Integrated care has moved from the small niche it traditionally occupied in academia, accessible only to experts in the field and applied merely on a project specific or pilot effort basis, now onto the radar of politicians and health system planners the world over.
Integrated care has moved from the small niche it traditionally occupied in academia, accessible only to experts in the field and applied merely on a project specific or pilot effort basis, now to the radar of politicians and health system planners the world over.
More than a buzzword for the 21st century, coordinated/integrated health services delivery is a necessity. From changing demographics and increasing chronicity to the persisting threat of communicable diseases, coupled with modern technologies, rising patient expectations and a perpetual context of fiscal constraints, new and innovative approaches to the delivery of health care, that ensure high-quality services which are efficient in their provision and delivered according to an individual's needs, must be given the utmost priority.
Strengthening the coordination/integration of care is ultimately best viewed as a means, rather than an end in itself, for improved health outcomes. The activity in this area can be credited to this presumed causal relation. The vast number of initiatives to design and implement integrated care programmes across countries in the WHO European Region is astounding. These examples extend from local initiatives like integrated care pilots in North West London in the United Kingdom  to regional efforts seen in Lithuania and Ukraine to strengthen disease management, and on the largest scale, national efforts like that of the Basque Strategy to tackle chronicity in Spain , or the Croatian eHealth strategy paving the way for coordinated communication flows .
Still, there remains a long way ahead to transform services to people-centred care: lack of clearly defined and measurable aims, consistent communication strategies or participatory approaches in developing and implementing integrated care are only a few of the shortcomings that may lead to sub-optimal outcomes or present challenges in order to implement efforts sustainably and at scale. Ensuring system-wide implementation is often further hampered by ambiguous incentive structures, a lack of adequately trained professionals and/or outdated legal frameworks.
The variability in approaches is in itself a testament to the diversity and flexibility of integrated care – a characteristic that is also its strong point, as integrated care has never been intended as a mere theoretical concept, but was rather developed from practice and for practice. Reforming a health system to meet the challenges of the 21st century is no small feat and it is only with the many different attempts to integrating care that we have come to understand the complexities of health system. As Goodwin recently acknowledged , there is a growing interest in ‘what works, how, where and why’, and there are already some very impressive examples of having gotten integrated care ‘right’ [1,5].
As the interest for integrated care has grown, so has the attention of governments, the World Health Organization, the European Union and other international institutions in this topic. At the WHO Regional Office for Europe, attention is drawn to the vision of Health 2020  for improving health system performance through innovative approaches to modernise and transform the delivery of health services towards more people-centredness. The newly founded WHO Centre for Primary Health Care in Kazakhstan will promote the idea of people-centred care, advocating a proactive primary health care setting and will create a platform for capacity-building and knowledge exchange in the region.
Just this past October, the WHO Regional Office for Europe officially launched the roadmap to develop a Framework for Action towards coordinated/integrated health services delivery at the 5th Tallinn Charter Anniversary WHO High-Level Meeting in Tallinn, Estonia. This framework follows the call from Member States for contextualised, evidence-based policy options to enable system-wide changes and the need for tools to implement these changes. The framework is aligned with other WHO global initiatives in this area and involves a wide range of stakeholders including national representatives from countries across Member States and international experts, among others, to solicit their input through various consultations and feedback loops. The way forward was defined in the aforementioned roadmap document, which outlines three pillars for action. These pillars correspond to three topical questions:
The WHO Regional Office for Europe new health policy, Health 2020 , calls for a whole-system and whole-society-approach to meet the challenges of the 21st century and create more people-centred health systems. These transformations call for a paradigm shift in thinking health, actively involving people to participate in the organisation of health systems, and strengthening communities to create healthy environs. In order to support these efforts in the Member States, the Health Services Delivery Programme (HSD) in the Division of Health Systems and Public Health (DSP) of the WHO Regional Office for Europe initiated the development of a Framework for Action towards CIHSD. From 2013 until 2016, this participatory process will synthesise the evidence on integrated care delivery and change management, gather field evidence across the WHO European Region and design a toolkit for sustainable system transformation. Along this way, active participation of the Member States, experts, patients and provider organisations is solicited to meet the principles set forth in Health 2020 .
Note: As a first effort to consolidate experiences, we invite the exchange of practices to create more coordinated/integrated services from across the WHO European Region through an open call for initiatives. Whether a local effort to minimise fragmentation of care in a given centre, or a regionally or nationally planned initiative linking providers across sites and levels of care – whichever the scale, shape and form – your support in capturing these efforts is needed. For more information on this open call for practices and to fill in the simple electronic questionnaire to do so – as a manager, policy-maker, provider or participant in an initiative – we invite you to visit our website at: www.euro.who.int/en/what-we-do/health-topics/Health-systems/health-service-delivery
To send questions, feedback or input, please contact firstname.lastname@example.org
Greaves, F Pappas, Y Bardsley, M Harris, M Curry, N Holder, H et al. (2013). Evaluation of complex integrated care programmes: the approach in North West London. International Journal of Integrated Care, http://www.ijic.org/index.php/ijic/article/view/URN:NBN:NL:UI:10-1-114283
Bengoa, R (2013). Transforming health care: an approach to system-wide integration. International Journal of Integrated Care, http://www.ijic.org/index.php/ijic/article/view/URN:NBN:NL:UI:10-1-114747
Varga, S , . Mobile and eHealth platforms for chronic disease management; Presentation during the eHealth Week; 13–15th May; Dublin, Ireland. 2013. Available from: http://www.worldofhealthit.org/2013/wp-content/uploads/presentations/Mobile_and_eHealth_Platforms.pdf
Goodwin, N (2013). How do you build programmes of integrated care? The need to broaden our conceptual and empirical understanding. Editorial. International Journal of Integrated Care 13http://www.ijic.org/index.php/ijic/article/view/URN%3ANBN%3ANL%3AUI%3A10-1-114748
The King's Fund , . Clinical and service integration: the route to improved outcomes. London: The King's Fund. 2010. Available from: www.kingsfund.org.uk/publications/clinical_and_service.html
WHO Regional Office for Europe , . Regional Committee for Europe Sixty-second Session. Copenhagen: WHO Regional Office for Europe. 2012. Health 2020 Policy Framework and Strategy.
Laucevičius, A Kasiulevičius, V Jatužis, D Petrulionienė, Ż Ryliškytė, L Rinkūnienė, E et al. (2012). Lithuanian High Cardiovascular Risk (LitHiR) primary prevention programme – rationale and design. Seminars in Cardiovascular Medicine 18: 3.
NHS Scotland , . The Healthcare Quality Strategy for NHS Scotland. The Scottish Government. 2010. Available from: http://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf
Curtis, M , . Copenhagen: WHO Regional Office for Europe. 2010. Building integrated care services for injection drug users in Ukraine.