By Bert Vrijhoef
Published in International Journal of Care Coordination July 22, 2022
In December 2021 the European Commission has launched the “Healthier Together – EU Non-Communicable Disease Initiative” to support EU countries in reducing the human and financial burden on non-communicable diseases (NCDs). It does so by reinforcing and supporting policy implementation and effective action of EU countries’ health authorities and stakeholders in five strands: (a) a horizontal strand on shared health determinants, focussing on population-level health promotion and disease prevention of NCDs (completing the actions of Europe’s Beating Cancer Plan); (b) diabetes; (c) cardiovascular diseases; (d) chronic respiratory diseases; and (e) mental health and neurological diseases.1
In June 2022 the European Commission published, what is referred to as, an ‘open document’ or a ‘toolkit’ to guide and coordinate action on NCDs, and to identify and create windows of opportunity for high-impact actions to be implemented across countries for the years 2022–2027. Inputs for the document are obtained via a co-creation process involving numerous stakeholders. The document or toolkit is a rich source of what is referred to as ‘possible priority areas’ which are translated into ‘collaborative actions’. In addition to the five strands, an integrated and coordinated approach composed of transversal actions is suggested because major NCDs share many risk factors which could be addressed more effectively and efficiently by the suggested approach.1
As part of the integrated approach, ‘health system redesign to deliver person-centred and integrated care’ is endorsed as a priority area by 16 EU countries. Interestingly, this priority area is endorsed by 1 EU country for diabetes, 10 EU countries for mental health and neurological diseases, and remains unmentioned for cardiovascular diseases and chronic respiratory diseases.1
Since the process to develop the tool is ongoing and with the tool reflecting an intermediate state, it is too early to draw conclusions at this moment. However, one wonders why more countries endorse a systems’ approach for mental health and neurological diseases than for other NCDs. And, related to this, does endorsement reflect activity or lack of activity in a specific area? In the document, the European Commission repeatedly invites EU countries to comment on the suggested work packages and their content. For readers of the International Journal of Care Coordination, the “Healthier Together” initiative and accompanying reports and tools should have your attention, at the very least
The first paper in this issue of the International Journal of Care Coordination reports on how community health workers can maximize the impact of their services on high-risk adult clients to help mitigate their risk and overcome barriers to controlling chronic diseases.2 In doing, so Chiyaka et al.2 make use of observational data from participants of the Northwest Ohio Pathways Community model. In times when health services delivery is shifting in favour of telehealth services, this study shows the importance of in-person interactions to engage adults in managing their chronic diseases.
Lim et al. conducted a cross-sectional prospective study including a survey to explore patient and clinician perspectives on acute ophthalmology presentations during the coronavirus disease 2019 (COVID-19) pandemic between April and June 2020 in Northwest London.3 They conclude that COVID-19 may have caused a delay in presentation for emergency eye care. Further, with patients and clinicians not equally enthusiastic about video/remote consultations as an alternative to face-to-face consultation, the importance of information campaigns in educating patients about telemedicine is emphasized.3
By conducting a mixed-methods approach Wu et al. aimed to provide a more comprehensive picture about the workflow of inpatient care coordinators and to improve the efficiency of clinical workflow analysis.4 Workflow barriers faced by inpatient care coordinators are long travel time, heavy documentation load, and suboptimal communication. Wu et al.4 suggest several design considerations for developing a Health Information Technology solution that supports the work of inpatient care coordinators.
The final paper in this issue of the International Journal of Care Coordination presents a study by Katona et al.5 assessing whether variation exists in long-term health care costs, diabetes-related complications and hospital admissions of patients with type 2 diabetes receiving integrated care organised by care groups in the Netherlands. Katona et al. used a quantitative cohort study with data from over 143,000 patients using medication for their diabetes in the period 2014–2018. Data were analysed using generalized linear mixed models (GLMM). In addition to showing that GLMM in combination with a 5-year cohort is a tool to study variations in long-term outcomes of integrated care initiatives, Katona et al.5 concluded that Dutch care groups accounted only minimally for the large variation between patients in terms of health care costs and complications.
As pointed out above, when discussing the “Healthier Together” publication by the European Commission,1 variation seems the common denominator of existing integrated care initiatives in Europe (and beyond). Future studies of coordination and integration of care services could learn from robust analytical approaches, such as those presented by Katona et al.,5 since it is important to understand the variation between integrated care initiatives.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the United States Centers for Disease Control and Prevention (CDC), Akron Children’s Hospital Rebecca D. Considine Research Institute, Hospital Council of Northwest Ohio,