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Moran M, Shrewsbury D. Integrated care and clinical education. CLINICAL TEACHER 2024:e13745. [PMID: 38586946 DOI: 10.1111/tct.13745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/24/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Monica Moran
- WA Centre for Rural Health, Geraldton, Australia
| | - Duncan Shrewsbury
- Reader in Clinical Education & Primary Care, Brighton & Sussex Medical School, Brighton and Hove, UK
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O'Shea C, Manuel A, Te Ao B, Silwal PR, Harwood M, Murphy R, Ramke J. How have services for diabetes, eye, hearing and foot health been integrated for adults? Protocol for a scoping review. BMJ Open 2024; 14:e082225. [PMID: 38485479 PMCID: PMC10941158 DOI: 10.1136/bmjopen-2023-082225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION The global population is ageing, and by 2050, there will be almost 2.1 billion people over the age of 60 years. This ageing population means conditions such as diabetes are on the increase, as well as other conditions associated with ageing (and/or diabetes), including those that cause vision impairment, hearing impairment or foot problems. The aim of this scoping review is to identify the extent of the literature describing integration of services for adults of two or more of diabetes, eye, hearing or foot services. METHODS AND ANALYSIS The main database searches are of Medline and Embase, conducted by an information specialist, without language restrictions, for studies published from 1 January 2000 describing the integration of services for two or more of diabetes, eye, hearing and foot health in the private or public sector and at the primary or secondary level of care, primarily targeted to adults aged ≥40 years. A grey literature search will focus on websites of key organisations. Reference lists of all included articles will be reviewed to identify further studies. Screening and data extraction will be undertaken by two reviewers independently and any discrepancies will be resolved by discussion. We will use tables, maps and text to summarise the included studies and findings, including where studies were undertaken, which services tended to be integrated, in which sector and level of the health system, targeting which population groups and whether they were considered effective. ETHICS AND DISSEMINATION As our review will be based on published data, ethical approval will not be sought. This review is part of a project in Aotearoa New Zealand that aims to improve access to services for adults with diabetes or eye, hearing or foot conditions. The findings will be published in a peer-reviewed journal and presented at relevant conferences.
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Affiliation(s)
- Claire O'Shea
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand claire.o'
- Waikato Regional Diabetes Service, Health New Zealand - Te Whatu Ora, Hamilton, New Zealand
| | - Alehandrea Manuel
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Braden Te Ao
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Pushkar Raj Silwal
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Matire Harwood
- General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Rinki Murphy
- Department of Medicine - Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jacqueline Ramke
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
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Gordon BL, Koebele EA, Rego JJ, Harpold AA, Ajami NK. Adaptable and comprehensive vulnerability assessments for water resources systems in a rapidly changing world. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2024; 352:119958. [PMID: 38266525 DOI: 10.1016/j.jenvman.2023.119958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/26/2024]
Abstract
Comprehensive and adaptive approaches to vulnerability assessment are crucial for guiding effective adaptation in global water resources systems. A common approach to quantify vulnerability is through indicators, which capture the 'spirit of vulnerability' while retaining practical ease-of-use benefits. However, a comprehensive meta-analysis of reveals two specific limitations of global indicator-based vulnerability assessments for water resources systems: 1) vulnerability is influenced by complex interactions among multi-domain factors, for which indicator quality and data vary; and 2) vulnerability is dynamic and evolves over time, an aspect overlooked in most approaches. In response to these identified challenges, we propose a new dynamic "build-your-own" approach to vulnerability assessment. Our approach focuses on correcting for the identified gaps and biases in indicators and data to improve assessment comprehensiveness. This approach also incorporates guidance around adapting assessments over time to better reflect vulnerability under changing conditions. The open-source nature of our approach and underlying data can facilitate the development and customization of indicator-based vulnerability assessments for diverse applications, supporting practical and relevant planning for more resilient water resources systems.
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Affiliation(s)
- Beatrice L Gordon
- Division of Hydrologic Sciences, Desert Research Institute, 2215 Raggio Pkwy, Reno, NV, 89512, USA; Graduate Program in Hydrologic Sciences, University of Nevada, Reno 1664 N. Virginia St., Reno, NV, 89557, USA.
