Integrating primary care and social services for older adults with multimorbidity: A qualitative study

Abstract

BackgroundGrowing demand from an ageing population, chronic preventable disease and multimorbidity has resulted in complex health and social care needs requiring more integrated services. Integrating primary care with social services could more efficiently utilise resources, and improve experiences for patients, their families and carers. There is limited evidence on progress including key barriers and drivers of integration to inform large-scale national change.AimTo elicit stakeholder views on drivers and barriers of integrated primary care and social services. and highlight opportunities for successful implementation.Design and settingA qualitative interview study.MethodSemi-structured interviews with maximum variation sampling to capture stakeholder views across services and professions.ResultsThirty-seven interviews were conducted across England including GPs, nurses, social care staff, commissioners, local government, voluntary and private sectors, patients and carers. Drivers of integration included groups of like-minded individuals supported by good leadership, expanded interface roles to bridge gaps between systems and co-location of services. Barriers included structural and interdisciplinary tension between professions, organisational self-interest and challenges in record-sharing.ConclusionsDrivers and barriers to integration identified in other contexts are also present in primary care and social services. Benefits of integration are unlikely to be realised if these are not addressed in the design and execution of new initiatives. Efforts should go beyond local and professional level change to include wider systems and policy-level initiatives. This will support a more systems-wide approach to integrated care reform, which is necessary to meet the complex and growing needs of an ageing multimorbid population.

Quality of life of older Australians receiving home nursing services for complex care needs

“…In the current, fragmented health system, people with complex issues require multiple services to access the care they need (Australian Health Ministers' Advisory Council, 2017). Care that integrates health and social services could better address their holistic needs and enable a more person‐centred approach (Dambha‐Miller et al, 2021; Martínez‐González et al, 2014). Further, effective integration with social services could potentially release capacity in primary care, reduce duplication, increase efficiency and improve experiences for patients (Dambha‐Miller et al, 2021).…”

“…Care that integrates health and social services could better address their holistic needs and enable a more person‐centred approach (Dambha‐Miller et al, 2021; Martínez‐González et al, 2014). Further, effective integration with social services could potentially release capacity in primary care, reduce duplication, increase efficiency and improve experiences for patients (Dambha‐Miller et al, 2021). Nurses providing home care are well positioned to integrate health and social care (Delaney, 2018) and future work implementing and evaluating integrated nurse‐led, home‐based social care initiatives are warranted.…”

Integrating primary care and social services for older adults with multimorbidity: policy implications

“…Stakeholders included patients, care service users, carers, primary and secondary care clinicians, social prescribers, community nurses, social workers, voluntary sector workers, and multiple other relevant individuals. 7 We used Valentijn’s Rainbow Model of Integrated Care 8 as an analytical and spatial lens to interrogate and understand both the literature we identified and the empirical data derived from the semi-structured interviews. This conceptual framework describes integration occurring at and across a range of scales: the whole system level (macro-level integration); the organisational and professional level (meso-level); and the level of clinical and service integration (micro-level).…”