Abstract
Introduction: The growing number of people with chronic conditions is a major challenge for health and social care system in almost all countries around the world. In order to improve the efficiency of care, separate national policies have been developed in France over the past decades targeting different populations such as frail elderly people, disabled adults, persons with stroke, persons with cancer, persons with rare disease, and persons with mental health disorders.
Aims: In the study we realized about these different policies, a particular emphasis has been placed on the issue of coordination and integration between health and social care systems. Our intent was to assess the need for specific policies targeting different populations. An additional aim was to identify the major issues that most of these policies have been facing overtime, to provide some clues about repeated failures, and to set the basis for recommendations to health and social authorities.
Results: Through an extensive analysis of the scientific and grey literature, we first found that each integrated-care policy has a specific pattern: the cancer policy has been centered on clinical research, the policy for disabled people received a strong input of end-users and family associations, the policy for stroke has been very much focused on the acute care, and the policy for rare diseases particularly aimed at improving the network of resource centers. Second, we identified some common features. Since the 2004 Public Health Act, most policies are conducted through large 3 to 5 years national plans with some similar purposes such as the increased involvement of general practitioners, the creation of case managers’ positions, and the scheduling of a mid-term assessment process. Finally, we identified recurrent difficulties:
• Reports are too superficial and the lack of learning process over time tends to result in repeatedly providing similar proposals, like the creation of new coordination schemes.
• The assessment procedures that are included in national plans are not taking into consideration the conditions which would facilitate the accomplishment of the objectives. We observed also that assessment teams do not include enough people with management science background and very little end-users.
• Finally, there is a lack of coordination between the different policies which could generate competition between them. For example, every policy intends to set up new training programs for GPs – for Alzheimer disease, rare diseases, cancer, stroke prevention, but also team work, evidence-based medicine and so on – which is likely to fail because it is too demanding.
Conclusion and recommendations: We propose that a generic plan should be designed, capitalizing on all policies experiences and including a “conditions for success” section that would be the basis for new plans whatever the target population. We suggest also that assessment teams should include more end-users and persons competent in change management.