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Health problems of the elderly: Do we need more integration? Prof. Güzel Dişçigil, Adnan Menderes Univ, Medical School, Family Medicine Department Asistant.

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Presentation on theme: "Health problems of the elderly: Do we need more integration? Prof. Güzel Dişçigil, Adnan Menderes Univ, Medical School, Family Medicine Department Asistant."— Presentation transcript:

1 Health problems of the elderly: Do we need more integration? Prof. Güzel Dişçigil, Adnan Menderes Univ, Medical School, Family Medicine Department Asistant Prof. Serap Çifçili, Marmara Univ, Medical School, Family Medicine Department EFPC Conference, İstanbul, 2013

2 Program 15:00-15:20 Wellcome and introduction 15:20-15:40 Presentation: Current health services and status of the elderly in Turkey. (Güzel Dişçigil) 15:40-15:50 Brain storming: Challenges of primary care in terms of care for the elderly focusing on integration and co-ordination of care. 15:50-16:20 Coffee Break and formation of the groups 16:20-16:40 Presentation: Care for the elderly: Integration of care across Europe (Serap Çifçili) 16:40-17:00 Group discussions about solutions to our problems 17:00-17:15 Sharing ideas that came up in the groups. EFPC Conference, İstanbul, 2013

3 Serap Çifçili Marmara University Medical School Care for the elderly: Integration of care across Europe EFPC Conference, İstanbul, 2013

4 What is integration of care 1 ? “the purposeful working together of independent elements in the belief that the resulting whole is greater than the sum of the individual parts” (Woods, 2001). 1. MacAdam M. Frameworks of Integrated care for the Elderly: A Systematic Review. CPRN Research Report, April 2008 (http://www.insp.mx/geriatria/acervo/pdf/60%2049813_EN.pdf) EFPC Conference, İstanbul, 2013

5 What is integration of care 1 ? “a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion”. (WHO European Office for Integrated Health Care Services). “a means to improve the services in relation to access, quality, user satisfaction and efficiency” (Gröne and Garcia- Barbero, 2001). EFPC Conference, İstanbul, 2013

6 Why is it needed 1 ? Poor quality of care being delivered to those with chronic conditions. Episodic, short-term intervention to long-term, comprehensive care EFPC Conference, İstanbul, 2013 Acute care needs Fragmentation of care

7 Why is it needed 1 ? To improve integration of continuing care services. Care of the elderly has been a particular focus with one or more chronic conditions, their high use of health care services EFPC Conference, İstanbul, 2013

8 The Goal: To improve accessibility, quality of care and financial sustainability EFPC Conference, İstanbul, 2013

9 Terminology 1 (Leutz 1999) Linkage; allows individuals with mild to moderate health care needs to be cared for in systems that serve the whole population without requiring any special arrangements. Coordination; requires that explicit structures be put in place to coordinate care across acute and other health care sectors. While coordination is a more structured form of integration than linkage, it still operates through separate structures of current systems. EFPC Conference, İstanbul, 2013

10 Terminology 1 (Leutz 1999) Full integration creates new programs or entities where resources from multiple systems are pooled. EFPC Conference, İstanbul, 2013

11 Does it work and what kind? Bird et. al. (2007) Integrated Care Facilitation for Older Patients with Complex Needs Reduces Hospital Demand, Australia Intervention: Case management, facilitated access to health and socail services, self-management education Outcome: %21 reduction in ER visits %28 reduction in admissions Cost-effective over the existing system (1M$) EFPC Conference, İstanbul, 2013

12 Does it work and what kind? Beland et. al. (System Integrated Care for Older Persons, Canada) SIPA Intervention: Case management, multidisciplinary teams, home support services, clinical protocols, intensive home care, 24 hour on-call Outcome: No additional cost, increased client satisfaction, no cost savings. EFPC Conference, İstanbul, 2013

13 Does it work and what kind? US department of Health and Human Services. Program for All- Inclusive Care of the Elderley (PACE). Intervention: Case management, interdisciplinary team, adult day care, access to supportive health and social services, capitation payment Outcome: Lower rates of hospital use, NH and ER visits, lower mortality, better health stastus and quality of life. No cost savings. EFPC Conference, İstanbul, 2013

14 Does it work and what kind? Barnabel et.al. (1998, Italy). Integrated care. Intervention: case managemnt, geriatric evaluation, involvement of GPs, coordianed health and social service delivery. Outcome: Reduced use of hospial and nursing home, improved physical and cognitive function. Cost-effective. EFPC Conference, İstanbul, 2013

