TY - JOUR
AU - S. Morris
AU - E. Massou
AU - J. Magnusson
AU - S. Gandhi
AU - P. L. Ng
AU - A. I. Ramsay
AU - N. J. Fulop
A1 - 
AB - BACKGROUND: Evidence suggests that centralising specialist healthcare services can improve outcomes for patients but increase travel distances and times. Traditionally, people requiring specialist health care were cared for by a single specialist, with mental and physical health care delivered by separate services. Recent trends involve greater collaboration between specialists. Integrated care is the highest level of collaboration, including shared access to medical records and multidisciplinary care. OBJECTIVES: To investigate how centralisation of specialised healthcare services can be characterised. To examine the proposed integration between physical and mental health services in the care of children and young people with eating disorders and functional symptom disorders in one region of England. DESIGN: Mixed-methods study comprising: a scoping review (conducted in November 2020) of four databases to characterise centralisation of specialised healthcare services; a systematic literature review (conducted in August 2022, updated in July 2024) of three databases to evaluate integration of physical and mental health services for children and young people with eating disorders and functional symptom disorders; an interview study of parents (n = 10 participants), healthcare professionals (n = 14 participants) and a project lead (n = 1 participants) to understand perspectives on integration, which analysed data in themes organised within the Consolidated Framework for Implementation Research; and two discrete choice experiments of preferences using online surveys (n = 400 participants). RESULTS: The scoping review (n = 93 studies) found that definitions of centralisation commonly lacked detail but, where available, covered centralisation's form, objectives, mechanisms and drivers. Limited evidence suggests centralisation could be linked to better outcomes, but many important outcomes were rarely examined. The systematic review of integration found one low-quality (uncontrolled) pre-post study of eating disorders in Australia. Findings from the interviews suggest that service redesign should ensure the concept of 'integration' has shared meaning among professionals, and that agreement is reached over roles and responsibilities. From the discrete choice experiments, the main things that mattered to parents when thinking about integration were days missed from school in the case of eating disorders and time to diagnosis for functional symptom disorders. LIMITATIONS: Limited, poor-quality literature in the reviews; small numbers of interview participants; difficulties engaging parents, carers and healthcare professionals for the discrete choice experiment. CONCLUSIONS: There is a lack of evidence around integrated care for children and young people affected by eating disorders and functional symptom disorders. Implementation of integrated services needs to address concerns regarding roles, responsibilities and leadership. Future evaluations should measure impact in terms of the factors found to matter most to participants in this study. FUTURE WORK: Mixed-methods studies to evaluate integrated pathways. FUNDING: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR133613.; ‘Specialised healthcare services’ are teams who are expert in treating people with certain kinds of health problem. Sometimes, they are joined up into a smaller number of larger services, so that they can treat more patients with the same condition: this is called ‘centralisation’. Previous evidence suggests that centralising specialist healthcare services can improve outcomes for patients, but it can also increase travel distances and times for patients and families. We reviewed the evidence on centralisation of specialised services. The evidence was limited, but said that centralisation was linked with better care or outcomes. We also did a more focused study looking at integration between physical and mental health services for children and young people, to inform the development of a new children’s hospital. Traditionally, people requiring specialised health care were cared for by a single specialist, with mental and physical health care delivered by separate services. More recent trends involve greater collaboration between specialists. Integrated care is the highest level of collaboration, involving shared access to medical records and multidisciplinary care. We focused on two health conditions, eating disorders and functional symptom disorders (experiencing physical symptoms, for which there is no clear explanation). We looked for research to find out what is known about integrating services for these conditions and found little evidence. We also conducted interviews with healthcare professionals, and interviews and a survey of parents to find out their views. These found broad support for integrating services for children and young people affected by these conditions. There were several concerns about integration, mostly around clearly defining roles and responsibilities of staff. The main things that mattered to parents when thinking about integration were days missed from school in the case of eating disorders, and time to diagnosis in the case of functional symptom disorders.; eng
AD - Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.; UCL Department of Behavioural Science and Health, University College London, London, UK.; Department of Women & Children's Health, King's College London, London, UK.
