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Purpose: The COVID-19 pandemic has demonstrated the urgency of better chronic disease management and the importance of making it an integral part of the recovery agenda in Europe. This paper aims to explore the shift towards digital and integrated care systems in Europe. Design/methodology/approach: In this viewpoint paper the Expert Group for Integrated Care and Digital Health Europe (EGIDE) group argues that an orchestrated shift towards integrated care holds the solution to the chronic disease pandemic. Findings: The development of integrated care cannot happen without shifting towards a digitalised healthcare system via large-scale initiatives like the European Health Data Space (EHDS) and the involvement of all stakeholders. Originality/value: The EGIDE group has identified some foundational principles, which can guide the way to realise the full potential of the EHDS for integrated care and can support the involved stakeholders' thinking. [ABSTRACT FROM AUTHOR]

Purpose: Big Data is likely to have significant implications for the way in which services are planned, organised or delivered as well as the way in which we evaluate them. The increase in data availability creates particular challenges for evaluators in the field of integrated care and the purpose of this paper is to set out how we may usefully reframe these challenges in the longer term. Design/methodology/approach: Using the characteristics of Big Data as defined in the literature, the paper develops a narrative around the data and research design challenges and how they influence evaluation studies in the field of care integration. Findings: Big Data will have significant implications for how we conduct integrated care evaluations. In particular, dynamic modelling and study designs capable of accommodating new epistemic foundations for the phenomena of social organisations, such as emergence and feedback loops, are likely to be most helpful. Big Data also generates opportunities for exploratory data analysis approaches, as opposed to static model development and testing. Evaluators may find research designs useful that champion realist approaches or single-n designs. Originality/value: This paper reflects on the emerging literature and changing practice of data generation and data use in health care. It draws on organisational theory and outlines implications of Big Data for evaluating care integration initiatives. [ABSTRACT FROM AUTHOR]

Purpose: Interpersonal skills are increasingly important tools in long-term care with older people, especially against the backdrop of loneliness affecting older people and expectations for a person-centred, joined-up approach. However, the term is used as a composite and its definition lacks shape and focus. In existing literature, participants appear to be selected on the basis of specific illnesses rather than age. Better understanding of the features of everyday communication processes associated with person-centred care can lead to improvements in policy and practice. Design/methodology/approach: A scoping review examined communication features associated with person-centred care for older adults. This identified the extent and nature of literature. Several databases were searched; after screening and hand-searching, 31 were included. Findings were analysed for patterns and contradictions, against the objectives of person-centred and integrated care. Findings: Emotional intelligence and the ability to employ various communication styles are crucial skills of person-centred communication. Such approaches can have positive effects on the well-being of older people. Research limitations/implications: Some studies' validity was weakened by methodological designs being founded on value judgements. Practical implications: Using personalised greetings alongside verbal and non-verbal prompts to keep residents emotionally connected during personal care is considered good practice. Stimulating feedback from people using services and their relatives is important. Originality/value: The role of communication is highlighted in many professional guidance documents on person-centred and integrated care, but the process of implementation is decentralised to individual employers and workers. This paper draws on the findings of contemporary literature, grounded in naturalistic data, with implications for practice and policy. [ABSTRACT FROM AUTHOR]

Purpose: The National Health Service (NHS) is facing unprecedented financial strain. These significant economic pressures have coincided with concerns regarding the quality and safety of the NHS provider sector. To make the necessary improvements to performance, policy interest has turned to encouraging greater collaboration and partnership working across providers. Design/methodology/approach: Using a purposive search of academic and grey literature, this narrative review aimed (1) to establish a working typology of partnering arrangements for improvement across NHS providers and (2) inform the development of a plausible initial rough theory (IRF) of partnering to inform an ongoing realist synthesis. Findings: Different types of partnership were characterised by degree of integration and/or organisational change. A review of existing theories of partnering also identified a suitable framework which incorporated key elements to partnerships, such as governance, workforce, leadership and culture. This informed the creation of an IRF of partnerships, which proposes that partnership "interventions" are proposed to primarily cause changes in governance, leadership, IT systems and care model design, which will then go on to affect culture, user engagement and workforce. Research limitations/implications: Further realist evaluation, informed by this review, will aim to uncover configurations of mechanisms, contexts and outcomes in various partnering arrangements and limitations. As this is the starting point for building a programme theory, it draws on limited evidence. Originality/value: This paper presents a novel theory of partnering and collaborating in healthcare with practical implications for policy makers and practitioners. [ABSTRACT FROM AUTHOR]

