Literature Collection

INTRODUCTION: Early Intervention in Psychosis (EIP) services in England offer up to 3 years' time-limited support to people experiencing early psychosis. Service users (SUs) are discharged to primary care, a community mental health team (CMHT), or other specialist mental health service. The aim of this study is to explore the SU and carer journey through discharge from EIP and into the early post-discharge period. METHODS: Qualitative longitudinal study comprising semi-structured interviews with SUs and carers at, or shortly after, discharge from EIP, and follow-up interviews with SUs 6-11 months later. Data collection conducted between January 2023-September 2024 and informed by information power. Data were thematically analysed by a multidisciplinary team. RESULTS: SUs and carers expressed their desire to be actively involved in EIP discharge planning and decision-making. They contrasted close relationships with EIP practitioners with inaccessibility of care and difficulties navigating healthcare systems after discharge. Some SUs described feelings of abandonment and expressed a wish for transitional support, and proactive, relationship-based care post-discharge. Carers played an important role as patient advocates but were rarely offered support themselves. CONCLUSION: Improved collaboration is needed between SUs, carers and primary care/CMHT practitioners in the build-up to EIP discharge. There should be proactive contact from primary care at the point of discharge and in the early post-discharge period. Carer needs are often overlooked; primary care could utilise the 'carers register' and proactively offer support. PATIENT OR PUBLIC CONTRIBUTION: Patient and carer involvement and engagement was key to all stages of this study. The research team met regularly with our two co-investigators with lived experience (as a service user and a carer), who contributed to data analysis and writing this paper. We worked closely with our patient and carer advisory group, EXTEND-ing, throughout the research process. They helped formulate research questions, co-designed topic guides and participant information sheets, and contributed to data analysis and interpretation.

OBJECTIVES: The global increase in the older population, which is expected to reach 1.5 billion by 2050, poses significant challenges for publicly funded health care systems. Life expectancy, although positive, is leading to an increase in chronic diseases requiring complex and costly health and social solutions. This study explores key strategies to address these challenges. DESIGN: Qualitative interviews followed by a survey. SETTING AND PARTICIPANTS: The study involved experts, students, artificial intelligence, and participants at a congress. METHODS: We first interviewed 5 experts from different countries representing health care management and psychology from Belgium, health economics from Canada, sociology from France, and geriatrics from Switzerland. In addition, a focus group session with medical students in physical therapy and queries to ChatGPT increased the range of perspectives. A synthesis of all opinions or insights was used to formulate concrete strategies. These strategies were incorporated into an online survey that was distributed to 215 participants of the Geriatric and Gerontologic Congress in Montreal, Canada, in September 2023. RESULTS: All 20 potential solutions were duly acknowledged, with particular attention paid to the following 5 priorities: the urgent need to integrate geriatric training into the education of future health professionals, the promotion of home-based care models, the establishment of comprehensive and integrated care systems, the strengthening of primary care services, and the emphasis on primary prevention strategies. CONCLUSION AND IMPLICATIONS: This study highlights key priorities for addressing the health needs of the older population. By emphasizing education, home-based care, and integrated services and strengthening primary care and prevention, health systems can respond effectively to the challenges of an ageing population. Although these needs may not be entirely unmet, they indicate areas where existing services are insufficient in providing adequate coverage and support to ensure tailored and sustainable health care solutions for older people.

BACKGROUND: Although coordination of care and integrated care models aim to enhance patient satisfaction and perceived care quality, evidence regarding their practical implementation remains scarce. Understanding the nuances of collaboration across care providers to achieve effective coordination of care is imperative for seamless care integration. The aim of this study was to construct a grounded theory of how inter-organizational collaboration is performed to support coordination of care for patients with complex care needs. METHODS: A qualitative design with a constructivist grounded theory approach was applied. In total, 86 participants with diverse backgrounds were recruited across multiple care settings, including hospitals, ambulance services, primary care centers, municipal home healthcare and home care services. The grounded theory was developed iteratively, based on a combination of observations and interviews, and using constant comparative analysis. RESULTS: Coordination of care, a complex process that occurs across interconnected healthcare organizations, is manifested as "Negotiating care in organizational borderlands." Care coordination evolves through a spectrum of inter-organizational collaboration, ranging from "Dividing care by disease-specific expertise" to "Establishing paths for collaboration" and ultimately "Co-constructing a comprehensive whole." These categories highlight the challenges of coordinating care across both professional and organizational boundaries. In the multifaceted healthcare landscape, effective care coordination occurs when healthcare professionals actively bridge the divides, leveraging their collective expertise. Importantly, organizational boundaries may serve a purpose and should not be dissolved to facilitate effective care coordination. CONCLUSIONS: The key to effective care coordination lies in robust inter-organizational collaboration. Even when patients receive integrated care, healthcare professionals may have fragmented roles. This research emphasizes the importance of clearly defined lines of accountability, reinforcing mutual responsibility and facilitating bridging of professional and organizational boundaries. Healthcare professionals and policymakers can use these insights to effectively utilize inter-organizational collaboration in supporting care coordination for patients with complex care needs.