claim that they can strengthen integrated care for patients with complex or chronic health issues. However, it remains unclear how patient portals can achieve this, since indicators of integrated care are absent in most research on the matter. Objective: This study investigates the claim that patient portals can strengthen integrated care by reviewing the current research with Minkman's model of integrated care. Methods: A systematic search of PubMed, PsycInfo and Embase was conducted on research literature about patient portals (and related search terms) that was published between 2006 and 2016. Parts of the selected texts were scored on items which contribute to or hinder clusters of the Minkman model, or were absent from the model. Results:The 22 selected studies we analyzed with the Minkman model implicitly address several clusters of integrated care. Most prevalent were patientcenteredness (55 mentions), delivery system (49 mentions) and performance management (33 mentions); the least prevalent were interprofessional teamwork (3 mentions) and commitment (2 mentions). Five studies showed ways in which portals can hinder integrated care (12 mentions), while four studies showed ways in which they can promote integrated care that is not yet present in Minkman's model. Conclusions: Since the majority of the studies described items that contribute towards clusters of the Minkman model, the claim that patient portals can strengthen integrated care appears to have some merit. Items with negative impact are few and are primarily related to the implementation of portals for users. Based on our findings, we advocate using all the clusters of the Minkman model, since it can help patient portals be designed and implemented more effectively.

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Section: Transparent Entrepreneurship (7 Elements)supporting

confidence: 76%

In pursuit of integrated care: the contribution of patient portals (Preprint)

Zwikker¹,

Scheepers²,

Smit³

et al. 2018

Preprint

View full text Add to dashboard Cite

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“…Furthermore, unlike researchers, policy-makers must take into account potential public support for their measures as well as the political context and reality they operate in. This may substantially limit the amount of reform they can pursue at once [39]. As a result, we know that governments have a strong tendency to adopt incremental policy changes over comprehensive reforms [16,17].…”

Section: Empirical Challengesmentioning

confidence: 99%

Challenges in turning a great idea into great health policy: the case of integrated care

Raus

Mortier

Eeckloo

2020

BMC Health Serv Res

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Background: In the organization of health care and health care systems, there is an increasing trend towards integrated care. Policy-makers from different countries are creating policies intended to promote cooperation and collaboration between health care providers, while facilitating the integration of different health care services. Hopes are high, as such collaboration and integration of care are believed to save resources and improve quality. However, policy-makers are likely to encounter various challenges and limitations when attempting to turn these great ideas into effective policies. In this paper, we look into these challenges. Main body: We argue that the organization of health care and integrated care is of public concern, and should thus be of crucial interest to policy-makers. We highlight three challenges or limitations likely to be encountered by policy-makers in integrated care. These are: (1) conceptual challenges; (2) empirical/methodological challenges; and (3) resource challenges. We will argue that it is still unclear what integrated care means and how we should measure it. 'Integrated care' is a single label that can refer to a great number of different processes. It can describe the integration of care for individual patients, the integration of services aimed at particular patient groups or particular conditions, or it can refer to institution-wide collaborations between different health care providers. We subsequently argue that health reform inevitably possesses a political context that should be taken into account. We also show how evidence supporting integrated care may not guarantee success in every context. Finally, we will discuss how promoting collaboration and integration might actually demand more resources. In the final section, we look at three different paradigmatic examples of integrated care policy: Norway, the UK's NHS, and Belgium. Conclusions: There seems widespread agreement that collaboration and integration are the way forward for health care and health care systems. Nevertheless, we argue that policy-makers should remain careful; they should carefully consider what they hope to achieve, the amount of resources they are willing to invest, and how they will evaluate the success of their policy.

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“…Consequently, healthcare workforce has diversified in several directions with formalised roles for health care assistants, specialised roles for nurses and technicians, advanced roles for physician associates and nurse practitioners, and new roles for new services, such as case managers [3, 4]. This workforce reconfiguration exemplifies a growing international trend in healthcare policy to redistribute resources on the basis of professional accomplishment rather than historical workforce hierarchies and roles [3, 5].…”

Section: Introductionmentioning

confidence: 99%

Reconfiguring health workforce: a case-based comparative study explaining the increasingly diverse professional roles in Europe

Bont

Exel

Coretti

et al. 2016

BMC Health Serv Res

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BackgroundOver the past decade the healthcare workforce has diversified in several directions with formalised roles for health care assistants, specialised roles for nurses and technicians, advanced roles for physician associates and nurse practitioners and new professions for new services, such as case managers. Hence the composition of health care teams has become increasingly diverse. The exact extent of this diversity is unknown across the different countries of Europe, as are the drivers of this change.The research questions guiding this study were: What extended professional roles are emerging on health care teams? How are extended professional roles created? What main drivers explain the observed differences, if any, in extended roles in and between countries?MethodsWe performed a case-based comparison of the extended roles in care pathways for breast cancer, heart disease and type 2 diabetes. We conducted 16 case studies in eight European countries, including in total 160 interviews with physicians, nurses and other health care professionals in new roles and 600+ hours of observation in health care clinics.ResultsThe results show a relatively diverse composition of roles in the three care pathways. We identified specialised roles for physicians, extended roles for nurses and technicians, and independent roles for advanced nurse practitioners and physician associates. The development of extended roles depends upon the willingness of physicians to delegate tasks, developments in medical technology and service (re)design. Academic training and setting a formal scope of practice for new roles have less impact upon the development of new roles. While specialised roles focus particularly on a well-specified technical or clinical domain, the generic roles concentrate on organising and integrating care and cure.ConclusionThere are considerable differences in the number and kind of extended roles between both countries and care pathways. The main drivers for new roles reside in the technological development of medical treatment and the need for more generic competencies. Extended roles develop in two directions: 1) specialised roles and 2) generic roles.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1898-0) contains supplementary material, which is available to authorized users.

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Implementation of integrated services networks in Quebec and nursing practice transformation: convergence or divergence?

Cited by 18 publications

References 24 publications

In pursuit of integrated care: the contribution of patient portals (Preprint)

In pursuit of integrated care: the contribution of patient portals (Preprint)

Challenges in turning a great idea into great health policy: the case of integrated care

Reconfiguring health workforce: a case-based comparative study explaining the increasingly diverse professional roles in Europe

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