AN - 41427482
BT - Health Soc Care Deliv Res
C5 - Healthcare Disparities
CP - 43
DA - Dec
DO - 10.3310/clha1094
DP - NLM
IS - 43
JF - Health Soc Care Deliv Res
LA - eng
N2 - BACKGROUND: Evidence suggests that centralising specialist healthcare services can improve outcomes for patients but increase travel distances and times. Traditionally, people requiring specialist health care were cared for by a single specialist, with mental and physical health care delivered by separate services. Recent trends involve greater collaboration between specialists. Integrated care is the highest level of collaboration, including shared access to medical records and multidisciplinary care. OBJECTIVES: To investigate how centralisation of specialised healthcare services can be characterised. To examine the proposed integration between physical and mental health services in the care of children and young people with eating disorders and functional symptom disorders in one region of England. DESIGN: Mixed-methods study comprising: a scoping review (conducted in November 2020) of four databases to characterise centralisation of specialised healthcare services; a systematic literature review (conducted in August 2022, updated in July 2024) of three databases to evaluate integration of physical and mental health services for children and young people with eating disorders and functional symptom disorders; an interview study of parents (n = 10 participants), healthcare professionals (n = 14 participants) and a project lead (n = 1 participants) to understand perspectives on integration, which analysed data in themes organised within the Consolidated Framework for Implementation Research; and two discrete choice experiments of preferences using online surveys (n = 400 participants). RESULTS: The scoping review (n = 93 studies) found that definitions of centralisation commonly lacked detail but, where available, covered centralisation's form, objectives, mechanisms and drivers. Limited evidence suggests centralisation could be linked to better outcomes, but many important outcomes were rarely examined. The systematic review of integration found one low-quality (uncontrolled) pre-post study of eating disorders in Australia. Findings from the interviews suggest that service redesign should ensure the concept of 'integration' has shared meaning among professionals, and that agreement is reached over roles and responsibilities. From the discrete choice experiments, the main things that mattered to parents when thinking about integration were days missed from school in the case of eating disorders and time to diagnosis for functional symptom disorders. LIMITATIONS: Limited, poor-quality literature in the reviews; small numbers of interview participants; difficulties engaging parents, carers and healthcare professionals for the discrete choice experiment. CONCLUSIONS: There is a lack of evidence around integrated care for children and young people affected by eating disorders and functional symptom disorders. Implementation of integrated services needs to address concerns regarding roles, responsibilities and leadership. Future evaluations should measure impact in terms of the factors found to matter most to participants in this study. FUTURE WORK: Mixed-methods studies to evaluate integrated pathways. FUNDING: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR133613.; ‘Specialised healthcare services’ are teams who are expert in treating people with certain kinds of health problem. Sometimes, they are joined up into a smaller number of larger services, so that they can treat more patients with the same condition: this is called ‘centralisation’. Previous evidence suggests that centralising specialist healthcare services can improve outcomes for patients, but it can also increase travel distances and times for patients and families. We reviewed the evidence on centralisation of specialised services. The evidence was limited, but said that centralisation was linked with better care or outcomes. We also did a more focused study looking at integration between physical and mental health services for children and young people, to inform the development of a new children’s hospital. Traditionally, people requiring specialised health care were cared for by a single specialist, with mental and physical health care delivered by separate services. More recent trends involve greater collaboration between specialists. Integrated care is the highest level of collaboration, involving shared access to medical records and multidisciplinary care. We focused on two health conditions, eating disorders and functional symptom disorders (experiencing physical symptoms, for which there is no clear explanation). We looked for research to find out what is known about integrating services for these conditions and found little evidence. We also conducted interviews with healthcare professionals, and interviews and a survey of parents to find out their views. These found broad support for integrating services for children and young people affected by these conditions. There were several concerns about integration, mostly around clearly defining roles and responsibilities of staff. The main things that mattered to parents when thinking about integration were days missed from school in the case of eating disorders, and time to diagnosis in the case of functional symptom disorders.; eng
PY - 2025
SN - 2755-0060
SP - 1
EP - 19+
ST - Integration of specialised services for eating disorders and functional symptom disorders in children and young people: discrete choice experiments and qualitative study
T1 - Integration of specialised services for eating disorders and functional symptom disorders in children and young people: discrete choice experiments and qualitative study
T2 - Health Soc Care Deliv Res
TI - Integration of specialised services for eating disorders and functional symptom disorders in children and young people: discrete choice experiments and qualitative study
U1 - Healthcare Disparities
U3 - 10.3310/clha1094
VL - 13
VO - 2755-0060
Y1 - 2025
ER -