Purpose Severe mental illness affects a significant number of people and, if left untreated, leads to poor quality of life and disability. Many of the aspirations proposed for new models of care assert that better preventative services, closer integration between professionals, and increased access to cognitive behavioural therapy in primary care will bring substantial benefits and improved outcomes. The purpose of this paper is to explore the benefits of integrating mental health services into primary care, and improving collaboration between secondary services and primary care. There is a transition underway in healthcare whereby a focus on illness is being supplemented with, or refocused towards achieving better patient well-being. New approaches to service provision are being proposed that: focuses on more holistic outcomes; integrates services around the user; and employs innovative system techniques to incentivise professional and organisational collaboration. Such a transition must be inclusive of those with mental health needs managed in primary care and for those people with serious mental illness in secondary care.Design/methodology/approach This paper discusses the issues of professional collaboration and the need to provide mental healthcare in a continuous and coordinated manner and; how this may improve timely access to treatment, early diagnosis and intervention. Importantly, it is essential to consider the limitations and reality of recent integration initiatives, and to consider where the true benefit of better integrating mental health into a more collaborative system may lie.Findings Identifying and addressing issues of parity is likely to call for a new approach to service provision that: focuses on outcomes; co-designs services integrated around the user; and employs innovative contracting techniques to incentivise provider integration.Practical implications There is a transition underway in healthcare whereby a focus on illness is being supplemented with or refocused towards working towards wellness. Such a transition requires primary care mental health services to be provided in a continuous and coordinated manner in order to meet the health needs of people with serious mental illness.Originality/value It discusses the issues of professional collaboration and how this may improve timely access to treatment, early diagnosis and intervention. It is essential to consider the limitations and reality of recent integration initiatives, and to consider where the true benefit may lie. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to describe the approach adopted to building relationships between health and social care in Birmingham. Design/methodology/approach -- This is a practical case study, reflecting on personal experience of being directly involved in the situations and discussions described. It supplements a 2012 paper (Lotinga and Glasby, 2012) on the creation of Birmingham's Health and Well-being Board. Findings -- Local history and context is crucial in shaping the nature of local joint working initiatives -- understanding where local services have come from and why they have made the choices they have is a crucial pre-requisite for understanding current and future opportunities. Research limitations/implications -- This paper aims to place joint working between general practice and social work in a broader organisational, financial and policy setting -- and placing local developments in this wider context is crucial for understanding barriers and opportunities locally. Originality/value -- In the absence of a detailed evidence base, front-line practice is often far ahead of the current research evidence. This means that local case studies like this are crucial in terms of sharing learning with other areas of the country, with policy makers and with researchers. While many case studies of joint working are small in nature, Birmingham is the largest local authority in Europe -- so this paper also contributes learning based on trying to develop joint working in very large, complex authorities. [ABSTRACT FROM AUTHOR]

Purpose:The purpose of this paper is to discuss integrated working between the arts and those in care settings. Identifying that the field is very broad, with diverse evidence and experience within it, the paper argues that there is a need to find ways in which to be clearer about the purpose of specific arts and care integrated projects. The paper draws on a case study project to develop some insights and a framework to help address this challenge. Design/methodology/approach: The paper is a conceptual discussion and development drawing upon insights from relevant literature and a case study analysis of an integration project between a hospice service, an art gallery and an artist. Findings: The integrated working case study project between the hospice, art gallery and artist highlights some points about a lack of conceptual frameworks to help locate the purpose of diverse arts and care projects. There is scope for much confusion about the nature and purpose of such integration projects without a clear framework for articulating the aims of individual integration endeavours and their place in relation to other arts and care work. This paper develops a framework and a clear understanding about the different kinds and goals of integrated working between arts and care settings to help with future practical and research projects. Research limitations/implications: The paper reports a case study which highlights key themes from which generalisation to other services will require interpretation for particular contexts. Practical implications: The ideas present a helpful approach to articulating the goals of individual projects and to better understand the place of projects in relation to other arts and care initiatives. Social implications: There is much scope for better integrated working between arts and care settings to achieve better outcomes for users of care services, and the ideas presented here should help to better organise and evaluate such developments. Originality/value: This is the first paper to set out the framework presented to help with better integrated working between arts and care settings. