More on Integrated Care

We summarised results of an overview of integrated care carried out by CLAHRC WM in a recent News Blog.[1] Multi-disciplinary teams emerged as one of the most effective interventions among the broad range of services within the broad rubric of ‘integrated care’. This conclusion is corroborated in a recent New England Journal of Medicine article [2] where multi-disciplinary teams are promoted as a method to offer intensive care at home. Such a care package requires doctors who move between community and hospital, well-trained community nurses, and telemedicine. The evidence, taken in the round, supports health benefits (from less delirium to lower mortality), slightly lower admission rates, and reduced costs. What’s not to like? There is a real risk of supplier-induced demand – placing people on intensive programmes when they would have done perfectly well without. Also, the system needs to change so that hospitals are not penalised for lower service provision – accountable care organisations in the US and Sustainability and Transformation Plans in England. We have written before about the burn-out inducing nature of endless consultations in General Practice.[3] So how about replacing the ‘hospitalist’ and the GP with an extensivist – a generic internal medicine consultants who work in both community and hospital? That would be a fun job in a good purpose?

— Richard Lilford, CLAHRC WM Director

References:

  1. Lilford RJ.
  2. Ticona L, & Schulman KA. Extreme Home Makeover – The Role of Intensive Home Health Care. N Engl J Med. 2016; 375: 1707-9.
  3. Lilford RJ.
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