Integrated Care

An integrated care system provides seamless, coordinated care across different levels of the health system from prevention to end of life, according to patient needs over time. Patients and their families are at the core of integrated care. Ideally, an integrated care system not only connects services within the health care sector, but it also links with social services, housing, education and others.

For rural communities, integrated care is particularly important. Rural residents need treatments that consider their immediate medical concerns, their physical environment, as well as their social and financial situation. 

It would be challenging for a single organization or health clinic to address all these needs. By collaborating with others, rural health care organizations can offer a wider range of services that address the social determinants of health.

Patients will know when a health-care system is integrated when they:

• Do not have to repeat their health story for each provider encounter. Instead, their health information flows to all of their providers through a single health record 
• Experience coordinated and collaborative care 
• Do not have to undergo the same test multiple times for different providers 
• Have 24-hour access to a primary care provider 
• Have easy-to-understand information about their health condition, treatment options, and expected outcomes 
• Can access their own health data and are engaged in decisions about their own care 
• Have a health-care team that works together across all levels of care to meet their needs 

For a great example of how integrated care makes a difference to the life of a patient, check out Sam’s story. While the example is set in the UK, the same benefits of integrated care would be expected for someone living in rural Alberta. 

In the Auditor General’s 2017 report, he urges Alberta to move towards an integrated health care system to achieve the highest quality health of care. Integrated care is seen a powerful way to solve current health-care challenges. These challenges include increasing costs for health care, not well-coordinated services, and lack of health providers to care for the rising burden of chronic diseases. 

Greg’s Wings is a story of one man falling through the cracks and how it inspired change in Alberta’s health-care system.

The concept of integration is not new but dates back to the 1990s. It is no longer a theoretical concept, and many of the highest performing health-care systems around the world have integrated health systems.  

Data shows that integrated health-care systems have better outcomes for their patients. Integration can also reduce inefficiencies and duplication of services with helps to better use resources and save cost. This is important for rural areas that often have limited health-care resources.  

Integrated care also has benefits for rural health care providers that feel often isolated. When collaborating with others, they may feel better supported. This can make rural practices more attractive and prompt providers to stay in their rural communities.  

Alberta is moving towards integrated care. For example, forming one single health authority (Alberta Health Services) has combined many of the administrative departments of the previous health regions. This led to big reductions in administrative costs. The primary care networks (PCNs) have improved coordination between primary care and the rest of the system. Electronic medical systems, such as Netcare and the electronic medical record (EMR), enhance information flow between providers and levels of care.  

New service models have emerged like community health centres that make care for local residents more seamless. This gives much hope that Alberta’s health-care system continues to move towards full integration for the benefit of all. Integrated care is a win-win-win where the system, providers and the patients benefit, and it can lead to healthier rural communities.  

For more integrated care examples from other countries and how they made a difference to the lives of patients and their family’s lives visit: 

• https://www.rcplondon.ac.uk/projects/outputs/your-stories-integrated-care 
• https://www.pcpcc.org/content/successful-examples-integrated-models  
• https://www.integratedcare4people.org/ 

For patients with mental health issues, seamless, integrated care is critical to allow for a comprehensive approach to physical and mental wellbeing. This is, however, not the experience of all patients seeking mental health services as they often struggle with access and episodic care. The Canadian Mental Health Association website states that in any given year, 1 in 5 Canadians will experience a mental health problem. This will not only affect their personal health and wellbeing, but also impact on family, friends and colleagues.

Despite the large number of people struggling with mental health, less than one-third of them seek treatment. This might be related to stigma associated with mental health and the difficulties in accessing timely care.

Mental health information and resources available to Albertans are growing. The Canadian Mental Health Association, their Alberta Division, and Alberta Health Services all have comprehensive lists of resources and links to services.

Nevertheless, services in Alberta rural communities may be limited. A thorough review conducted in 2015 found that mental health services in Alberta are inadequate to meet people’s needs.

Two important recommendations from the review were that:

• Alberta Health and Alberta Health Services must work towards an integrated care system for addiction and mental health that offers timely and flexible access to care.
• Primary health care providers must play a stronger role in addiction and mental health, with a greater focus on screening, prevention, early intervention, and continuity of care, to reduce distress, suffering and health care costs.

Similarly, the Joint Statement on Access to Mental Health Care from the Canadian Medical Association and Canadian Psychiatric Association published in 2016 stressed the importance of collaboration among health professionals, patients and their families; timely access to mental health services; and the need to reduce the stigma and discrimination that Canadians with mental health disorders face.

Having primary care providers taking a bigger role in mental health care makes perfect sense. Given the lack of mental health specialists in rural areas, family practices are often the first stop for patients seeking mental health services.

However, family doctors might not have the supports, resources, knowledge, or time to treat patients with mental illnesses. So-called ‘shared care models’ offer a good solution. In these models, a mental health specialist is a vital member of the primary care team. The primary care provider can refer patients to the mental health specialist for assessment and initiation of treatment. Patients can receive mental health counselling right at their primary care clinic, which improves access and avoids lengthy travel in rural areas.

Many Primary Care Networks in Alberta have shared care models where behavioural health consultants work with patients to resolve issues around depression, anxiety, relationships, parenting, addiction, workplace stress and more. The focus of the intervention is on behavioural modifications to help patients regain their life balance. They also offer a range of resources.

