Renewing the expertise of health and social care professionals to provide integrated care: Evaluation of an intervention in a deprived Dutch neighbourhood

Abstract

Rationale, aims and objectives: Multimorbidity in deprived populations is associated with longer hospital stays, more avoidable admissions and complications, higher costs, and lower satisfaction with available services. While integrated care has been proposed as a solution, the expertise of professionals to deliver this type of care has received little attention. Our case study evaluates an intensive intervention in a deprived neighbourhood in the Netherlands, launched in 2008, to tackle multimorbidity and the expertise of health and social care professionals to cater to the population’s health needs.Methods: Mixed-methods evaluation. Between 2009-2012 semi-structured interviews (n= 11), field observations, conversations, dialogue sessions and documentary review. In 2012 and 2013 quantitative before-and-after study with web-based questionnaire in the intervention and two control neighbourhoods (n= 86 at t0 and n=117 at t1).Results: The intervention sought to develop professional expertise in population health orientation, generalism, and coaching. Activities were supported by management that emphasized learning by doing, working bottom-up with direct application in practice, and professionals enjoying discretion to experiment. The intervention’s widely supported mission brought cohesion to its activities. In the interviews, professionals reported becoming more adept at understanding the common causes behind patients’ complaints, unravelling their multiple problems, and encouraging them to be more active in addressing their own health and well-being. But this was not supported by the quantitative data measuring professionals’ attitudes.Conclusion and practice implications: Neighbourhood interventions can strengthen professionals’ expertise in population health orientation, generalism and coaching, and the communication and collaboration skills necessary to employ them. Whether they can lead to more adequate responses to multimorbidity and more effective integrated care arrangements needs to be further researched.

How does an integrated primary care approach for patients in deprived neighbourhoods impact utilization patterns? An explorative study

“…The study period ranges from 2006 to 2011, the period in which the pilot interventions were implemented (Additional file 1 : Table S1). A previous study has shown that during the intervention period, primary care professionals in the intervention district increasingly accustomed to a more integrated working approach over this period of time [ 25 ]. We therefore expect the impact of the integrated care approach on health care use to become increasingly stronger over the course of time.…”

“…An intervention was implemented with the aim to stimulate primary care professionals to improve their expertise, attitude, behaviour and tools to better support them to provide more comprehensive forms of integrated care. Within this area-based programme improvement of integrated care approaches led to professionals taking on a population health orientation, a focus on prevention, applying a generalist view to patients enabling the undertaking of cross domain actions, and coaching behaviour to empower patients to become participants in their own care processes and self-manage their own health [ 25 ].…”

“…This study therefore aims to contribute to the evidence base by exploring the primary care and secondary care utilization patterns of residents of a deprived district in The Netherlands (Overvecht) where health and social care professionals in the period 2006–2011 increasingly have renewed their expertise, attitude, behaviour and tools to provide more tailored integrated services for their citizens, as part of an area-based programme [ 25 ]. In addition, we will compare these patterns with those in two control districts.…”

“…In addition, one in five residents of the dictrict Overvecht were obese, half of residents were overweight, and one in three residents were socially isolated. Van den Broeke et al (2015) [ 25 ] described the area-based programme aimed at promoting integrated care that health insurer ‘Agis Health Insurance’ with the Municipality of Utrecht implemented in the district Overvecht. Additional file 1 : Table S1 summarizes the activities within the programme.…”

“…The professionals became more able to coach patients to actively take part in solving their health and social problems. They gradually succeeded in developing this comprehensive integrated care approach together and spread it throughout the district which is still an ongoing process [ 25 ].…”