Tackling Addiction with Integrated Care

Addiction is recognised as one of the chronic illnesses, often leading to medical, psychological, economic, and social problems, making multi-dimensional care for these people within the existing system a challenge. This loads an already loaded primary and secondary care system. The Verslavingskoepel Kempen (VKK) is an initiative to answer this challenge as it aims to integrate the care provided by the zeroth to third-line care around addiction treatment. Zeroth refers to the care and support provided by the human context of the patients, such as family and peers. This extends the integrated care model that is suggested by the WHO. The aim of the dissertation is firstly, to identify the organizational aspects crucial for the success of the network. The Findings show that success is confirmed by participating local communities when highlighting the importance of the intramural connection between their community social services and professionals, hospitals, and experience holders. All interviewees recognize collateral and process leadership with resources emerging from different partners and without hierarchical management. The second aim considers whether success must be attributed to the instrumental organizational aspects of the collaboration or the values of the different caregivers. The Findings show that in this network the organizational aspects and the caregivers’ values are complementary. The third aim is to develop conclusions on the transferability of the network model. This is confirmed;however, the governmental policy is not accompanied by a funding system within the institutionalized remuneration and reimbursement structure. It makes the initiative dependent on the motivation of partner organizations to participate financially, raises doubt about the sustainability of the initiative, and sets conditions for as well as limitations on transferability.

Tackling Addiction with Integrated Care

Addiction is recognised as one of the chronic illnesses, often leading to medical, psychological, economic, and social problems, making multi-dimensional care for these people within the existing system a challenge. This loads an already loaded primary and secondary care system. The Verslavingskoepel Kempen (VKK) is an initiative to answer this challenge as it aims to integrate the care provided by the zeroth to third-line care around addiction treatment. Zeroth refers to the care and support provided by the human context of the patients, such as family and peers. This extends the integrated care model that is suggested by the WHO. The aim of the dissertation is firstly, to identify the organizational aspects crucial for the success of the network. The Findings show that success is confirmed by participating local communities when highlighting the importance of the intramural connection between their community social services and professionals, hospitals, and experience holders. All interviewees recognize collateral and process leadership with resources emerging from different partners and without hierarchical management. The second aim considers whether success must be attributed to the instrumental organizational aspects of the collaboration or the values of the different caregivers. The Findings show that in this network the organizational aspects and the caregivers’ values are complementary. The third aim is to develop conclusions on the transferability of the network model. This is confirmed;however, the governmental policy is not accompanied by a funding system within the institutionalized remuneration and reimbursement structure. It makes the initiative dependent on the motivation of partner organizations to participate financially, raises doubt about the sustainability of the initiative, and sets conditions for as well as limitations on transferability.

Classification,prevalence and integrated care for neurodevelopmental and child mental health disorders:A brief overview for paediatricians

‘Neurodevelopmental disorders’comprise a group of congenital or acquired longterm conditions that are attributed to disturbance of the brain and or neuromuscular system and create functional limitations,including autism spectrum disorder,attention deficit/hyperactivity disorder,tic disorder/Tourette’s syndrome,developmental language disorders and intellectual disability.Cerebral palsy and epilepsy are often associated with these conditions within the broader framework of paediatric neurodisability.Co-occurrence with each other and with other mental health disorders including anxiety and mood disorders and behavioural disturbance is often the norm.Together these are referred to as neurodevelopmental,emotional,behavioural,and intellectual disorders(NDEBIDs)in this paper.Varying prevalence rates for NDEBID have been reported in developed countries,up to 15%,based on varying methodologies and definitions.NDEBIDs are commonly managed by either child health paediatricians or child/adolescent mental health(CAMH)professionals,working within multidisciplinary teams alongside social care,education,allied healthcare practitioners and voluntary sector.Fragmented services are common problems for children and young people with multi-morbidity,and often complicated by subthreshold diagnoses.Despite repeated reviews,limited consensus among clinicians about classification of the various NDEBIDs may hamper service improvement based upon research.The recently developed“Mental,Behavioural and Neurodevelopmental disorder”chapter of the International Classification of Diseases-11 offers a way forward.In this narrative review we search the extant literature and discussed a brief overview of the aetiology and prevalence of NDEBID,enumerate common problems associated with current classification systems and provide recommendations for a more integrated approach to the nosology and clinical care of these related conditions.

