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Integrating primary and secondary care for children and young people: sharing practice
Jenny Woodman1, Hannah Lewis1, Ronny Cheung2
1Children's Policy Research Unit, Population, Policy and Practice, UCL Institute of Child Health, London, UK.
Insights
Innovative pediatric service models integrating primary care are detailed. These initiatives aim to improve shared responsibility, upskill general practitioners (GPs), and enhance collaboration between specialists and primary care providers.
Area of Science:
- Pediatric healthcare delivery
- Integrated care models
- Primary care enhancement
Background:
- Paediatric services face challenges in seamless integration with primary care.
- Innovative models are emerging to bridge the gap between specialist paediatric care and primary care settings.
- There is a need to understand the practical implementation and mechanisms of these integrated services.
Purpose of the Study:
- To share detailed insights into innovative paediatric service delivery models.
- To provide practical information for paediatricians planning service improvements.
- To inform the prioritization of interventions for wider implementation.
Main Methods:
- A realist review approach was adopted to understand practice.
- Data were collected through case studies of five initiatives across three clinical commissioning groups (CCGs).
- Information was gathered via meetings and telephone interviews with key informants, with updates.
Main Results:
- Four types of integrated paediatric services were identified: telephone multidisciplinary teams, hospital at home, GP outreach clinics, and advice and guidance.
- Common mechanisms for success included promoting shared responsibility, upskilling general practitioners (GPs), building relationships between paediatricians and primary care professionals, and delivering specialist care within the patient's home.
- Programme theory was generated for each initiative, outlining aims and mechanisms.
Conclusions:
- The detailed descriptions of integrated care initiatives can guide discussions on prioritizing interventions.
- There is an urgent need for rigorous evaluation of these interventions.
- Further in-depth research is required to assess the mechanisms and effectiveness of integrated paediatric care models.
Objective:
To share innovative practice with enough detail to be useful for paediatricians involved in planning services.
Design:
A review of practice, adopting a realist approach.
Setting:
We collected detailed information about five initiatives which were presented at two meetings in July and October 2014 and telephone interviews between July and November 2014 with key informants, updating information again in February 2015.
Results:
The five case studies involved three clinical commissioning groups (CCGs): Islington CCG and Southwark and Lambeth CCG in London and Taunton CCG in the Southwest. All five initiatives involved acute paediatric units. We heard about four distinct types of services designed to bring paediatric expertise into primary care and/or improve joint working between paediatricians and primary care professionals: telephone multidisciplinary team, hospital at home, general practitioner (GP) outreach clinics, and advice and guidance. We defined four common ways that initiatives might work: promoting shared responsibility; upskilling GPs; establishing relationships between paediatricians and primary healthcare professionals; and by taking specialist care to the patient.
Conclusions:
We derived common aims and mechanisms and generated programme (mid-level) theory for each integrated care initiative about how they might work. These descriptions of what is being done can inform debate about which interventions should be prioritised for wider implementation. There is an urgent need for evaluation of these interventions and more indepth research into how mechanisms and their effectiveness could be assessed.
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