Having mental health services integrated into primary care has many benefits. It makes it easier for primary care providers and mental health specialists to collaborate for the benefit of the patient. Together, they can manage a broader range of health issues and also focus on activities such as early detection and education.

Integrated mental health care also offers easier access to care for underserved populations including Indigenous peoples and many individuals who may not wish to attend specialized mental health services for fear of stigma and concerns over privacy.

In Primary Care Networks (PCNs), groups of family physicians work with other health-care professionals to provide comprehensive patient care to Albertans. Other providers include nurses, nurse practitioners, dietitians, pharmacists, social workers, and mental health professionals. Each PCN operates a bit differently based on the decisions made by the governing board. The programs and resources PCNs offer also depend on the needs of the patients the PCNs serve. PCNs follow a team-based health-care model.  

 Formation of primary care networks was an important step toward better integration of primary care with the rest of the health-care system. – Auditor General Report 2017, p16

PCNs are an important integrated health-care structure in Alberta. There are over 40 PCNs operating throughout Alberta with more than 3,800 family physicians, and more than 1,400 other health practitioners. PCNs support collaboration between family physicians, specialists, and other health-care providers. This results in better access to health services and continuity of care for patients. Thanks to PCNs, most Albertans now have a regular primary care provider. 

There are several PCNs in Alberta’s north and south that work with rural communities to address their specific needs. To find a PCNs in your area go to: https://pcnpmo.ca/alberta-pcns/pages/list.aspx  

Engaging patients and their families in all aspects of health care is a cornerstone of integrated care. The hope is that when patients have a say and their voices are being heard, health care will better meet their needs and preferences. Engaged patients also have better outcomes and reduced health care-costs.

Some places have invited patients as co-creators of new programs and services. For example, the People Powered Health program was an innovative project in the UK. Health-care providers and patients worked together to design and deliver new services for people living with long-term health conditions. There is also the idea of a “health pact” or a contract that describes responsibilities of all those involved in care. It puts a duty on people to get involved and take responsibility for their health and care at every level – from healthy living choices to giving feedback on services.   

 ePatient movement is a global effort to help people become equipped, enabled, and educated to participate actively in their healthcare, no matter their health, or socio-economic, status.

Alberta residents have a say in health care through the 12 Health Advisory Councils (HACs) across the province. Health Advisory Council members meet regularly and members can share their local perspectives. 

The Alberta Medical Association created a platform that engages patients in dialogue about health care in the province.

AHS has a number of options how patients and families can help improve health services. For more information visit their patient experience website.   

The Patient’s Medical Home (PMH), also referred to as Patient’s Health Home, is the future of family practice in Canada. Patient Medical Homes put the patient and their families at the centre of care and are the place patients feel most comfortable to discuss their personal and family health concerns. In the Patient Medical Home, patients receive comprehensive, coordinated and continuous care from a family physician and a health-care team.  

 The Patient’s Medical Home (PMH) is a family practice that patients describe as the place they feel most comfortable to discuss their personal and family concerns. – College of Family Physicians Canada 

 The Patient’s Medical Home vision outlines 10 goals for family practice:

The College of Family Physicians of Canada first presented the concept of Patient’s Medical Homes in 2011. The vision is now fully supported by the Alberta College of Family Physicians, the Alberta Medical Association and the Primary Care Networks.  

There are several successful examples of Patient’s Medical Homes in Alberta and across Canada. As a matter of fact, Alberta is leading the country with successful implementation of Patient’s Medical Homes! 

The Sylvan Family Health Centre in Sylvan Lake is part of the local Primary Care Network and is a great example of what a Patient Medical Home can look like. The centre offers a broad range of services, a unique patient portal and some virtual health options. The centre received the Patient Medical Home Outstanding Family Practice Award in 2017 for their excellent work. 

Embedded within Alberta Health Services (AHS), the Primary Health Care Integration Network aims to better integrate primary health care in Alberta. The network connects Primary Care Networks, AHS zones and programs, patients and their families, community-based organizations, Alberta Health, and academic partners to improve care coordination and transitions in care for Albertans.  

The network focuses on three areas:  

1. Keeping care in the community;  
2. Linking to specialty services and back; and  
3. Transitioning from home to hospital and back to home.  

All three initiatives are critical to improving care and care experiences for rural patients.  

Click here to read more about the Primary Health Care Integration Network and the three focus areas.

Integrated care is seen as the way to achieve high quality health services and better outcomes for patients. While the idea of integrated care is well accepted, creating a fully integrated health-care system is a difficult task. Policy makers and planners for health services can get help! 

Health Standards Organization just released a standard for integrated care. Standards are guidelines that are based on best practice and research evidence and set out benchmarks that organizations aim to achieve.  

Patients, health care providers, policy-makers, researchers and health-care administrator worked together for more than two years to create the standard for integrated care. Canada is the first country in the world to have an integrated care standard. The standard is an important tool for health system planners and helps them create better integrated health-care systems.

To read more about the standard go to: https://healthstandards.org/general-updates/learn-five-facts-hsos-new-integrated-people-centred-health-systems-standard/  

What is people-centered care?

Interesting Reads

• World Health Organization report on integrated people-centred health services
• International Foundation for Integrated Care, the leading authority driving integrated care internationally
• Kings Fund explainer on integrated care and evidence base for integrated care
• McKinsey and Company’s 2015 report on evidence for integrated care
• Kaiser Permanente, one of the world’s biggest and oldest integrated care system