Population Based Approaches to the Integration of Primary and Secondary Care

Abstract

Health systems have become increasingly fragmented. Conditions such as diabetes, which require a multidisciplinary approach to care involving both the primary and secondary care sectors, have been particularly affected by the lack of coordination. In order to integrate care around the needs of the patient, a complex process is required to gain agreement on how care should be delivered. Using diabetes as a case study, and by applying the Delphi technique and access to the available evidence, we have shown that patients, doctors, nurses and allied health workers can agree upon the scope of care required for a given clinical scenario and with the criteria for referral between those with different skills. These agreements can form the basis of Care-maps, which in turn allow the definition of gaps in care, required educational materials, needed assessment pro forma, tools for enhancing communication between health workers, and training activities. Existing integrated care approaches in the United Kingdom and the United States, focusing on quality of care rather than resource, have been associated with improvements in health care delivery. Those working in primary care should consider this approach for stimulating enhancements in both clinical quality and efficiency.