Article published on International Journal of Care coordination, Sage Journals, December 31, 2021
Author: Hubertus JM Vrijhoef
Changing perspectives: From care coordination to health coordination
Existing health inequalities have been brought to the fore by the COVID-19 pandemic. Investing in the conditions that improve people’s health (i.e., education, employment, housing, social networks, healthy environment) should be an essential part of the COVID-19 recovery for societies. The UK government has set out to ‘level up the nation’s health’. In their briefing ‘A whole government approach to improving health’, Merrifield & Nightingale call for continued action from across the whole of government and beyond. They argue that such action is needed both through how government organizes itself to deliver impact and through pursuing the policies that will make a real difference. Acknowledging that health improvement is the responsibility of a range of departments, not just the Department of Health and Social Care, requires all departments to understand the health implications of the decisions they make and the costings involved.1
Important lessons regarding policies that will make a real difference as part of this movement could be taken from Miller’s et al. overview of integrated care policy in England from 2010 to 2020.2 They argue that ‘English health and social care services were simply not designed as a system or with integration in mind.’ In yet another analysis of three national programmes piloting integrated care in England, Lewis et al. question ‘why the debate about how best to integrate health and social care remains unfinished business’.3 In discussing the ambiguous conceptualization of integrated care, they point out the importance of focusing ‘not on what is done within what organisational construct, but on what patients and carers consider to be needed and what will best support care workers of all sorts to work effectively together’.3
If some systems are unable to be integrated because they simply do not fit together, then perhaps coordination is a more realistic strategy to level up a nation’s health. Health coordination should become the new standard, with care coordination and integration as supporting strategies, if and where appropriate. By bridging the human and its supporting system, health coordinators make use of what works and are well positioned to identify what hinders health improvement. In this light, narrowly focused approaches such as ‘integrated primary care’ and ‘integrated diabetes care’ do not seem sustainable strategies. A redistribution of resources away from disease-oriented or sector-focused policies in the direction of a broad health ecosystem is urgently needed to make a real impact.
In this double issue of the International Journal of Care Coordination, van Tuyl et al. report on a scoping review of international literature about task-shifting expert interviews and in-depth analysis of five task-shifting cases in the Netherlands.4 They discuss that only when designed to face specific complexities at the workplace and taking into account the balance between specialists and generalists, task shifting may substantially contribute to enhanced quality of care that meets the changing needs of society.4 In other words, similar to the discussion on integrated and social care, for task shifting to make a real impact its broader implications for health need to be understood.
By using interpretive description methodology, Chapman et al. describe clinician communication surrounding initiation and withdrawal of non-invasive ventilation in adults with Motor Neuron(e) Disease.5 From their study, four important learnings emerged. Both the clinicians’ lack of awareness of international guidelines and the discomfort about discussing the benefits and burdens of non-invasive ventilation and percutaneous gastrostomy tube prior to or at the onset of respiratory symptoms clearly indicate room for improvement. Perhaps most worrisome is the learning that family participants and their relatives with Motor Neuron(e) Disease found clinicians’ communication to be inadequate resulting in seeking for information from less authoritative sources.5
In our ongoing fight against the COVID-9 pandemic, training of health workers is crucial in promoting pandemic preparedness. Yanti et al. used a cross-sectional study design with an online survey to self-assess knowledge, attitude, behaviour and preparedness of health workers in Aceh Pidie Jaya, a district in Indonesia, against the COVID-19 pandemic.6 Only half of the health workers report good preparedness indicating the importance of ongoing education and training of health workers.6
Kokorelias et al. report on the experiences and perceptions of community and hospital healthcare professionals in a seniors’ patient navigator program in Toronto.7 It was found that the role of patient navigators gets understood inconsistently which leads to uncertainty regarding their role in patient care. The authors identified five strategies that may help to improve collaboration and organizational performance to better meet the needs of older adults transitioning from hospital to home.7
By using a retrospective cohort study, Tanya et al. aimed to identify patterns of eye-care utilization among refugee patients with type 2 diabetes mellitus in Canada under an interdisciplinary clinic model.8 With refugees having higher rates of referral to eye-care providers and utilization of eye-care services but also experiencing a longer time to access such services, Tanya et al. suggest a role for increased collaboration across family physicians, eye-care providers and settlement services to improve the accessibility of vision screening services.8
The two final papers in this issue of the International Journal of Care Coordination focus on pediatric care. By making use of data from the 2016–2017 US National Survey of Children’s Health, Anyigbo et al. describe the prevalence of need and unmet need for care coordination by adverse childhood experience-type and score and examine associations between these variables.9 Based on the study findings, the authors suggest the need for a more comprehensive design and implementation of care coordination in the pediatric medical home and other systems serving vulnerable children, particularly those who have endured adverse childhood experiences.9
Kobussen et al. explored the attitudes and perspectives of pediatric subspecialty healthcare providers working in a Canadian pediatric hospital with pediatric complex chronic patients.10 This was done by using a survey study exploring healthcare providers’ perspectives when caring for pediatric complex chronic patients compared to non-pediatric complex chronic patients. Several differences were identified and from these opportunities to enhance care provision were reported.10 Given the paucity of literature examining healthcare provides attitudes and behaviours when caring for pediatric complex chronic patients, the authors rightfully invite others to help strengthen the evidence base.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) received no financial support for the research, authorship, and/or publication of this article.
1. Merrifield, K, Nightingale, G. Briefing: a whole-government approach to improving health. Health Foundation 2021. https://doi.org/10.37829/HF-2021-HL13 (accessed 7 December 2021).
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Google Scholar | Crossref | Medline
4. van Tuyl, L, Vrijhoef, B, Laurant, M, et al. Broadening the scope of task shifting in the organisation of healthcare. Int J Care Coordination 2021; 24: 91–95.
5. Chapman, C, Bayes, S, Sim, M. Communication surrounding initiation and withdrawal of non-invasive ventilation in adults with Motor Neuron(e) Disease: clinicians’ and family members’ perspectives. Int J Care Coordination 2021; 24: 96–106.
6. Yanti, B, Armita, N, Zakaria, I. The role of knowledge, attitudes, and health workers’ bahaviour in COVID-19 pandemic preparedness at Aceh Pidie Jaya District, Indonesia. Int J Care Coordination 2021; 24: 107–112.
7. Kokorelias, KM, Posa, S, DasGupta, T, et al. “I think like if Albert Einstein and Superman had a baby, that’s what it would take”: the experiences and perceptions of community and hospital healthcare professionals in a seniors’ patient navigator program. J Care Coordination 2021; 24: 113–119.
8. Tanya, SM, He, B, Aubrey-Bassler, C. Eye-care utilization among a Canadian diabetic refugee population: retrospective cohort study of an interdisciplinary care model. J Care Coordination 2021; 24: 120–124.
9. Anyigbo, C, Fuller, AE, Cheng, YI, et al. Associations between adverse childhood experiences and need and unmet need for care coordination. J Care Coordination 2021; 24: 125–132.
10. Kobussen, TA, Hansen, G, Holt, TR. Comparing subspeciality and intensive care providers perspectives on pediatric complex chronic patients: a survey study. J Care Coordination 2021; 24: 133–141.