Integrated primary care, the search for coherence Msc Pim P. Valentijn; Bruijnzeels, Marc A; Opheij, Wilfrid Jan van Es Institute, Dutch Expert Centre Integrated Primary Care EFPC congres 2012 Gothenburg

Content: The fragmentation of primary care Integration and inter-organisational collaboration The search for theoretical guidance Conceptualisation of integrated primary care From idea to reality

The fragmentation of primary care From mono disciplinary small scale enterprises to complex inter- organisational relationships The ‘Primary focus’ program ( ): Stimulate integration through inter-organisational collaboration By subsidizing 70 collaboration initiatives What hampers or facilitates inter-organisational collaboration?

The search for theoretical coherence There is a lack of conceptual clarity regarding integration through inter- organisational collaboration that hampers a systematic evaluation Identify an overarching framework based on the theoretical concepts of integrated- and primary care that enables us to understand the inter- organisational collaboration processes

Some theoretical guidance Primary care: A broad societal strategy requires inter-sectorial collaboration (WHO, 1978) Precise definition of the functions (Starfield, 1992) Integrated care: Lack of an uniform definition Multidimensional construct (Kodner, 1999) Inter-organisational relationship: Lack of an uniform definition (Cropper et al, 2008)

Conceptualisation of integrated primary care A.Perfect primary care: Person-focused and population based Provided as: accessible, comprehensive, and coordinated services (Starfield, 2009) Critical hub in a health system (Nasmith, 2010) B.Integrated care: Micro, meso and macro integration processes……. Linking primary care with the macro level: system integration Comprehensive services that address the needs of people and populations (Suter, 2009) Streamlining services: Vertical- and horizontal integration through partnerships (Kodner, 2009, Shortell 1996)

Macro level: System integration and primary care

Micro level: Clinical and service integration -Clinical integration is disease-focused instead of person-focused care

Meso level: Professional integration -Inter-professional partnerships with a collective responsibility towards a defined population

Meso level: Functional integration −The aligning mechanism between the service-, professional and organisational layers within a system -Back-office functions that support professionals and management in their decisions

Meso level: Organisational integration - Inter-organisational relationships, including common governance mechanisms to deliver comprehensive services to a defined population

Meso level: Organisational integration

All levels: Normative integration -A common frame of reference (e.g. shared values, culture, mission and vision) across all the levels of an integrated system

Integrated primary care, connecting the dots The proposed conceptual framework provides directions to evaluate the integration the 70 collaboration initiatives The patterns of successful integration and collaboration….

From idea to reality? Methodological implications…… −Lack of standardized, validated tools and indicators to measure integration Further work: Developing a comprehensive measurement approach……….

Guidance for further research What is your opinion?

Thank you very much for your attention Dutch Expert Center for Integrated Primary Care