Analysis of the Effect of Integrated Extended Care Model in Improving the Quality of Life of Elderly Patients with Type 2 Diabetes Mellitus

Objective: To analyze the impact of an integrated extended care model on improving the quality of life of elderly patients with Type 2 Diabetes Mellitus (T2DM). Methods: A total of 176 patients admitted to the hospital from March 2015 to February 2018 were selected and randomly assigned to an observation group and a control group, with 88 patients each. The control group implemented conventional nursing interventions, and the observation group carried out an integrated extended-care model. The level of glycemic control, quality of life, and daily medication adherence between both groups were compared. Results: The observation group showed significant improvement in the level of glycemic control, and their fasting blood glucose, 2-hour postprandial blood glucose, and glycated hemoglobin levels were significantly lower as compared with those in the study group (P < 0.05). The quality of life of the patients in the observation group was higher than that of the control group (P < 0.05). The observation group had a higher compliance score (95.48 ± 7.45) than the control group (81.31 ± 8.72) (t = 8.909, P < 0.05). Conclusion: The integrated extended care model allows patients to receive comprehensive and individualized nursing services after discharge, which improves the effect of drug therapy and the quality of life of patients.

Positive health:An integrated quantitative approach in patients with chronic gastrointestinal and hepato-pancreatico-biliary disorders

BACKGROUND The concept of positive health(PH)supports an integrated approach for patients by taking into account six dimensions of health.This approach is especially relevant for patients with chronic disorders.Chronic gastrointestinal and hepatopancreatico-biliary(GI-HPB)disorders are among the top-6 of the most prevalent chronically affected organ systems.The impact of chronic GI-HPB disorders on individuals may be disproportionally high because:(1)The affected organ system frequently contributes to a malnourished state;and(2)persons with chronic GIHPB disorders are often younger than persons with chronic diseases in other organ systems.AIM To describe and quantify the dimensions of PH in patients with chronic GI-HPB disorders.METHODS Prospective,observational questionnaire study performed between 2019 and 2021 in 235 patients with a chronic GIHPB disorder attending the Outpatient Department of the Maastricht University Medical Center.Validated questionnaires and data from patient files were used to quantify the six dimensions of PH.Internal consistency was tested with McDonald’s Omega.Zero-order Pearson correlations and t-tests were used to assess associations and differences.A P value<0.05 was considered significant.RESULTS The GI-HPB patients scored significantly worse in all dimensions of PH compared to control data or norm scores from the general population.Regarding quality of life,participation and daily functioning,GI-HPB patients scored in the same range as patients with chronic disorders in other organ systems,but depressive symptoms(in 35%)and malnutrition(in 45%)were more frequent in patients with chronic GI-HPB disorders.Intercorrelation scores between the six dimensions were only very weak to weak,forcing us to quantify each domain separately.CONCLUSION All six dimensions of PH are impaired in the GI-HPB patients.Malnutrition and depressive symptoms are more prevalent compared to patients with chronic disorders in other organ systems.

Implementation Strategy of“Eight in One”of Integrated Medical and Care Service System in China:A Case Study of Anshan City of Liaoning