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to present a case study of an intersectoral partnership that has taken place in Scotland (United Kingdom) entitled Gamechanger. The main idea of Gamechanger was for statutory, commercial and voluntary organisations to work in partnership to harness the power of football (soccer), to tackle health inequalities and social exclusion. The paper will detail how Gamechanger has been developed, with reference to the newly developed "Incite" model for effective intersectoral partnership working. Design/methodology/approach: This paper draws on the authors' experiences of leading and evaluating intersectoral partnerships from 2015 to 2019. The report draws on the work which took place during that period, and the achievements in relation to Gamechanger. Findings: Gamechanger has led to significant innovations. It has encouraged sectors to work together, and develop new ways of responding to difficult societal problems. Originality/value: Gamechanger is believed to be the first initiative of its kind developed with a football club in Scotland. Conclusions: This work has been developed through robust community-informed efforts. The scope and scale of the projects to deliver community benefits is significant. Gamechanger has provided a means for football to take a different approach to how it works to benefit communities. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to provide a summary of some of the lessons about implementing different types of integrated care. Design/methodology/approach: The author used evidence from the author's own evaluations and the findings of other researchers to identify some important lessons for policy makers and practitioners. Findings: The author identifies eight high-level lessons which may be of interest to policy makers and practitioners working in the field. Research limitations/implications: The lessons outlined in the paper provide only a starting point for those designing interventions or evaluation. Practical implications: The changes required to implement integrated care are complex and are embedded in a complex context. Change of this type is difficult and generally takes longer to deliver than expected. The evaluation of these models often requires longer than is often available and needs to focus on the impact on the whole system rather than narrow measures, e.g. hospital utilisation. Originality/value: This is a viewpoint paper synthesising evidence from the English pilot programmes in integrated care. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to discuss the different meanings of integration as expressed in dementia care practice and service organisation in England. Dementia is frequently complicated by concurrent illnesses or long-term conditions at the end of life. Design/methodology/approach - This is a policy discussion. Findings - The paper describes three forms of integration: linkage, co-ordination of care, and full integration. Each form or level is related to dementia as a progressive neurological disorder with multiple symptoms, which also overlaps with other long-term conditions, making each individual's dementia unique. Linkage means being able to identify appropriate resources to meet the needs of the individual and their family. Co-ordination usually means multi-disciplinary working at least with general practice and often wider practitioner input. Full integration is best expressed by the work of care homes, which co-ordinate care and often draws on diverse funding streams. Practical implications - Greater specificity of the meaning of integration may be helpful to policy makers and practitioners. The care and treatment of people with dementia may be optimised if practitioners think about work styles and engagement with other sectors, agencies and professionals rather than pursuing all-encompassing organisational integration. Care homes may have much to teach other practice settings about full integration. Originality/value - Integration is often seen uncritically as the solution to all problems; this paper explores the varieties of integration and explores their implications for practitioners and policy makers supporting people with dementia and their carers. