Care integration – coordination barriers – aspects of integrated care – patients with complex needs – Czech Republic

Summary

Background: Fragmentation of health and social care systems requires intense coordination among various stakeholders in order to provide continuity of care that reflects the needs of patients, especially those with complex needs. Almost two decades of trials to address problems of care fragmentation and poor outcomes for patients by policy makers and professionals in the Czech Republic have not lead to any substantial change in the way how care is provided. The objective of this study was to identify the barriers and opportunities to effective integration of health and social care for patients with complex needs in the Czech Republic as perceived by key stakeholders.

Methods: Mixed method research design was used. Literature review relating to topics of care integration/coordination from 2000 to 2016 was performed followed by 16 semi-structured interviews of key health and social care stakeholders that have been involved in the policymaking processes or have executive functions within the healthcare sector and 2 interviews with care recipients. The typology of P. Valentijn at al. was used to assess attitudes about 37 components of integrated care (IC) and their development in the Czech Republic.

Results: Mind map shows the major topics dealt by stakeholders as financing (130), change (96), (in)ability to cooperate (94), communication (86), participation (85), willingness to solve the problem (64), „silo-mindsets“ (47), healthcare insurance (45). The attributes of IC considered most important and the most developed in CZ are: trust (9,2/4,9), assessment of complex needs (9,1/4,1), team cooperation within one provider (8,6/4,7). The least developed aspects of IC in CZ are considered: joint health and social care strategy and financing (1,8;1,6), financing for care coordination (2,0), support for new models of care, change management, visionary leadership, sharing of information and use of communication technologies (2,5–2,9).

Conclusion: Separate systems of financing and legislation of healthcare and social care were considered to be the chief obstacle to effective health and social care integration. However, the main weakness of existing systems was poor communication, cooperation and fear of change among healthcare and social care stakeholders, silo-mindsets and particular interests that feed inability to reach a consensus on the macro level. However, positive experience (although limited) with care integration exists at the micro-meso level based on the proactive approach of local stakeholders.

Keywords:

Czech Republic – care integration – coordination barriers – aspects of integrated care – patients with complex needs