With the gradual intensification of aging in China,the issue of elderly care has become the primary issue that needs to be urgently solved in society.The construction of a reasonable and scientific integrated medical and care service system can not only efficiently allocate medical resources and services,but also better meet the needs of the elderly.Due to the involvement of multiple disciplines such as architecture,sociology,psychology,and behavioral science in the construction of the system,as well as the restriction of various objective factors such as medical capacity,spatial scale,and operating costs,the government and elderly care institutions have always been unable to find the best solution for how to scientifically and reasonably construct an integrated medical and care service system.This paper is based on Anshan City,Liaoning Province,which has prominent aging issues and distinct characteristics of the elderly population.Through extensive field research in elderly care institutions,and face-to-face communication with personnel from relevant government departments such as the Municipal Commission on Aging,the Civil Affairs Bureau,the Health Commission,the Medical Insurance Bureau,and the Human Resources and Social Security Bureau,it truly understands the problems that arise in the construction of the urban integrated medical and care service system.From three aspects:urban situation,institutional situation and the needs of the elderly,it is proposed to establish a clear departmental linkage mechanism with clear rights and responsibilities,a policy guarantee mechanism tailored to local conditions,a multi-measure operation mechanism,a technology first intelligent response mechanism,a warm and efficient service mechanism for the people,an overall layout mechanism,an evaluation and supervision mechanism for full process control,and a talent supply mechanism of external introduction and internal training.It aims to provide reference for the construction of an integrated medical and care service system in similar cities.

Clinical Efficacy of the Integrated Medical Care Model Combined with Psychological Intervention in Tuberculosis Patients with Lung Cancer

Objective:To explore the clinical efficacy of the integrated medical care model combined with psychological intervention in pulmonary tuberculosis patients with lung cancer.Methods:From January to December 2022,60 pulmonary tuberculosis patients with lung cancer admitted to our hospital were selected as the research subjects.Using the random number table method,the patients were divided into two groups,a control group and a study group,with 30 cases in each group.The chest computed tomography(CT)examination results,mental state assessment(including depression scale and anxiety scale)scores,incidence of adverse reactions,treatment effect,and length of hospital stay were compared between the two groups.Results:The treatment effect of the patients in the study group was better than that of the patients in the control group(P<0.05);the duration of hospitalization,chest CT examination results,mental state assessment scores,and incidence of adverse reactions of the study group and the control group,were significantly different(P<0.05).Conclusion:The integrated medical care model combined with psychological intervention can effectively improve the treatment effect of pulmonary tuberculosis patients with lung cancer and prevent the occurrence of adverse reactions;thus,it should be promoted in clinical practice.

Observation on the Effect of Integrated Medical and Nursing Care in Patients with Pulmonary Tuberculosis Combined with Lung Cancer

Objective:To explore the effect of integrated medical and nursing care in patients with pulmonary tuberculosis combined with lung cancer.Methods:From August 2021 to August 2022,60 patients with pulmonary tuberculosis combined with lung cancer were admitted.All patients were diagnosed with pulmonary tuberculosis according to the Guidelines for the Diagnosis and Treatment of Pulmonary Tuberculosis and with lung cancer by pathology.The patients were randomly divided into two groups,with 30 cases in each group.The control group received daily nursing care,whereas the study group received integrated medical and nursing care.The sputum conversion rate,tumor remission rate,and quality of life of patients were observed and analyzed.Results:The item function score and symptom function score of the observation group were higher than those of the control group(P<0.05);the total effective rate of the observation group was significantly higher than that of the control group(P<0.05);the sputum conversion rate of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:For patients with pulmonary tuberculosis combined with lung cancer,the application of integrated medical and nursing care can help consolidate the treatment effect and improve the quality of life of patients;thus,it is worthy of promotion and application.

Family integrated care:Supporting parents as primary caregivers in the neonatal intensive care unit

Family integrated care (FICare) is a collaborative model of neonatal care which aims to address the negative impacts of the neonatal intensive care unit (NICU) environment by involving parents as equal partners, minimizing separation, and supporting parent-infant closeness. FICare incorporates psychological, educational, communication, and environmental strategies to support parents to cope with the NICU environment and to prepare them to be able to emotionally, cognitively, and physically care for their infant. FICare has been associated with improved infant feeding, growth, and parent wellbeing and self-efficacy;important mediators for long-term improved infant neurodevelopmental and behavioural outcomes. FICare implementation requires multi-disciplinary commitment, staff motivation, and sufficient time for preparation and readiness for change as professionals relinquish power and control to instead develop collaborative partnerships with parents. Successful FICare implementation and culture change have been applied by neonatal teams internationally, using practical approaches suited to their local environments. Strategies such as parent and staff meetings and relational communication help to break down barriers to change by providing space for the co-creation of knowledge, the negotiation of caregiving roles and the development of trusting relationships. The COVID-19 pandemic highlighted the vulnerability within programs supporting parental presence in neonatal units and the profound impacts of parent-infant separation. New technologies and digital innovations can help to mitigate these challenges, and support renewed efforts to embed FICare philosophy and practice in neonatal care during the COVID-19 recovery and beyond.