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to outline relevant policies on the integration of health and social care (HSC) in the four home nations: Scotland, Wales, Northern Ireland and England and offer a comparison of emphasis and approaches and draw out general insights on the implementation of integrated care policy.Design/methodology/approach The paper is written as a piece of critical reflection by drawing on the authors’ knowledge and expertise and wider evidence where available.Findings Since 2010, HSC integration has started to diverge significantly in the four constituent countries of the UK. Although England and Wales have undergone considerable re-organisation of the NHS, Scotland and Northern Ireland have largely been marked by organisational continuity. However, beyond organisational differences, policy approaches, policy emphases and implementation strategies have also started to show considerable dissimilarity across the UK. An important contributory factor may be different ideological perspectives on the role of competition and pilots, partnership, patient choice and organisational incentives to bring about change in the field.Research limitations/implications The paper identifies a serious lack of comparative research in integration policy, despite the considerable opportunities for quasi-experimental studies. This lack of empirical research impedes shared learning across the home nations.Originality/value The paper presents a descriptive comparison of current integration policy between HSC providers in the four home nations. It reveals considerable opportunities for further research and comparative modelling of integration approaches. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to report on the findings of the first stage of a project seeking to evaluate and overcome inter-professional barriers between health and social care staff within a single, co-located, integrated community team. The project seeks to answer the following questions: first, Do inter-professional barriers to integrated working exist between health and social care staff at the interface of care delivery? Second, If inter-professional barriers exist, can joint health and social care assessments help to overcome them? The paper develops the current evidence base through findings from a staff questionnaire and the initial findings of a pilot study of joint health and social care assessments aimed at overcoming inter-professional barriers to integration.Design/methodology/approach The first stage of the project involved running an anonymous, online questionnaire with health and social care staff within a single, co-located community adult health and social care team. The questionnaire aimed to explore staffs' perceptions of inter-professional collaboration when assessing the health and care needs of service users with a high degree of complexity of need. The second element of the study presents the initial findings of a small pilot of joint health and social care assessments. A second staff survey was used in order to provide a "before and after" comparative analysis and to demonstrate the effect of joint assessments on staffs' perceptions of inter-professional collaboration at the interface of care delivery.Findings Health and social care staff value joint working as a means of improving quality of care. However, they also felt that inter-professional collaboration did not occur routinely due to organisational limitations. Staff members who participated in the pilot of joint assessments believed that this collaborative approach improved their understanding of other professional roles, was an effective means of enabling others to understand their own roles and helped to better identify the health and care needs of the most complex service users on their caseloads. Initial findings suggest that joint assessments may be a practical means of overcoming inter-professional barriers related to a lack of communication and lack of understanding of job roles.Practical implications The questionnaires highlighted the need for integration strategies that are aimed at facilitating collaborative working between staff of different professions, in order to achieve the aims of integration, such as a reduction in duplication of work and hand-offs between services.Originality/value To date, few studies have explored either staff perceptions of collaborative working or the effectiveness of joint assessments as a means of overcoming inter-professional barriers. This paper adds new data to an important area of integration that legislators and researchers increasingly agree requires more focus. Although the findings are limited due to the small scale of the initial pilot, they provide interesting and original data that will provide insight into future workforce integration strategies. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to discuss “system transformation” in the context of different workforces and organisations seeking to support people experiencing multiple exclusion homelessness (MEH). From a relational and integrated care perspective it aims to identify barriers to achieving more effective ways of working in the prevailing context of “managerial domination”. Communities of practice (COPs) are evaluated to identify their potential to overcome some of these barriers. Design/methodology/approach – The paper presents a theoretical and conceptual discussion of a project in which a number of COPs were established and evaluated to ascertain their value in developing more relational ways of working in the context of MEH. Case studies of COPs operating in the context of MEH are explored and discussed. Findings – It is concluded that COPs have the potential to deliver small-scale changes (“little miracles”) which are characteristically more subversive than transformative. Nevertheless, the authors still see these small gains as significant when compared to the inertia that is often found in local systems of care where more traditional management techniques (such as “payment by results”) prevail. The authors also draw attention to the scope for much improved service quality which flows from moving beyond the “tick box” and into the realms of what it really takes to tackle homelessness and multiple exclusion. In other words, although often requiring considerable amounts of “craft and graft” to deliver seemingly very small amounts of change, these “little miracles” may actually be more conducive in the long run to delivering the kind of tangible “real” change that is often aspired to by both workers and service users and their carers. Research limitations/implications – The COPs project was limited in terms of time and scale and, hence, further research would be needed to, for example, ascertain their longer-term potential. Practical implications – There is merit in the theoretical perspectives discussed and, from these, of understanding how best to establish and operate COPs as a vehicle for achieving better outcomes through integrated or collaborative working. Social implications – There is much scope for better integrated or more collaborative working in the context of MEH and this paper draws attention to how COPs could be one means of achieving better outcomes for people experiencing MEH. Originality/value – This is the first paper to set out the theoretical analysis of COPs as a means of achieving better integrated or collaborative working. [ABSTRACT FROM AUTHOR]

