Background: The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch ‘Blue Care’ pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision. Methods: This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors. Results: A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient’s diagnosis independently influenced the referral decisions following PC+. Conclusion: The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.
INTRODUCTION: The conceptual ambiguity of the integrated care concept precludes a full understanding of what constitutes a well-integrated health system, posing a significant challenge in measuring the level of integrated care. Most available measures have been developed from a disease-specific perspective and only measure certain aspects of integrated care. Based on the Rainbow Model of Integrated Care, which provides a detailed description of the complex concept of integrated care, a measurement tool has been developed to assess integrated care within a care system as a whole gathered from healthcare providers' and managerial perspectives. This paper describes the methodology of a study seeking to validate the Rainbow Model of Integrated Care measurement tool within and across the Singapore Regional Health System. The Singapore Regional Health System is a recent national strategy developed to provide a better-integrated health system to deliver seamless and person-focused care to patients through a network of providers within a specified geographical region.METHODS: The validation process includes the assessment of the content of the measure and its psychometric properties.CONCLUSION: If the measure is deemed to be valid, the study will provide the first opportunity to measure integrated care within Singapore Regional Health System with the results allowing insights in making recommendations for improving the Regional Health System and supporting international comparison.
In most countries, the demand for integrated care for people with chronic diseases is increasing as the population ages. This demand requires a fundamental shift of health-care systems towards more integrated service delivery models. To achieve this shift in China, the World Health Organization, the World Bank and the Chinese government proposed a tiered health-care delivery system in accordance with a people-centred integrated care model. The approach was pioneered in Luohu district of Shenzhen city from 2015 to 2017 as a template for practice. In September 2017, China's health ministry introduced this approach to people-centred integrated care to the entire country. We describe the features of the Luohu model in relation to the core action areas and implementation strategies proposed and we summarize data from an evaluation of the first two years of the programme. We discuss the challenges faced during implementation and the lessons learnt from it for other health-care systems. We consider how to improve collaboration between institutions, how to change the population's behaviour about using community health services as the first point of contact and how to manage resources effectively to avoid budget deficits. Finally, we outline next steps of the Luohu model and its potential application to strengthen health care in other urban health-care systems.
Over a million people in the Netherlands have type 2 diabetes (T2D), which is strongly related to overweight, and many more people are at-risk. A carbohydrate-rich diet and insufficient physical activity play a crucial role in these developments. It is essential to prevent T2D, because this condition is associated with a reduced quality of life, high healthcare costs and premature death due to cardiovascular diseases. The hormone insulin plays a major role in this. This hormone lowers the blood glucose concentration through uptake in body cells. If an excess of glucose is constantly offered, initially the body maintains blood glucose concentration within normal range by releasing higher concentrations of insulin into the blood, a condition that is described as “prediabetes”. In a process of several years, this compensating mechanism will eventually fail: the blood glucose concentration increases resulting in T2D. In the current healthcare practice, T2D is actually diagnosed by recognizing only elevated blood glucose concentrations, being insufficient for identification of people who have prediabetes and are at-risk to develop T2D. Although the increased insulin concentrations at normal glucose concentrations offer an opportunity for early identification/screening of people with prediabetes, there is a lack of effective and reliable methods/devices to adequately measure insulin concentrations. An integrated approach has been chosen for identification of people at-risk by using a prediabetes screening method based on insulin detection. Users and other stakeholders will be involved in the development and implementation process from the start of the project. A portable and easy-to-use demonstrator will be realised, based on rapid lateral flow tests (LFTs), which is able to measure insulin in clinically relevant samples (serum/blood) quickly and reliably. Furthermore, in collaboration with healthcare professionals, we will investigate how this screening method can be implemented in practice to contribute to a healthier lifestyle and prevent T2D.
Promoting entrepreneurship is an enabler of smart, sustainable and inclusive growth and it is one objective EU regions have pursued since the EC included it into 2020 Strategy. Entrepreneurship development has economic and social benefits, since it is not only a driving force for job creation, competitiveness and growth; it also contributes to personal fulfillment and to achieve social objectives. That is why the EU encourages entrepreneurial initiatives and to unlock the growth potential of businesses and citizens. However, only a 37% of Europeans (Eurobarometer 2012) would like to be self-employed. The Entrepreneurship Action Plan adopted by the EC in 2013 to reignite Europe’s entrepreneurial spirit includes initiatives for educating young people on entrepreneurship. To ensure that EU economy remains globally competitive, young generations of Europeans need to be inspired to develop their entrepreneurial mindset. EU 2020 Action Plan argues that young people benefitting of a specialised entrepreneurial education are more likely to start-up a business and to better tackle challenges in their professional career and life in general. Hence, there is good reason to ensure better quality of entrepreneurial education. Most approaches in recent years have focused on improving the skills or competences youngsters should obtain only within the education system. However, an integrated approach is needed, where the school, their friends, family and the social environment, shall play each one a relevant role, contributing to generate a more adequate atmosphere to boost their entrepreneurial mindsets, intrapreneurial attitudes and innovation capacities. This project will identify and exchange – through a quadruple helix approach- good practices for creating friendlier entrepreneurial ecosystems and actions to boost entrepreneurship in young people mindsets. The good practices and lessons learnt will be transferred into Action Plans to be included in regional policies.
