If, like me, you have struggled with defining “integrated care,” then Richard Vize’s Feature on the subject is definitely worth a read, if only to be reassured that it is, as you suspected, an “imprecise term.”
Despite the lack of a concrete definition, most people, Vize says, agree that integration will be better for patients. But one of the problems with integrated care is that many of its benefits, both financially and for patients, are difficult to measure.
Perhaps surprisingly, integrated care schemes can also uncover substantial unmet need. A project for patients with heart failure in Swansea, for example, saw a dramatic increase in the number of heart failure patients following its launch.
Integrated care schemes can also identify previously unseen social needs, which are often more difficult to manage, Vize says. “While it is true that, for example, ensuring elderly people are feeding themselves properly will help reduce falls, there is not a simple substitution of food and nutrition support for an emergency admission.”
Despite the limitations of the evidence in favour of integrated care, it is still the preferred option, Vize says, and will always be better than offering patients “fragmented care.” However, it is clear that any integration must be beneficial and evident to patients, and not just lead to “much nicer, cosier conversations between professionals.”
It is exactly this sort of nice, cosy conversation between professionals that Margaret McCartney is championing in her most recent column. For years, she says, GP practices have used their coffee breaks to exchange information about patients and set the world to rights.
“It is a few moments to exchange information about the families that our district nurses are caring for, to share dismay over the latest ludicrous requirement of the general practice contract, and to laugh at the idiot who injured her ear canal because she didn’t notice that the rubber bung was missing from the aural end of her stethoscope. (Yes, that was me),” she says.
Sadly, with the increased pressures of the quality and outcomes framework, appraisals and technology, these meetings are becoming increasingly rare. And that, McCarthy warns, may well be detrimental to patients.
Abi Rimmer is BMJ Careers news reporter.