Integrated care for the complex medically ill
International Journal of Integrated Care, 4 October 2007 - ISSN 1568-4156
Book review
Integrated care for the complex medically ill
Edited by Frits J. Huyse and Friedrich C. Stiefe
(Medical clinics of North America, Jul 2006 Vol. 90, No. 4) W.B. Saunders Company (Elsevier), Philadelphia: 2006, pp 234,
ISBN 1 4160 38888 4
Debbie Kralik, RN, MN, PhD, Director, Research Unit, Royal District Nursing Service, South Australia, Associate Professor, University of Adelaide, University of South Australia

The focus for this book is integrated care for people with complex multimorbid chronic conditions. The prevention and management of chronic conditions is at the forefront of the health agendas in countries across the world. While not usually immediately life threatening, chronic conditions are the leading causes of premature mortality and often life changing for individuals and family and sometimes, impacting on the capacity and viability of entire communities. Globally, the focus is on understanding the needs of this population and building the capacity of health systems and services to respond based on those needs. The relevance and value of this book is precisely in this context.

Strategies to improve care for this population group have moved from traditional disease specific, bio-medical models towards coordinated and integrated health care framed by cultural and social sensitivity. The organizational structure of health systems in developed countries is often a significant obstruction to integrated care, in addition to the fragmentation of health care due to medical and allied health specialization. People with complex multimorbid conditions are particularly vulnerable to the gaps in fragmented health systems and reactionary responses from services. This book focuses on identification of this population group, consideration of what issues they may experience, and the possibilities of new models of service and care delivery that will better meet the anticipated needs of people with complex multimorbid conditions.

Even though most of the contributing authors are medical doctors, the editors report the book as being suitable for clinical professionals such as medical doctors, nurses, paramedical professionals, psychiatrists and psychologists working across all aspects of the health and social services. It is also a fundamentally important text for health service managers, policy makers and politicians who are often the directors of resources. Cooperation, coordination and integration of care can be context dependent. The twenty-one contributors are from the Netherlands (8), United States of America (8), Australia (2), Spain (1), Germany (1) and Switzerland (1), hence transferability of the models, tools and frameworks presented by the authors may be limited.

The first chapter identifies and synthesizes the learning's and characteristics of integrated care and its related activities. It also discusses the conceptual and methodological difficulties that obstruct the progress of research that studies and evaluates its application. The authors point out that there has been a lack of consensus about definitions used so an important starting point is an examination of the evidence around terms such as ‘complexity’ and ‘inter-professional collaboration’.

The chapters that follow are a relatively comprehensive collection of aspects of the concept of complexity and integrated care models for people with biopsychosocial multimorbidities. Common across the chapters is the degree of conceptual depth and empirical rigor in which the authors deal with topics. This includes aspects of early identification, health promotion, early assessment, and interdisciplinary communication and care coordination. Each chapter outlines the importance of the assessment, provision and monitoring of integrated care activities. The concluding chapters present different models of integrated care and ways of operationalising complexity in clinical practice. This is fundamentally important to enable the transference of integrated care research into practice.

The value of this book is its well-structured and well-written descriptions of what is usually poorly defined common language constructs. In each chapter, readers are provided with a comprehensive understanding of definitions and interesting and important information on the various topics related to integrated care. Absent from this text, however, is the voice of the people who are living with complex multimorbid conditions. The inclusion of a qualitative study that enhances the issues and concerns from the person's perspective would have made a valuable contribution. Integrated care services cannot claim to meet the needs of people until our research, services and systems value the voice of the very people they claim to serve. With this gap, as a reader I felt that the book does not completely live up to the expectations of the editors to facilitate improved care and knowledge for this population group. It is after all, people with complex multimorbid conditions that must be the judge of system and service improvement.