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Renewing the expertise of health and social care professionals to provide integrated care: Evaluation of an intervention in a deprived Dutch neighbourhood

Jennifer van den Broeke, Maartje van der Aa, Wim Busschers, Karien Stronks, Thomas Plochg

Abstract


Rationale, aims and objectives: Multimorbidity in deprived populations is associated with longer hospital stays, more avoidable admissions and complications, higher costs, and lower satisfaction with available services. While integrated care has been proposed as a solution, the expertise of professionals to deliver this type of care has received little attention. Our case study evaluates an intensive intervention in a deprived neighbourhood in the Netherlands, launched in 2008, to tackle multimorbidity and the expertise of health and social care professionals to cater to the population’s health needs.

Methods: Mixed-methods evaluation. Between 2009-2012 semi-structured interviews (n= 11), field observations, conversations, dialogue sessions and documentary review. In 2012 and 2013 quantitative before-and-after study with web-based questionnaire in the intervention and two control neighbourhoods (n= 86 at t0 and n=117 at t1).

Results: The intervention sought to develop professional expertise in population health orientation, generalism, and coaching. Activities were supported by management that emphasized learning by doing, working bottom-up with direct application in practice, and professionals enjoying discretion to experiment. The intervention’s widely supported mission brought cohesion to its activities. In the interviews, professionals reported becoming more adept at understanding the common causes behind patients’ complaints, unravelling their multiple problems, and encouraging them to be more active in addressing their own health and well-being. But this was not supported by the quantitative data measuring professionals’ attitudes.

Conclusion and practice implications: Neighbourhood interventions can strengthen professionals’ expertise in population health orientation, generalism and coaching, and the communication and collaboration skills necessary to employ them. Whether they can lead to more adequate responses to multimorbidity and more effective integrated care arrangements needs to be further researched.


Keywords


Coaching, communication skills, deprived neighbourhood, expanded chronic care model, expertise, holistic attitude, integrated care, multi-morbidity, person-centered healthcare, population health orientation, primary care, public health, self-management

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References


Hoeymans, N., Melse, J.M. & Schoemaker, C.G. (2010). Gezondheid en determinanten. Deelrapport van de VTV 2010 Van gezond naar beter. Bilthoven: RIVM.

Barnett, K., Mercer, S.W., Norbury, M., Watt, G., Wyke, S. & Guthrie, B. (2012). Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380, 37-43.

Mackenbach, J.P., Stribu, I., Roskam, A.R., Schaap, M.M., Menvielle, G., Leinsalu, M., Kunst, A.E. & European Union Working Group on Socioeconomic Inequalities in Health. (2008). Socioeconomic Inequalities in Health in 22 European Countries. New England Journal of Medicine 358, 2468-2481.

De Koning, J. (2008) Resultaten Utrechtse Gezondheidspeiling 2006 naar wijk en subwijk. Utrecht: GG&GD Utrecht.

Pilgram, K. (2011). Rapportage NWW in aandachtswijken December 2010. Amsterdam: UWV.

Wittebrood, K., Permentier, M. & Pinkster, F. (2011). Wonen, wijken & interventies. Krachtwijkenbeleid in perspectief. Den Haag: Sociaal en Cultureel Planbureau.

Stronks, K., Ravelli, A.C.J. & Reijneveld, S.A. (2001). Immigrants in the Netherlands: Equal access for equal needs? Journal of Epidemiology & Community Health 55, 701-707.

Wright, S.P., Verouhis, D., Gamble, G., Swedberg, K., Sharpe, N. & Doughty, R.N. (2003). Factors influencing the length of hospital stay of patients with heart failure. European Journal of Heart Failure 5 (2) 201-209.

Wolff, J.L., Starfield, B. & Anderson, G. (2002). Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Archives of Internal Medicine 162 (20) 2269-2276.

Fortin, M., Soubhi, H., Hudon, C., Bayliss, E.A. & Van den Akker (2007). Multimorbidity's many challenges. British Medical Journal 334 (7602) 1016-1017.

Lehnert, T., Heider, D., Leicht, H., Heinrich, S., Corrieri, S., Luppa, M., Riedel-Heller, S. & König, H.H. (2011). Review: health care utilization and costs of elderly persons with multiple chronic conditions. Medical Care Research and Review 68 (4) 387-420.

