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Investigating Integration of Formal and Informal Care in Primary and Community Care

Authors:

Federico De Luca ,

Politecnico Di Milano, Italy, IT
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Eleonora Gheduzzi,

Politecnico Di Milano, Italy, IT
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Giuliana Costa,

Politecnico Di Milano, Italy, IT
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Cristina Masella

Politecnico Di Milano, Italy, IT
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Abstract

Introduction: According to the Organisation for Economic Co-operation and Development (OECD), Long-Term Care (LTC) services are becoming increasingly crucial given population aging and require a structured deinstitutionalization of care for the elderly. To address the care deinstitutionalization of LTC patients, informal and formal care need integration. While formal care has a clear role and defined responsibilities, informal care is identified as unpaid and unprofessional care provided by a person or a group with whom LTC patients have a social relationship. Although the literature supports the integration of formal and informal care, the role of informal careers and how they influence integration are still unclear. This integration is particularly relevant in Primary Care, essential for providing and delivering first-contact, person-centered, longitudinal, comprehensive, and coordinated care. This research aims to investigate the integration of formal and informal care in primary care to define the critical areas of integration.

Methods: This research was conducted by analyzing an Italian case study related to the Case della Salute (CdS) of Piacenza in the Emilia Romagna region. CdS are a team-based health care delivery model intended to provide comprehensive and continuous medical care to patients within a defined community. The interviews investigated the existing integration between formal and informal careers in a multi-dimensional taking charge of the patient, how the interaction between formal and informal careers occurs, and where the main critical points of integration are. Six semi-structured interviews address six organizational health workers of the Italian CdS, selected based on areas of expertise to answer questions about the organization's perspective on integration. Five semi-structured interviews address social workers and voluntary associations outside the organization that interface with the CdS and assist patients. The aim is to define better which informal careers interact with the CdS and map the current critical areas of integration with formal care in this primary care model, from inside and from the outside the CdS organization. The data analysis coded the information using Nvivo software based on an abductive approach from a verbal transcription. This approach allows starting deductively with a set of codes defined through frameworks based on the literature on integrated care, inductively arrive at new codes.

Results/Conclusions: At present, interviews results show an uneven integration among several different informal careers. This inhomogeneity is related to contextual factors such as the size of the different structures in the territory and the staff's behavior to interact with informal careers. In particular, the informal careers that emerged in the research referred only to the associations present in the community, which integration covers more the logistic coordination, and by the family caregivers that integrate the social-health assistance. Other typologies of careers present in the literature have not emerged. Factors such as the use of non-interoperable and non-inclusive of the patient's careers information systems, the lack of flexible and open spaces functional to the interaction between informal and formal careers influenced the integration effectiveness. Furthermore, the situation related to the Covid-19 pandemic negatively impacted the progress of integration, stopping some activities.

 

How to Cite: De Luca F, Gheduzzi E, Costa G, Masella C. Investigating Integration of Formal and Informal Care in Primary and Community Care. International Journal of Integrated Care. 2022;22(S3):70. DOI: http://doi.org/10.5334/ijic.ICIC22288
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Published on 04 Nov 2022.

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