Purpose - Integrating services does not necessarily lead to improved outcomes for people with care and support needs and fails to address the need for workforce integration. Workforce integration requires different professional groups to give up personal power, put the people they are supporting ahead of entrenched professional rivalries and be versatile not flexible in how they work. Integration is not important to people with care and support needs, unless it makes a difference to their ability to lead an independent life. The paper aims to discuss these issues. Design/methodology/approach - A personal opinion piece based on learning from the development of principles for workforce integration with social care and health employers. Findings - Integration takes time and there is no quick fix or magic solution, but it can happen. People's behaviour and motivations are complex, confusing and often inconsistent, and mandating service integration will not change the way workers behave. Perhaps it is now time to stop using service integration as a way of avoiding making tough decisions about the more challenging issue of workforce integration and what this means for those with power and control over people's lives. Originality/value - The paper separates integration into service and workforce integration and argues that too much focus is given to the former rather the latter. [ABSTRACT FROM AUTHOR]

Purpose: The scaling up of promising, innovative integration projects presents challenges to social and health care systems. Evidence that a new service provides (cost) effective care in a (pilot) locality can often leave us some way from understanding how the innovation worked and what was crucial about the context to achieve the goals evidenced when applied to other localities. Even unpacking the "black box" of the innovation can still leave gaps in understanding with regard to scaling it up. Theory-led approaches are increasingly proposed as a means of helping to address this knowledge gap in understanding implementation. Our particular interest here is exploring the potential use of theory to help with understanding scaling up integration models across sites. The theory under consideration is Normalisation Process Theory (NPT). Design/methodology/approach: The article draws on a natural experiment providing a range of data from two sites working to scale up a well-thought-of, innovative integrated, primary care-based dementia service to other primary care sites. This provided an opportunity to use NPT as a means of framing understanding to explore what the theory adds to considering issues contributing to the success or failure of such a scaling up project. Findings: NPT offers a framework to potentially develop greater consistency in understanding the roll out of models of integrated care. The knowledge gained here and through further application of NPT could be applied to inform evaluation and planning of scaling-up programmes in the future. Research limitations/implications: The research was limited in the data collected from the case study; nevertheless, in the context of an exploration of the use of the theory, the observations provided a practical context in which to begin to examine the usefulness of NPT prior to embarking on its use in more expensive, larger-scale studies. Practical implications: NPT provides a promising framework to better understand the detail of integrated service models from the point of view of what may contribute to their successful scaling up. Social implications: NPT potentially provides a helpful framework to understand and manage efforts to have new integrated service models more widely adopted in practice and to help ensure that models which are effective in the small scale develop effectively when scaled up. Originality/value: This paper examines the use of NPT as a theory to guide understanding of scaling up promising innovative integration service models. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to examine the association between multi-agency working and psychosocial characteristics of work, practitioner time-use and job satisfaction. Design/methodology/approach – A comparison of practitioners working in multi-agency (health and social care) and single-agency (social care-only) teams, using data from the 2008 evaluation of individual budgets pilots in England. Participants worked in care manager roles supporting adult social care service users, and comprised social workers and a smaller number of health professionals. Data were collected using a self-completed questionnaire. Findings – Data were returned from 249 respondents (a 29 per cent response rate), with two-thirds working in single-agency teams. No significant differences were found between team type and job satisfaction. Respondents in multi-agency teams reported greater decision authority but poorer supervisory support than those in single-agency teams. The latter finding was robust to further exploration using regression to control for confounding factors. Research limitations/implications – These data were not specifically collected for the study and response rates were relatively low due to organisational upheaval at the time of data collection, which may affect interpretation. Practical implications – Government policy is dedicated to extending integrated forms of working, including multi-agency teamwork. This research suggests that such structures need careful planning for them to work effectively, with particular attention to supervision arrangements. Originality/value – This research gives a systematic and objective exploration of the relationship between job characteristics, time-use and satisfaction of practitioners in single as compared to multi-agency teams. