Integrated care: The Basque perspective

Nuño-Solinís, Roberto; Pérez, Patricia Vázquez; Polanco, Núria Toro; Hernández-Quevedo, Cristina

doi:10.1179/2047971913y.0000000046

Cited by 10 publications

(9 citation statements)

References 8 publications

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“…Even in countries where access to health services is guaranteed and does not seem to be a major concern, the diversity of health policies at a regional level can explain these inequalities on the pro-poor or pro-rich orientation of the publicly–funded mental healthcare provision. For instance, the Basque Country Health System has been a pioneer in the adoption of chronic care strategies and the emerging healthcare delivery model offers excellent potential for international comparisons, given its specific characteristics: a relatively homogeneous system providing universal coverage; a model based on primary care in the community; good integration of primary care and mental health; and successful implementation of a model of comprehensive care for chronic conditions [ 70 , 71 ]. At the same time, the health system should promote the right continuity and coordination of care for individuals suffering from mental health conditions and other chronic conditions [ 10 , 72 ].…”

Section: Discussionmentioning

confidence: 99%

Mental Illness Inequalities by Multimorbidity, Use of Health Resources and Socio-Economic Status in an Aging Society

García-Goñi

Stoyanova

Nuño-Solinís

2021

IJERPH

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Background: Mental illness, multi-morbidity, and socio-economic inequalities are some of the main challenges for the public health system nowadays, and are further aggravated by the process of population aging. Therefore, it is widely accepted that health systems need to focus their strategies for confronting such concerns. With guaranteed access to health care services under universal coverage in many health systems, it is expected that all services be provided equally to patients with the same level of need. Methods: In this paper, we explore the existence of inequalities in the access to services of patients with mental illness taking into account whether they are multimorbid patients, their socioeconomic status, and their age. We take advantage of a one-year (2010–2011) database on individual healthcare utilization and expenditures for the total population (N = 2,262,698) of the Basque Country. Results: More comorbidity leads to greater inequality in prevalence, being the poor sicker, although with age, this inequality decreases. All health services are more oriented towards greater utilization of the poor and sicker, particularly in the case of visits to specialists and emergency care. Conclusions: Mental health inequalities in prevalence have been identified as being disproportionally concentrated in the least affluent areas of the Basque Country. However, inequalities in the utilization of publicly-provided health services present a pro-poor orientation. As this region has adopted a system-wide transformation towards integrated care, its mental health delivery model offers excellent potential for international comparisons and benchlearning.

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Section: Discussionmentioning

confidence: 99%

Mental Illness Inequalities by Multimorbidity, Use of Health Resources and Socio-Economic Status in an Aging Society

García-Goñi

Stoyanova

Nuño-Solinís

2021

IJERPH

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“…The Strategy has been described and analysed in various publications, and preliminary evaluations of results have already been published. [4][5][6][7][8] However, there is a lack of understanding of the social mechanisms by which this large-system transformation effort has achieved its impacts in this particular context.…”

Section: Introductionmentioning

confidence: 99%

A system-wide transformation towards integrated care in the Basque Country: A realist evaluation

Urtaran-Laresgoiti

Alvarez‐Rosete²,

Nuño-Solinís

2018

International Journal of Care Coordination

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Introduction: In 2010, in a context of severe economic recession, the Basque Government launched the Strategy to tackle the challenge of chronicity in the Basque Country to transform the Basque health system to cope with the challenges of chronicity, ageing, health system fragmentation and sustainability in the long run. Methods: A realist evaluation has been conducted, and through a combination of research methods, information has been analysed to identify context, mechanisms and outcomes. The research provides a snapshot of the experience of a system-wide, complex health system transformation, which aims to identify 'what has worked, for whom and under what circumstances'. Twenty-two semi-structured interviews held between June 2015 and December 2016, allowed us to obtain both retrospective and real-time accounts on the transformation phenomenon. Results: Research pointed out that system-wide transformation requires time, effort, leadership, vision and narrative, as well as commitment, inclusiveness, collaborative decision-making processes with local implementers, 'muddling through' and constant learning. Key levers to shake and shift the health and social care systems towards closer alignment, coordination and integration to meet the needs of people include promoting collaborative relationships between health professionals to ensure care continuity, developing new staff roles, investing in integrated electronic health records, stratifying the population by risk and facilitating bottom-up innovation. Discussion: Research has shown that system-wide changes in health and social care have been viable in the Basque Health System, although the interplay between context, mechanisms and outcomes is more complex than expected, leading to many unexpected factors, patterns and relationships.

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“…The current organisational model – mainly focused on acute hospital care – must be able to adapt, as well as to adopt tools to face the aforementioned types of social changes and demands [16]. The current organisational model is not ideal for delivering care to these patients; indeed, it fails to meet their needs, which include continuity of care, prevention of dependence, and stopping or slowing the progression of the diseases they already have.…”

Section: Introductionmentioning

confidence: 99%

“…This situation poses a problem: if we provide care to patients with chronic diseases and those with social and/or long-term, low-intensity healthcare needs in hospitals with resources for acute illnesses, we may not be able to maintain the balance between access and quality, on the one hand, and the sustainability of the healthcare and social systems, on the other. The current organisational model – mainly focused on acute hospital care – must be able to adapt, as well as to adopt tools to face the aforementioned types of social changes and demands [ 1 6 ]. The current organisational model is not ideal for delivering care to these patients; indeed, it fails to meet their needs, which include continuity of care, prevention of dependence, and stopping or slowing the progression of the diseases they already have.…”

Section: Introductionmentioning

confidence: 99%

Qualitative Evaluation of the Implementation of an Integrated Care Delivery Model for Chronic Patients with Multi-Morbidity in the Basque Country

Jauregui

Silvestre

et al. 2016

International Journal of Integrated Care

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Introduction:The objective of this study was to assess a model for improving healthcare integration for patients with multiple chronic diseases in an integrated healthcare organisation in the Basque Country and to propose areas for improvement.Methods:We organised four nominal groups composed of representatives from different categories of clinicians involved in the development of an integrated healthcare organisation and in the integrated care of patients with multiple diseases, namely, internists, general practitioners, and primary care and hospital nurses.Results:The aspect rated most positively was the concept itself of an integrated care model, which is able to improve communication between levels of care, increase the quality of the care provided and enhance patient safety. Additionally, it was agreed that the role of assigned clinicians is a key element. The problems identified mostly concern its implementation in daily practice.Conclusions:The results of this study made it possible to suggest at least 8 areas of improvement to be implemented. These are related to: nurses’ roles; care and monitoring of stable patients; team work; communication with patients; coordination with social workers and between internists and family doctors; as well as the development of an office of medical services to lead the integration process.

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Integrated care: The Basque perspective

Cited by 10 publications

References 8 publications

Mental Illness Inequalities by Multimorbidity, Use of Health Resources and Socio-Economic Status in an Aging Society

Mental Illness Inequalities by Multimorbidity, Use of Health Resources and Socio-Economic Status in an Aging Society

A system-wide transformation towards integrated care in the Basque Country: A realist evaluation

Qualitative Evaluation of the Implementation of an Integrated Care Delivery Model for Chronic Patients with Multi-Morbidity in the Basque Country

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