Effect of Integrated, Person-Centred Palliative Advanced Home and Heart Failure Care on NT-proBNP Levels: A Substudy of the PREFER Study

Objective: In 2012, we initiated a new person-centred model, integrated Palliative advanced home caRE and heart FailurE caRe (PREFER), to integrate specialised palliative home care with heart failure care. Natriuretic peptide-guided treatment is valuable for younger patients (age < 75 years), but its usefulness in palliative care is uncertain. We explored whether patients in PREFER reduced mean level of N-terminal pro B-type natriuretic peptide (NT-proBNP) more than the control group. Design: A pre-specified, exploratory substudy, analysed within the prospective, randomised PREFER study, which had an open, non-blinded design. Participants: Patients in palliative care with chronic heart failure, New York Heart Association class III-IV were randomly assigned to an intervention (n = 36;26 males, 10 females, mean age: 81.9 years) or control group (n = 36;25 males, 11 females, mean age:76.5 years). The intervention group received the PREFER intervention for 6 months. The control group received care as usual at a primary health care centre or heart failure clinic at the hospital. NT-proBNP was measured at the start and end of study. Results: Plasma levels of NT-proBNP differed significantly between groups at baseline. By the end of the study, no significant difference was found between the groups. The mean value for NT-proBNP decreased by 35% in the PREFER group but was not statistically significant (P = 0.074);NT-proBNP increased 4% in the control group. Conclusions: We found no statistically significant reductions of NT-proBNP levels neither between nor within the PREFER and the control group at the end of the study.

Identifying the Determinants for Attractiveness of Integrated Forms of Care from the Perspective of Health Care Professionals

Fostering integration between caregivers in the ambulatory sector involves transforming the institutional, organizational and technical flamework but also redesigning the work performed by health care professionals. Empirical research on the implementation of integrated care highlights professional engagement and commitment as a key success factor during the change process. Although a mismatch of motives during the integration process is often reported only a few studies have explored motivational aspects of health care integration. The aim of this study is to explore motivational factors for health care professionals in order to identify the determinants of attractiveness of integrated forms of care. An online-questionnaire was developed to identify the most important motivational factors for health care professionals and to reflect their perceptions on the attractiveness of interdisciplinary forms of care. The sample includes practicing physicians （general practitioners and specialists）, practicing nurses and non-physician professions （physiotherapists, midwives, speech therapists, occupational therapists）. Findings suggest that health care professionals are highly motivated by intrinsic motivators. Physicians turned out to be the most reluctant group towards integrated care models. Participating in integrated forms of care would challenge working independently which represents a strong motivator. The responses of nurses suggest that they are the most favorable group. Integrated care forms would be attractive offering more possibilities for social relationships, expanding responsibilities and challenging work. Results support the importance of health workforce engagement and participation in planning health care integration.

Patient-centered medical home and integrated care in the United States: An opportunity to maximize delivery of primary care

The reciprocal relationship between mental and physical health is well established.Undiagnosed,untreated,and poorly managed mental health conditions are associated with numerous physical health complications,poor treatment adherence,and decreased quality of life.Despite growing evidence regarding the importance of effectively addressing these conditions in primary care,the rates of identification remain low and follow-up and management by primary care providers has been criticized.The objective of this review was to demonstrate the role of Patient-Centered Medical Home(PCMH)and mental health integration in addressing comprehensive health care needs in primary care patients,and to describe common barriers and facilitators to the implementation of these types of programs.

Primary care and mental health: Where do we go from here?