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to report on the findings of the first stage of a project seeking to improve interprofessional working between general practice and adult social care teams. It develops the current evidence base through findings from focus groups and reflects on the implications of the findings for interprofessional collaboration. Design/methodology/approach -- The project involved running seven focus groups with general practice staff and adult social work teams to explore their perceptions and understanding of each other. Findings -- The focus groups highlighted that the negative aspects of interprofessional working outweighed the positives. Negatives included perceptions of different value bases, a lack of knowledge about each others' roles and responsibilities which resulted in resorting to stereotypes, poor interprofessional communication and a sense of an unspoken professional hierarchy with general practitioners (GPs) at the top leading preventing a culture of appropriate challenge. Research limitations/implications -- The research has only been conducted with four GP practices and three social work teams that had expressed an interest in improving their interprofessional working. Therefore the findings may not be generalisable. Practical implications -- The case study suggests that there is a lack of effective interprofessional working between social care teams and general practice. With the current health and social care agenda focused on integration, this suggests there should be a greater focus on this area. Originality/value -- This paper illustrates that despite many years of policy makers promoting better integration, the quality of the interprofessional collaboration between social care teams and general practice remains poor. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to present a case study of one element of the integrated work which has taken place in Central Manchester, the development of multi-disciplinary Practice-Integrated Care Teams (PICT). The paper will show how working together has become a practical reality for members of these teams, and is forming the building blocks for further integration across neighbourhoods. Design/methodology/approach -- This paper draws on the author's experience of working in the PICT project from 2012 to 2014. The report will draw on the evaluation work which took place during the project, and will include reflections from others involved in the project and members of the teams. Findings -- The integrated care teams which have been developed in Central Manchester have started to make significant changes to the ways that professionals work together, to the experience that patients have and to the costs of urgent care provision. Whilst there is still a long way to go, there has been significant learning from the PICT. This includes improved patient outcomes and experience. There has been an overall reduction in secondary care activity for patients the teams have been working with, with the largest reduction being in emergency admissions. Alongside this, patient feedback has reinforced the value of this personalised approach and increased overall satisfaction with the care and advice received from health and social care professionals and an improved professional experience. Evaluation has demonstrated that amongst professionals involved in the team there is a strong commitment to the principles of integrated care and that the confidence, skills and capacity of the teams have strengthened since this way of working has been introduced. As monitoring of financial impact continues to develop, cost savings from secondary care, particularly around emergency unplanned care, are encouraging. Originality/value -- This paper draws on the recent experience of designing and delivering integrated care across a range of multi-agency, multi-professional partners. The model which has been developed centres around the role of general practice, and has enabled primary care to take a key role in the development of an out-of-hospital integrated care system. This has enabled community professionals such as nurses and social workers to build a much stronger relationship with general practice and enable system linkages which will be essential to the delivery of joined-up health and social care in the future. The project has been accompanied by thorough and ongoing evaluation to support the validity of the learnings which have been reported. