Interdisciplinary and intersectoral approach: a challenge for integrated care

Integrated care for health disorders, particularly chronic diseases, is a long-term and complex challenge, particularly because of the involvement of many individuals with different beliefs, attitudes, assumptions and reward structures. Two basic conceptual models of disease--the biomedical and psychosocial--underlie many of these differences. The biomedical model views humans as the sum of multiple individual 'subsystems,' and disease represents dysfunction of one or more of these subsystems. This model is 'reductionist' and 'individualistic' in nature in that if 'THE' defective subsystem can be identified, studied and improved, it is assumed that health would return. The biomedical model focuses primarily on the individual with ill-health and has added greatly to our basic understanding of disease processes. The psychosocial model is 'interactive' and dynamic, and sees the 'whole' as more than the sum of its parts. This model values elements outside of the individual, e.g. work and home environment, as important in maintaining or establishing health. Because of fundamental differences between these 2 models of health and disease, conflicts, e.g. efficacy vs. exposure; role of individual vs. environment; etc., may exist among varying professionals regarding the nature, purpose, targets, structure, and consequences of integrated care programs. These fundamental conflicts, if unrecognized and ignored, can significantly attenuate the benefits of well-intentioned prevention and treatment integrated care programs.