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Evaluation of a multidisciplinary adult integrated respiratory service in the UK

Janet Scammell, Edwin van Teijlingen, Desiree Tait, Ashley Spriggs, Martin Hind, Caroline Belchamber

Abstract


Rationale, aims and objectives: Care integration, particularly for patients with long-term chronic conditions, has been viewed as a key imperative for service improvement over the last decade. In common with other industrialised nations, major care providers such as the National Health Service (NHS) in the United Kingdom (UK), have undertaken service evaluations to identify factors for effective integrated care in the context of increasing demand, but also cost-constraints. The aim of this paper is to report on an early process evaluation of a newly established Adult Integrated Respiratory Service (AIRS) in 3 localities in England, UK.

Methods: Applied qualitative methods using semi-structured interviews with clinical practitioners (n=19) plus focus group with patients (n=5). University research ethics approval was secured. 

Results: Despite finding staff commitment and enthusiasm for a new regional approach, as well as a very positive acclaim from patients, the study highlighted personal and organisational issues and concerns during the first four months of service implementation. The analysis revealed 4 inter-related themes: (a) service in transition; (b) resistance to change; (c) communication and (d) challenges to integrated working. The findings support conceptual and organisational elements of integrated care described elsewhere. The role of leadership and change management in the successful implementation of integrated care is explored.

Conclusions: The findings from a regional adult integrated respiratory service evaluation in England highlights the potential of collective leadership with authentic involvement of all stakeholders to effect successful change to build locally owned models for integrated care.  Further longitudinal research would yield valuable insights as the service evolves.


Keywords


Chronic respiratory disease, integrated care, person-centered healthcare, process evaluation, qualitative research, transition

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References


De Jong, I. & Jackson, C. (2001). An evaluation approach for a new paradigm - health care integration Journal of Evaluation in Clinical Practice 7 (1) 71-79

Berwick, D., Nolan, T. & Whittington, J. (2008). The triple aim: Care, Health and Cost. Health Affairs 27 (3) 759-769.

WHO. (2008). Making health care systems work: Integrated health services - what and why? Technical brief No. 1. Geneva: WHO.

National Collaboration for Integrated Care and Support (2013) Integrated care and support: our shared commitment. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/198748/DEFINITIVE_FINAL_VERSION_Integrated_Care_and_Support_-_Our_Shared_Commitment_2013-05-13.pdf [Accessed February 2016].

Department of Health (DOH). (2011). An Outcomes Strategy for Chronic Obstructive Pulmonary Disease (COPD) and Asthma in England. London: DOH.

Department of Health (DOH). (2014). Our ambition to reduce premature mortality: A resource to support commissioners in setting a level of ambition: NHS England. London: DOH.

Shahab, L., Jarvis, M.J., Britton, J. & West, R. (2006). Chronic obstructive pulmonary disease: Prevalence, diagnosis and relation to tobacco dependence of chronic obstructive pulmonary disease in a nationally representative population sample. Thorax 61 (12) 1043-1047.

Smith, M.P. (2011). Non-cystic fibrosis bronchiectasis. Journal of the Royal College of Physicians of Edinburgh 41, 132-139; quiz 139.

Cameron, E.J., McSharry, C., Chaudhuri, R., Farrow, S. & Thomson, N.C. (2012). Long-term macrolide treatment of chronic inflammatory airway diseases: risks, benefits and future developments. Clinical and Experimental Allergy Journal 42, 1302-1312.

Pasteur, M.C., Bilton, D. & Hill, A.T. (2010). British Thoracic Society Bronchiectasis non-CF Guideline Group. British Thoracic Society guideline for non-CF bronchiectasis. Thorax 65 (Supplement 1): i1-58.

King, T.E. Jr., Albera, C., Bradford, W.Z., Costabel, U., Hormel, P., Lancaster, L., Noble, P.W., Sahn, S.A., Szwarcberg, J., Thomeer, M., Valeyre, D., du Bois, R.M. & INSPIRE Study Group. (2009). Effect of interferon gamma-1b on survival in patients with idiopathic pulmonary fibrosis (INSPIRE): a multicentre, randomised, placebo-controlled trial. Lancet 374, 222-228.

National Institute of Clinical Excellence (NICE), (2013). Idiopathic pulmonary fibrosis: The diagnosis and management of suspected Idiopathic pulmonary fibrosis. NICE: 163.

Wessex HIEC Partnership. (2013). Dorset Clinical Commissioning Group: Admission Avoidance and Early Supported Discharge for Respiratory Services: Review Report of Dorset’s current service provision for COPD; Bronchiectasis; Pulmonary Fibrosis. NHS: University of Southampton. Available from: http://www.impressresp.com/index.php?option=com_docman&task=doc_view&gid=88&Itemid=70 [Accessed February 2016].

Dash. P. (2003). Increasing the impact of health services research on health services improvement. The Health Foundation and the Nuffield Trust.

Warburton, B. & Black, M. (2002). Evaluating processes for evidence-based health care in the National Health Service. British Journal of Clinical Governance. 7 (3) 158-164.

NHS Institute for Innovation and Improvement. (2010). The handbook of quality and service improvement tools. Coventry: NHS Institute for Innovation and Improvement

Savage, J. (2000). Ethnography and health care. British Medical Journal 321, 1400-1402.

Van Houdt, S, Sermeus, W., Vanhaecht, K. & De Lepeleire, J. (2014). Focus groups to explore healthcare professionals’ experiences of care coordination: towards a theoretical framework for the study of care coordination BMC Family Practice 15, (177) 1-11.

Lyngso, A., Godtfredsen, N., Host, D. & Frolich, A. (2013). Instruments to assess integrated care: a systematic review International Journal of Integrated Care 14, 1-15.

Forrest Keenan, K., van Teijlingen, E.R. & Pitchforth, E. (2005). The analysis of qualitative research data in family planning & reproductive health care. Journal of Family Planning and Reproductive Health Care 31, 40-43.

National Voices. (2013). A Narrative for Person-Centred Coordinated Care. Available from: http://www.nationalvoices.org.uk/sites/default/files/public/publications/narrative-for-person-centred-coordinated-care.pdf [Accessed February 2016].

Kelley, D. & Connor, D. (1979). The emotional cycle of change. In: The annual handbook of group facilitators, pp. 117-122. Jones, J. & Pfieffer, J. eds. LaJolla, CA: University Associates.

Barker, J. (2010). Evidence-based practice for nurses. London: Sage Publications.

Pearson, A., Field, J. & Jordan, Z. (2007). Evidence based clinical practice in nursing and health care: assimilating research, experience and expertise. Oxford: Blackwell.

Bevan, H. & Fairman, S. (2014). The new era of thinking and practice in change and transformation: a call to action for leaders of health and care. NHS Improving Quality. Available from: http://www.nhsiq.nhs.uk/resource-search/publications/white-paper.aspx [Accessed Feb. 2016].




DOI: http://dx.doi.org/10.5750/ejpch.v4i4.1185

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