Integrated care has come to the fore in the health policy landscape with the announcement of 14 integrated care pioneers and the better care fund.

Across the world, countries have taken different approaches to developing models for integrated care.  Canada and the UK face similar problems integrating care for people with complex needs including fragmented finances and poor collaboration between acute and community or primary care providers.

Some small, evaluated pilot programmes across Canada have demonstrated promising results. In Quebec, the PRISMA approach was developed in 1994 to improve continuity of care for older people.

The PRISMA model uses an integrated service delivery network of health and social care providers alongside case management delivered by multidisciplinary teams.

The key clinical features are:

  • coordination between services;
  • a single point of entry;
  • case management;
  • an assessment tool;
  • a personalised care plan; and
  • an information tool.

A four year evaluation comparing patient outcomes of the project in three pilot areas against three control areas found that the model significantly reduced both patient functional decline and visits to the emergency department.

Levels of patient satisfaction and empowerment also increased and yet the PRISMA model did not appear to reduce costs or significantly effect hospital admissions. In Quebec, the PRISMA approach did not demonstrate a positive impact until the third year of the evaluation. It should be remembered that new approaches need time as well as support to demonstrate real improvements in care for patients.

 

Ref: HSJ 24 January 2014