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Evidence on the Efficacy of Integrated Care
Abstract
The fragmented delivery of healthcare and social services was put on the agenda as a major problem by WHO in 2002. Early home-supported discharge (EHSD) of stroke patients combining efficacy with net savings represents a prototype of integrated care (IC) or overlapping services for better clinical continuity. Other frequent chronic conditions as heart failure, chronic obstructive pulmonary disease, and mental disease exhibit parallel results from home health interventions. A SWOT analysis of IC emphasizes: Strengths are 1) economic dominance, 2) benefits to a majority of the population, and 3) psychological motivators for the patient (Hawthorne effect). Weaknesses are 1) moderate improvements on a day-to-day basis, 2) some lack of RCT, and 3) lack of trust across settings. Opportunities are 1) job enrichment to health professionals, 2) low-tech improvements affordable to low and middle income countries, and 3) organisational quality. Threats are 1) fragmented financial conditions, 2) defensive specialists, and 3) mediocre implementations. A meso-strategy of implementation is recommended to EU (FP7): 1) Make a synthesis of existing and ongoing research as a health technology assessment (HTA) of IC in EU for improved interdisciplinary cooperation across the hospital and primary care interface for selected CC. 2) The organisational dimension should focus on the formation of country specific multidisciplinary networks on IC.
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