Health Problems of the Elderly: Integration of Care in Turkey and Europe
In this presentation, Prof. G.zel Di.igil and Prof. Serap.if.ili discuss the challenges and solutions related to the integration of care for the elderly in Turkey and Europe. They explore the concept of integrated care and its importance in improving the quality of services for the elderly population with chronic conditions. The need for better coordination and cooperation among healthcare providers is emphasized to address the fragmented care and deliver comprehensive, long-term support to the elderly.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.
E N D
Presentation Transcript
Health problems of the elderly: Do we need more integration? Prof. G zel Di igil, Adnan Menderes Univ, Medical School, Family Medicine Department Asistant Prof. Serap if ili, Marmara Univ, Medical School, Family Medicine Department EFPC Conference, stanbul, 2013
Program 15:00-15:20 Wellcome and introduction 15:20-15:40 Presentation: Current health services and status of the elderly in Turkey. (G zel Di igil) 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 if ili) 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, stanbul, 2013
Care for the elderly: Integration of care across Europe Serap if ili Marmara University Medical School EFPC Conference, stanbul, 2013
What is integration of care1? 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, stanbul, 2013
What is integration of care1? 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 (Gro ne and Garcia- Barbero, 2001). EFPC Conference, stanbul, 2013
Why is it needed1? Poor quality of care being delivered to those with chronic conditions. Fragmentation of care Acute care needs Episodic, short-term intervention to long-term, comprehensive care EFPC Conference, stanbul, 2013
Why is it needed1? 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, stanbul, 2013
The Goal: To improve accessibility, quality of care and financial sustainability EFPC Conference, stanbul, 2013
Terminology1(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, stanbul, 2013
Terminology1(Leutz 1999) Full integration creates new programs or entities where resources from multiple systems are pooled. EFPC Conference, stanbul, 2013
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, stanbul, 2013
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, stanbul, 2013
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, stanbul, 2013
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, stanbul, 2013
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, stanbul, 2013
Does it work and what kind2? 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 EFPC Conference, stanbul, 2013
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, stanbul, 2013
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 UK Portugal Nordic countries (Denmark, Finland, Iceland, Norway, Sweden) France Spain Belgium Netherlands Switzerland Italy Greece Austria Germany EFPC Conference, stanbul, 2013
Unmet needs3 Health needs, mobility needs, personal needs, housework needs 6 countries; Greece, Italy, Poland, UK, Germany, Sweden. % of care receivers with unmet needs Greece Italy Poland UK Germany Sweden Health needs 61,5 50,4 39,9 25.5 27.9 14.9 Mobility needs 61.1 49.8 38.1 33.0 37.5 20.7 Personal needs 58.9 48.8 32.2 33.6 32.8 17.9 Housework needs 58.5 45.5 38.1 29.8 32.1 15.3 Higher use of social care and integrated services 3. Bien B, McKee KJ, D hner 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, stanbul, 2013
Patents perspective2 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, stanbul, 2013
Comprehensive Care Practice guidelines, Disease Oriented programs Different guidelines, multiple providers Multi-dimensional geriatric assessments STEP, EASY-care; outcome? EFPC Conference, stanbul, 2013
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, stanbul, 2013
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. EFPC Conference, stanbul, 2013
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, D hner 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, stanbul, 2013