| | - Elizabeth A Koebele
- Graduate Program in Hydrologic Sciences, University of Nevada, Reno 1664 N. Virginia St., Reno, NV, 89557, USA; Department of Political Science, University of Nevada, Reno 1664 N. Virginia St., Reno, NV, 89557, USA
| | - Jesse J Rego
- Graduate Program in Hydrologic Sciences, University of Nevada, Reno 1664 N. Virginia St., Reno, NV, 89557, USA
| | - Adrian A Harpold
- Graduate Program in Hydrologic Sciences, University of Nevada, Reno 1664 N. Virginia St., Reno, NV, 89557, USA; Department of Natural Resources and Environmental Sciences, University of Nevada, Reno, 1664 N. Virginia St., Reno, NV, 89557, USA
| | - Newsha K Ajami
- Earth and Environmental Sciences Area, Lawrence Berkeley National Laboratory 1 Cyclotron Rd, Berkeley, CA, 94720, USA
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Zheng Y, Hu J, Li L, Dai T. Practice and Enlightenment of Chronic Disease Management at the County Level in China from the Perspective of Professional Integration: A Qualitative Case Study of Youxi County, Fujian Province. Int J Integr Care 2023; 23:6. [PMID: 37577141 PMCID: PMC10417912 DOI: 10.5334/ijic.7550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/31/2023] [Indexed: 08/15/2023] Open
Abstract
Background It is currently the most cost-effective management model to have multiple professionals from relevant institutions collaborate so as to provide integrated chronic disease management services. The "classified, color-coded, hierarchical and regionalized" chronic disease management model in Youxi County, Fujian Province is a typical case in China. However, related research is limited. This paper aims to analyze the practice measures and lessons learned in Youxi County, focusing on the professional integration of service providers. Methods From January to March 2021, interviews with 15 key informants in Youxi County were conducted to collect qualitative data, which was analyzed by the thematic framework method as well as the policy data, using the professional integration dimension in the evaluation framework of the integrated healthcare system. Results A series of measures were taken, such as improving the professional division and collaboration mechanism, establishing the incentive and restraint mechanism geared toward chronic disease management, formulating norms and standards of chronic disease management for patients with different color labels, and promoting the compatibility of inter-professional value and culture under the governmental institutional supply and the organizational support of the tight county healthcare alliance in Youxi County, to prompt professionals of different levels and types to collaborate in order to provide integrated chronic disease management services. However, some problems remained, such as limited capacity of primary health care, the relatively narrow range and weak effect of the incentive and restraint mechanism, inadequate implementation of the norms and standards, and so forth. Conclusions Our findings provide reference for other regions in China and other low- and middle-income countries in exploring the integrated chronic disease management model. Long-term follow-up surveys and mixed research designs are required in the future to enrich relevant evidence.
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Affiliation(s)
- Ying Zheng
- Center for Health Policy and Management, Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, CN
| | - Jia Hu
- Center for Health Policy and Management, Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, CN
| | - Li Li
- Center for Health Policy and Management, Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, CN
| | - Tao Dai
- Center for Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100020, CN
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Noor F, Gulis G, Karlsson LE. Exploration of understanding of integrated care from a public health perspective: A scoping review. J Public Health Res 2023; 12:22799036231181210. [PMID: 37435440 PMCID: PMC10331197 DOI: 10.1177/22799036231181210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/28/2023] [Indexed: 07/13/2023] Open
Abstract
Background Many health care systems attempt to develop an integrated care approach that is a whole population health-oriented system. However, knowledge of strategies to support this effort are scarce and fragmented. The aim of the current paper is to investigate existing concepts of integrated care and their elements from a public health perspective and to propose an elaborated approach that could be applied to explore the public health orientation of integrated care. Design and methods We applied a scoping review approach. A literature search was conducted in Embase, Medline, CINAHL, Scopus and Web of Science for the period 2000-2020 yielding 16 studies for inclusion. Results Across the papers, 14 frameworks were identified. Nine of these referred to the Chronic Care Model (CCM). Service delivery, person-centeredness, IT systems design and utilization and decision support were identified as the core elements of most of the included frameworks. The descriptions of these elements were mainly clinical-oriented focusing particularly on clinical care processes and treatment of diseases instead of wider determinants of population health. Conclusions A synthesized model is proposed that emphasizes the importance of mapping the unique needs and characteristics of the population it aims to serve, leans on the social determinants approach with a commitment to individual and community empowerment, health literacy and suggests reorienting services to meet the expressed needs of the population.
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Affiliation(s)
- Fadumo Noor
- Fadumo Noor, Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Degnevej 14, Campus Esbjerg, Esbjerg Ø 6705, Denmark.
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Winterton R, Brasher K, Ashcroft M. Evaluating the Co-design of an Age-Friendly, Rural, Multidisciplinary Primary Care Model: A Study Protocol. Methods Protoc 2022; 5:mps5020023. [PMID: 35314660 PMCID: PMC8938772 DOI: 10.3390/mps5020023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 12/02/2022] Open
Abstract
In the context of increased rates of frailty and chronic disease among older people, there is a need to develop age-friendly, integrated primary care models that place the older person at the centre of their care. However, there is little evidence about how age-friendly integrated care frameworks that are sensitive to the challenges of rural regions can be developed. This protocol paper outlines a study that will examine how the use of an age-friendly care framework (the Indigo 4Ms Framework) within a co-design process can facilitate the development of models of integrated care for rural older people within the Upper Hume region (Victoria, Australia). A co-design team will be assembled, which will include older people and individuals from local health, aged care, and community organisations. Process and outcome evaluation of the co-design activities will be undertaken to determine (1) the processes, activities and outputs that facilitate or hinder the co-design of a 4Ms integrated approach, and (2) how the use of the Indigo 4Ms Framework within a co-design process contributes to more integrated working practices. This protocol contributes to the development of a field of study examining how rural health and aged care services can become more age-friendly, with an emphasis on the role of co-design in developing integrated approaches to health care for older adults.
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Affiliation(s)
- Rachel Winterton
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Bendigo, VIC 3550, Australia
- Correspondence:
| | - Kathleen Brasher
- Upper Hume Primary Care Partnership, Wodonga, VIC 3690, Australia;
| | - Mark Ashcroft
- Beechworth Health Service, Beechworth, VIC 3747, Australia;
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