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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
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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
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The fragmentation of primary care From mono disciplinary small scale enterprises to complex inter- organisational relationships The ‘Primary focus’ program (2009-2013): Stimulate integration through inter-organisational collaboration By subsidizing 70 collaboration initiatives What hampers or facilitates inter-organisational collaboration?
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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
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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)
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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)
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Macro level: System integration and primary care
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Micro level: Clinical and service integration -Clinical integration is disease-focused instead of person-focused care
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Meso level: Professional integration -Inter-professional partnerships with a collective responsibility towards a defined population
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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
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Meso level: Organisational integration - Inter-organisational relationships, including common governance mechanisms to deliver comprehensive services to a defined population
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Meso level: Organisational integration
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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
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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….
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From idea to reality? Methodological implications…… −Lack of standardized, validated tools and indicators to measure integration Further work: Developing a comprehensive measurement approach……….
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Guidance for further research What is your opinion?
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Thank you very much for your attention Email: p.valentijn@jvei.nl Dutch Expert Center for Integrated Primary Care
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