Primary care has been dubbed the“de facto”mental health system of the United States since the 1970s.Since then,various forms of mental health delivery models for primary care have proven effective in improving patient outcomes and satisfaction and reducing costs.Despite increases in collaborative care implementation and reimbursement,prevalence rates of major depression in the United States remain unchanged while anxiety and suicide rates continue to climb.Meanwhile,primary care task forces in countries like the United Kingdom and Canada are recommending against depression screening in primary care altogether,citing lack of trials demonstrating improved outcomes in screened vs unscreened patients when the same treatment is available,high false-positive results,and small treatment effects.In this perspective,a primary care physician and two psychiatrists address the question of why we are not making headway in treating common mental health conditions in primary care.In addition,we propose systemic changes to improve the dissemination of mental health treatment in primary care.

上海市医养结合高质量发展评价指标体系构建:基于世界卫生组织《老年人综合照护实施框架》

目的构建上海市医养结合高质量发展评价指标体系,以评价医养结合现状,推动医养结合实现高质量发展。方法以世界卫生组织《老年人综合照护实施框架》为指导,通过文献归纳分析法查阅国内外与医养结合及评价相关的期刊文献、政策文件等,结合专家咨询与论证,明确医养结合高质量发展的理念、评价框架、指标在实践中的可行性等。结果在基于《老年人综合照护实施框架》明确医养结合高质量发展框架和国内医养结合高质量发展概念的基础上,构建涉及7个维度的指标体系:宏观层面包含加强管理和问责制度、加强体系建设;中观层面包含促使居民和社区参与并提升其能力、支持并协调多学科人员提供服务、面向社区的定向照护服务;微观层面包含对个人需求、偏好和目标进行评估,制定个性化的照护计划。结论研究构建的指标体系可为上海市医养结合高质量发展的评价工作提供参考。

Effects of parental involvement in infant care in neonatal intensive care units:a meta-analysis

Objective： This meta-analysis aimed to examine the effects of parental involvement in infant care in neonatal intensive care units （NlCUs）. Methods： PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure （CNKI）, Wanfang database, and VIP database were searched till November 2017. Randomized controlled trials （RCTs） and controlled clinical trials （CCTs） examining the effect of parental involvement in the NICU were considered for inclusion. Resulls： We included 10 studies （three RCTs, seven CCTs） with a total of 1,851 participants. The meta-analysis demonstrated that there were no statistically significant differences on nosocomial infection between two groups （risk ratio [RR] = 0.90, 95% CI 0.63-1.30, P = 0.58）. Compared with no parental involvement groups, parental involvement groups showed more weight gain （mean difference [MD] = 1.47, 95% CI 0.65-2.29, P 〈 0.05）, higher breast-feeding rate （RR = 1.38, 95% CI 1.25-1.53, P 〈 0.05）, lower readmission rate （RR = 0.35, 95% CI 0.15-0.80, P 〈 0.05）, and higher satisfaction rate （RR = 1.09, 95% CI 1.02-1.16, P 〈 0.05）.Conclusions： Parentaiinvolvement in the NICU interventions could not increase the rate of nosocomial infection of neonates, but could improve their weight gain, breast-feeding and parental satisfaction and decrease their readmission. However, since the conclusion of this meta-analysis was drawn based on the limited number of high-quality RCTs, more hioh-quality studies should be conducted in the future to confirm its positive intervention effects.

Research on the effect of health care integration on patients’ negative emotions and satisfaction with lung cancer nursing activities

BACKGROUND Lung cancer is a clinical disease with multiple malignant tumors.Currently,it is difficult for patients to benefit from routine clinical nursing due to the lack of a pertinent and systematic approach.AIM To investigate the effect of integrated nursing care on the negative emotions and satisfaction of lung cancer patients.METHODS From January 2018 to December 2019,92 patients with lung cancer were selected and divided into the study group and the control group;there were 46 patients in each group.The control group received routine nursing,and the study group received integrated medical care in addition to the care received by the control group.Negative emotions before and after the intervention,the self-management ability score after the intervention,family care burden after the intervention and nursing satisfaction after the intervention were measured in the two groups.RESULTS After the intervention,the self-rating anxiety scale and self-rating depression scale scores in the study group were lower than those in the control group(P<0.05);the scores for health knowledge,self-concept,self-responsibility and self-care skills in the study group were higher than those in the control group(P<0.05);the scores for individual burden and responsibility burden in the study group were lower than those before the intervention(P<0.05);and the nursing satisfaction in the study group(93.48%)was higher than that in the control group(78.26%,P<0.05).CONCLUSION An integrated nursing care approach for lung cancer patients can effectively relieve the patient’s negative feelings,improve their self-management ability,help to reduce the burden of family care and improve patient satisfaction with nursing activities.