15 Does it work and what kind? Department of Health and Ageing. Coordinated health Trials (Australia 2001, 2007). Intervention: Assessment and care planning, Enhancement of GP roles in some locations. Outcome: Round-1; No impact on health and well-being, increased use of community services, expenditures were greater. Round-2; Improved health and well-being and access to health services, indications of cost-effectiveness. EFPC Conference, İstanbul, 2013

16 Does it work and what kind 2 ? Darlington (UK) Challis D, Hughes J. Intervention: Case finding and screening, Assessment, Care planning, Monitoring and review, Case closure Outcome: Reduced the rates of institutionalization (50% at home after 12 months), increased the number of days at home (137 days versus 12 days), Increased the use and appropriateness of community services, increased morale, patient satisfaction and depression; limited generalizability due to the requirement for extensive social support or only moderate dependency

17 Primary care for older persons in Europe 3 Quality of care for older persons (professionals’ opinion, France) 1- Inadequate needs assessment process within primary care 2- Inadequate coordination of primary care services 3- Inadequate coordination of primary and secondary care 4- Perceived consequences for patients and families EFPC Conference, İstanbul, 2013

18 Primary care for older persons in Europe 2 Stronger PC system Generalist approach, first point contact of care, oriented to the context and community, provides continuity and comprehensiveness Weaker PC system UKPortugal Nordic countries (Denmark, Finland, Iceland, Norway, Sweden) France SpainBelgium NetherlandsSwitzerland ItalyGreece Austria Germany EFPC Conference, İstanbul, 2013

19 Unmet needs 3 Health needs, mobility needs, personal needs, housework needs 6 countries; Greece, Italy, Poland, UK, Germany, Sweden. Higher use of social care and integrated services 3. Bien B, McKee KJ, Döhner H, Triantafillou J, Lamura G, Doroszkiewicz H, Krevers B, Kofahl C. Disabled people’s use of health and social services and their unmet care needs in six European countries. The European Journal of public Health 2013;1-7. % of care receivers with unmet needs GreeceItalyPolandUKGermanySweden Health needs61,550,439,925.527.914.9 Mobility needs61.149.838.133.037.520.7 Personal needs58.948.832.233.632.817.9 Housework needs58.545.538.129.832.115.3 EFPC Conference, İstanbul, 2013

20 Patent’s perspective 2 Patient centered and individualised Easy accsess to providers (telephone, internet, in person) Clear communication of individualised care plans Support from a single coordinator Continuity of relationships EFPC Conference, İstanbul, 2013

21 Comprehensive Care Practice guidelines, Disease Oriented programs Different guidelines, multiple providers Multi-dimensional geriatric assessments STEP, EASY-care; outcome? EFPC Conference, İstanbul, 2013

22 Comprehensive Care Integrating Services Multidisciplinary team-work; community nurses, pharmacists, social workers Single coordination of care (generally GP) GPs are not well positioned to do the full clinical coordination EFPC Conference, İstanbul, 2013

23 Integrating services Single entry point in Italy (SEPs), GP is a proactive actor Case management by community matrons, UK Coordination of Professional Care for the elderly (COPA), GP and manager work together, targets old persons living alone. a single entry point; reinforced the role played by the GP, integrated health professionals into a multidisciplinary primary care team that includes case managers, introducing geriatricians into the community who intervene upon a GP request.

24 References 1.MacAdam M. Frameworks of Integrated care for the Elderly: A Systematic Review. CPRN Research Report, April 2008. 2.Johri M, Beland F, Bergman H. International experiments in integrated care for the elderly: a synthesis of the evidence. Int J Geriatr Psychiatry. 2003 Mar;18(3):222-3. 3.Boeckzstaens P, De Graaf P. Primary care and care for older persons: Position Paper of the European Forum for Primary Car. Quality in Primary Care 2011;19: 369-89. European Forum for Primary Care, Almere, The Netherlands. On behalf of the Position Paper Working Group: Aggie Paulus, Arno Van Raak, Peter Groenewegen (The Netherlands), Carmen de la Cuesta (Spain), Danica Rotar (Slovenia), Hanna Kaduskiewicz, Martina Hasseler, Ulrike Junius Walker (Germany), Isabelle Vedel (Canada), Jan De Lepeleire, Janneke Ronse, Jean- Pierre Baeyens (Belgium), Modesta Visca (Italy), Steve Illife (UK) 4.Bien B, McKee KJ, Döhner H, Triantafillou J, Lamura G, Doroszkiewicz H, Krevers B, Kofahl C. Disabled people’s use of health and social services and their unmet care needs in six European countries. The European Journal of public Health 2013;1-7. EFPC Conference, İstanbul, 2013


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