The 1960s saw the emergence of cooperation in healthcare; a development that started with the GP. Teams were established. A second wave of cooperation emerged in the 1980s. This second wave concerned care for people with chronic conditions. Primary care and secondary care started to cooperate: shared care was born. The first ten conferences of the International Foundation of Integrated Care (1999-2009) focused on cooperation in primary care, elderly care and chronic care and continued to do so in the years after. However, integrated care also expanded to mental healthcare, palliative care, emergency care and birth care. Currently, global efforts are made to expand integrated care to a great number of new patient groups and to study aspects of it.
At the conference in Barcelona, which was held in May this year, this was also highlighted by various speakers. Great emphasis was placed on primary care, chronic care and the aforementioned expansion into new territories. But there was more. The focus on integrated pharmaceutical care and the way it relates to health IT, for instance. We are currently witnessing the emergence of a third wave of cooperation between professionals and patients and their loved ones. This cooperation manifests itself in things like shared decision-making about possible treatment methods; a personal budget with which patients purchase their own care; the case manager who cooperates with patients and their family in creating an integral care/life plan; professionals who stimulate self-management as well as making the electronic health record accessible to patients. The third generation of cooperation is a good addition to existing integrated care, which mainly focuses on cooperation between professionals. After all, a well-functioning primary care team can easily come across as a threat to the patient who wants to deviate from multidisciplinary guidelines. And what is the added value of a professional, shared care team when patients do not stick to proposed precepts, do not adhere to their medication regime and when informal carers are exhausted?
In this model, patients and professionals are cooperation partners. Together they produce health: the patient is co-producer rather than consumer. This model proposes that this form of care is more effective than a form of care that relies solely on cooperation between professionals. The realisation of this model is hindered by several factors. One of them is that professionals do not have enough time to cooperate with patients. They do not have enough time to listen to specific questions asked by patients, to inform them and their family and to improve self-management. Secondly, when a patient becomes a partner, the relationship between patient and professional changes. It becomes more equal. Not all professionals want this. A myriad of interventions have been developed to stimulate cooperation between professionals and patients and their loved ones. These interventions were discussed at the conference in Barcelona. Examples include supervised lifestyle adaption; training self-management, e.g., pain management; psycho-education in mental healthcare; supporting informal carers; the use of decision aids and motivational interviewing. At the conference in Barcelona, many presentations dealt with this highly personalised form of integrated care: a truly new and exciting concept. I look forward to the global conference on integrated care in New Zealand and Ireland. There we will come together to continue the development of these theories about integrated care and provide them with empirical testing. Dear reader of this blog: I am looking forward to meeting you there.
Guus Schrijvers is a former professor of Public Health at the University Medical Center Utrecht, health economist and IFIC-chair.
Prof Guus Schrijvers
Chairman and Founder
International Foundation of Integrated Care (IFIC)