Health Workers’ Documentation Process as a Prerequisite to the Integration of Patient Care at a Regional Referral Hospital in Uganda

Background: Integrated patient care is necessary for better care outcomes. Documentation enhances the integration of care;however, in the Ugandan setting, documentation of care is poor (e.g., omissions and incomplete records) and integration of patient care is not visible. This study presents a review of patient health records that was undertaken to understand documentation of care at a regional referral hospital in Eastern Uganda. This information will help in developing a documentation model to facilitate the integration of patient care in Uganda. Methodology: This retrospective review involved 513 patient health records from the medical-surgical, pediatric, and obstetric/gynecological departments of Jinja Regional Referral Hospital. Data were collected using checklists. Stratified sampling was used to capture variations in ward unit records and identify a fair representation of each department. Data were analyzed with descriptive and inferential statistics. All analyses were performed with SPSS version 22. Results: On average, the study hospital attended to 1000 patients per day and discharged 100 patients per ward unit per month. Our record review showed that documentation by both nurses and doctors was incomplete, and care was fragmented. However, doctors documented care more often than nurses, although the integration of patient care was not evident in doctors’ documentation. Conclusion: To establish integrated patient care, documentation must meet standards set by relevant professional bodies. The findings of this study will inform the development of a feasible documentation model to facilitate the integration of patient care in Uganda.

Team-based stepped care in integrated delivery settings

Fragmented health care delivery is recognized as increasingly problematic.Integrated care has been advanced as a reform that will improve quality of care and lower costs.Despite the application of integrated care systems in the United States,there has been a limited amount of empirical work explicating the most effective health care pathways.Stepped care has been proposed as a framework by which to implement coordinated team-based care and has gained preliminary empirical support.In this manuscript a rationale for team-based stepped care is presented,tools for implementation are provided,and future research directions are suggested.

Challenges and improvement strategies in the hospitalization of chronic multimorbid patients

BACKGROUND Addressing the growing challenge of hospitalizing chronic multimorbid patients,this study examines the strain these conditions impose on healthcare systems at a local level,focusing on a pilot program.Chronic diseases and complex patients require comprehensive management strategies to reduce healthcare burdens and improve patient outcomes.If proven effective,this pilot model has the potential to be replicated in other healthcare settings to enhance the management of chronic multimorbid patients.AIM To evaluate the effectiveness of the high complexity unit(HCU)in managing chronic multimorbid patients through a multidisciplinary care model and to compare it with standard hospital care.METHODS The study employed a descriptive longitudinal approach,analyzing data from the Basic Minimum Data Set(BMDS)to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera Hospital throughout 2022.The HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge.RESULTS The study employed a descriptive longitudinal approach,analyzing data from the BMDS to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera Hospital throughout 2022.The HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge.CONCLUSION This study demonstrates the effectiveness of the HCU in managing patients with complex chronic diseases through a multidisciplinary approach.The coordinated care provided by the HCU results in improved patient outcomes,reduced unnecessary hospitalizations,and better management of patient complexity.The superiority of the HCU compared to standard care is evident in key outcomes such as fewer readmissions and higher patient satisfaction,reinforcing its value as a model of care to be replicated.

Trauma care system in China

With the development of modern society, high-energy trauma has become an increasing tendency, which brings a great challenge for trauma care. A well-running trauma care system that is composed by pre-hospital and in-hospital care has been proved to decrease the death and disability rate of trauma patients. However, establishment of trauma care system in China is still at the initial stage. Trauma care systems in China and developed countries represented by the United States and Germany are introduced respectively in this article. Construction of regional and hierarchical trauma center, training of specific trauma care team and performance of integrative trauma rescue model are recommended in China.