Schnitzer, S., Kuhlmey, A., Adolph, H., Holzhausen, J. & Schenk, L. (2012). Complaints as indicators of health care shortcomings: which groups of patients are affected? International Journal for Quality in Health Care 24 (5) 476-482.

Kodner, D.L. & Spreeuwenberg, C. (2002). Integrated care: meaning, logic, applications, and implications – a discussion paper. International Journal of Integrated Care 2, 1-6.

Barr, V., Robinson, S., Marin-Link, B., Underhill, L., Dotts, A., Ravensdale, D. & Salivaras, S. (2003). The expanded chronic care model. Hospital Quaterly 7 (1) 73-82.

Plochg, T. (2006). Building a tower of Babel in health care? Theory & practice of community based integrated care. Proefschrift Universiteit van Amsterdam. Amsterdam: Buijten en Schipperheijn.

Martin-Misener, R. & Valaitis, R. (2009). A scoping literature review of collaboration between primary care and public health. A report to the Canadian Health Services Research Foundation.

Stevenson Rowan, M., Hogg, W. & Huston, P. (2007). Integrating public health and primary care. Healthcare Policy 3 (1) 1-22.

Arah, O.A. (2009). On the relationship between individual and population health. Medicine, Health Care and Philosophy 12, 235-244.

Mackenbach, J.P. & Van der Maas, P.J. (2008). Volksgezondheid en gezondheidszorg. 4th edn. Maarssen: Elsevier gezondheidszorg.

Kindig, D. & Stoddart, G. (2003). What Is Population Health? American Journal of Public Health 93, 380-383.

Starfield, B. (2011). Point: the changing nature of disease: implications for health services. Medical Care 49, 971-972.

Twickler, T.B.M., Hoogstraaten, E., Reuwer, A.Q. et al. (2009). Laaggeletterdheid en beperkte gezondheidsvaardigheden vragen om een antwoord in de zorg. Ned Tijdschr Geneesk 153, A250.

Hibbard, J.H, Mahoney, E.R., Stock, R. & Tusler M. (2007). Results in improved self-management behaviors? Health Services Research 42, 1443-1463.

Overgoor, L., Aalders, M. & Statius Muller, I. (2006). Big!Move, beweging in gedrag van patiëmt en huisarts. Huisarts Wet 49 (1) 42-45.

Aalders, M., Overgoor, L. & Reitsma, S. (2010). Big!Move verankerd. Tijdschr Gezondheidswet 88,219-221.

De Geus, G., Hillen, S., Van der Goot, K. & Schreurs, H. (2011). Zwaan kleef aan: Over het creëren van draagvlak in een community project. TSG, Tijdschrift voor gezondheidswetenschappen 89, 142-145.

Greene, J.C., Caracelli, J. & Graham, W.F. (1989). Toward a conceptual framework for mixed-method evaluation designs. Educational Evaluation and Policy Analysis 11 (3) 255-274.

Van der Aa, M., Van den Broeke, J.R., Stronks, K., Busschers, W.B. & Plochg, T. (2015). Measuring renewed expertise for integrated care among health and social care professionals: development and preliminary validation of the ICE-Q questionnaire. In press.

Minutes of a meeting of members of the Director Group and Platform Healthy Neighbourhood Overvecht held in 2011 in Utrecht, the Netherlands.

www.youtube.com/watch?v=W80BsW311jw

O’Brien, R., Wyke, S., Githrie, B., Watt, G. & Mercer, S. (2011). An ‘endless struggle’: a qualitative study of general practitioners’ and practice nurses’ experiences of managing multimorbidity in socio-economically deprived areas in Scotland. Chronic Illness 7, 45-59.

Luijks, H.D., Loeffen, M.J.W., Lagro-Janssen, A.L., Van Weel, C., Lucassen, P.L. & Schermer, T.R. (2012). GP’s considerations in multimorbidity management: a qualitative study. British Journal of General Practice 62 (600) e503-510.

Smith, S.M., O’Kelly, S. & O’Dowd, T. (2010). GP’s and pharmacists’ experiences of managing multimorbidity: a ‘Pandora’s box’. British Journal of General Practice 60 (576) 285-294.

Jowsey, T., Jeon, Y-H., Dugdale, P., Glasgow, N.J., Kljakovic, M. & Usherwoon, T. (2009). Challenges for co-morbid chronic illness care and policy in Australia: a qualitative study. Australia and New Zealand Health Policy 6:22.




DOI: http://dx.doi.org/10.5750/ejpch.v3i4.1021

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