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to identify features of community mental health teams (CMHTs) for older people valued by their managers, and those they would most like to change. Design/methodology/approach: Content analysis was used to analyse "free text" responses to open questions from a national survey about CMHTs' organisational structures and processes. Responses were sorted into statements which were categorised into content areas and higher level dimensions. Findings: Free text information was provided by 376 teams (an 88 per cent response rate). Eight higher level dimensions were identified. One related specifically to integration with social care services, whilst several more included material about other aspects of intra-team integration (e.g. documentation and location). The largest proportion of statements related to staffing and teamwork. Statements about inter-personal and inter-professional issues were largely positive, whilst statements about resources, bureaucracy and integration with social care services typically detailed desired changes. Practical implications: Four key issues emerged comprising a high level of support from managers to develop integrated practices; a need to define the focus of CMHTs for older people and to be fully resourced; and the importance of a nurturing and supportive team environment. Originality/value: The methodology provides a bridge between qualitative and quantitative research, exploring the volume of statements on particular topics and their meaning. [ABSTRACT FROM AUTHOR]

Purpose: This article aims to address the need for a more structured partnership between civilian and military healthcare, particularly in the context of cross-border threats in the EU. While both systems are driven by the same goal of providing high-quality healthcare services and achieving optimal patient outcomes, they operate under different national approaches and resources. Design/methodology/approach: Two recent crises are presented as examples that highlight the necessity of cooperation between civilian and military medical systems. The Covid-19 Pandemic and the Ukrainian Conflict are described based on the experience gathered by the author as a member of the NATO Centre of Excellence for Military Medicine and form the base to shape a broader perspective on the future of civil-military interaction in healthcare at the European Union level. Findings: The ability to deliver coordinated responses during crises depend on the level of interoperability, preparation and mutual understanding. To improve synergies, a structured partnership should be established, prioritizing common standards of care and shared best practices. Integrating military and civilian healthcare pathways can be especially beneficial in situations where patients are moved from the point of injury or sickness across different military and civilian structures to receive the most appropriate treatment and rehabilitation for their conditions. Originality/value: The relationship between military and civilian healthcare systems is often discussed at multinational level, but a clear focus is lacking concerning their shared mission, distinct functions and potential for cross-border collaboration. [ABSTRACT FROM AUTHOR]

Purpose – Older adults with atrial fibrillation (AF) have put growing demands on a poorly integrated healthcare system. This is of particular concern in rural communities with rapid population aging and few healthcare resources elevating risk of stroke and mortality. The purpose of this paper is to explore healthcare delivery risks for rural older adults with AF. Design/methodology/approach – This qualitative study collected data from AF patients, healthcare providers and decision makers. Ten patients participated in six-month care journeys involving interviews, logs, photos, and chart reviews. In total, 13 different patients and ten healthcare providers participated in focus groups and two decision makers participated in interviews. Findings – Three key health service risks emerged: lack of patient-focussed access and self-management; unplanned care coordination and follow-up across the continuum of care; and ineffective teamwork with variable perspectives among patients, providers, and decision makers. Originality/value – This study extends the understanding of risks to the health system level. Results provide important information for further research aimed at interventions to improve health service delivery and policy change to mitigate risks for this population. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to focus on the Integrated Care Transitions Project between the emergency department (ED) of a university hospital and primary health care (PHC) services in a large city in Southern Brazil was the focus of this study. Care transitions occurred through telephone contact for patients discharged from the ED to PHC. Design/methodology/approach – This descriptive, exploratory qualitative research collected data via semi-structured interviews (n=14) including interns of health disciplines, advisors for interns, nurses, and physicians from the ED and PHC Family Unit. A thematic analysis of the data were conducted. Findings – ED providers felt they gained increased knowledge of the care networks available for patients in the community. Connection between the providers in ED and PHC facilitated confidence in the services provided in the community and increased continuity of care for patients’ needs. The PHC providers recognized integration promoted communication and better care planning for patients discharged from ED. Integrated care made the work in the PHC easier and benefited the users. Research limitations/implications – The study evaluated a program available in one hospital. Generalizability may be limited as services in the ED were provided by professional residents and their advisors, not employees of the hospital. Practical implications – Shared information by different health services leads to better care for patients and greater job satisfaction for providers. Originality/value – Care transitions are not well-managed in health care; there is limited research focusing on care transitions from ED to community. For providers and patients, this program assisted in building capacity and networks for transitions in care. [ABSTRACT FROM AUTHOR]