Research focus

How to ensure better integrated care

Three recent studies look at methods to facilitate greater integrated care

Navigating health and social care systems can be complex. Three recent studies look at methods to facilitate greater integrated care

Picture: iStock

Learning points

  • People of any age with complex needs may benefit from care coordination or navigation services
  • These services may generate considerable cost savings
  • Removing or reducing factors which hinder integrated care approaches could improve outcomes

Significant reductions in tertiary hospital encounters and less travel for families after implementation of Paediatric Care Coordination in Australia

A cohort study has revealed that a nurse-led care coordination role on family outcomes as well as the use of specialist hospital services achieved a significant reduction in healthcare costs and time savings.

Children with medical complexity struggle to have their needs met by Australian healthcare systems. This study measured changes to hospital usage and associated healthcare costs six months before and after implementation of the service for 452 children in Sydney, Australia.

Benefits to the family, including reduced school absence and travel time and costs were examined alongside other healthcare savings. After six months, emergency department presentations fell by 40%, and day-only admissions by 42%. An estimated Au$4.9 million (£2.6 million) was saved over two years, and more than 50,000 km of family travel and 370 school absences were prevented.

Breen C, Altman L, Ging J et al (2018) BMC Health Services Research. 18, 751. doi: 10.1186/s12913-018-3553-4

Carers as system navigators: exploring sources, processes and outcomes of structural burden

During interviews for a qualitative study, carers expressed anger and frustration about the emotional and time-consuming burdens placed on them and the person requiring care, when navigating care systems.

The ability to navigate a care system can affect an individual’s access to formal care. Little is known about how carers navigate health and social care systems and the burden placed on them.

In-depth interviews were used to explore the experiences of 32 families and informal carers of older adults navigating formal health and social care systems in Canada.

Three themes were identified:

1. Learning about services and resources – asking questions, identifying processes and building informal information networks. 

2. Securing access to services – navigating access and negotiating potentially complicated referral pathways.

3. Coordinating different services – linking different service providers and managing administrative demands.

Further research is recommended into the roles of formal care navigation services and whether they reduce barriers for patients and lessen carer burden.

Funk LM, Dansereau L and Novek S (2019) Gerontology. 59, 3, 426-35. doi: 10.1093/geront/gnx175

Service user, carer and provider perspectives on integrated care for older people with frailty, and factors perceived to facilitate and hinder implementation: a systematic review and narrative synthesis

Greater attention needs to be paid to service user and carer co-production and implementation of integrated care programmes for older people with frailty (OPF), research suggests.

OPF are targeted for integrated care interventions as they are at increased risk of poor outcomes and reduced quality of care due to fragmented care. This systematic review and narrative synthesis explored the perspectives of service users, carers and care providers on integrated care for OPF, and identified factors that might hinder or facilitate this arising from the 18 included studies.

Service users and carers emphasised the importance of trust and continuity of care, whereas providers highlighted better coordination of care between different providers as strategies for integrated care.

Different groups perceived the complexity of care needs of this population, difficulties with system navigation and access, and limited service user and carer involvement in care decisions as factors hindering implementation. Providers mainly highlighted other system and organisational issues.

Sadler E, Potterton V, Anderson R et al (2019) PLoS ONE. 14, 5, e0216488. doi: 10.1371/journal.pone.0216488


Compiled by Kat Millward,, lecturer in advanced nursing practice, City, University of London

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