Esperienze di integrazione nell’assistenza primaria basate sulla co-location dei servizi: quali prospettive per il modello della Casa della Salute?

Journal title MECOSAN
Author/s Manila Bonciani, Sara Barsanti, Daniela Matarrese
Publishing Year 2016 Issue 2015/96
Language Italian Pages 41 P. 81-121 File size 471 KB
DOI 10.3280/MESA2015-096005
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

Integration in primary care is a key challenge to deal with the more complex healthcare needs of people. At European and Italian level, different organisational models based on co-location have been implemented in primary care to face these emerging needs. The authors analyse these primary care experiences by using a conceptual framework of integrated care and co-location. A particular focus is on the model of Case della Salute (Primary Care Centres) promoted in Italy and the case study of Tuscany Region allows to identify, through a cluster analysis, three different organisational shapes of this model. The comparison between European, regional and local primary care experiences highlights strengths, weaknesses and potentialities of the integrated care model of Case della Salute.

Keywords: Primary care, integrated care, co-location, Primary Care Centres, Community Health Centres, organisational models

  1. Afrite A., Bourgueil Y., Daniel F., Mousquèsa F., Couralet P.E., Chevillard G. (2013). The impact of multi-professional group practices on healthcare supply. Evaluation aims and methods for “maisons”, “pôles de santé” and “centres de santé” within the framework of experiments with new mechanisms of remuneration. Questions d’économie de la santé, 189: 1-6. Disponibile al sito: http://www.irdes.fr/english/issues-in-health-economics/189-theimpact-of-multi-professional-group-practices-onhealthcare-supply.pdf
  2. Appleby N.J., Dunt D., Southern D.M., Young D. (1999). General Practice Integration in Australia. Primary Health Services Provider and Consumer Perceptions of Barriers and Solutions. Australian Family Physician, 28: 858-63. PubMed: 10495544.
  3. Aress (2013). La programmazione dei Centri di Assistenza Primaria in Piemonte. Regione Piemonte.
  4. Armitage G., Suter E., Oelke N., Adair C. (2009). Health systems integration: State of the evidence. International Journal of Integrated Care, 9: e82. Disponibile al sito: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2707589/
  5. Arosio L. (2013). L’analisi documentaria nella ricerca sociale. Metodologia e metodo dai classici a Internet. Milano: FrancoAngeli.
  6. Axelsson R., Bihari Axelsson S. (2006). Integration and collaboration in public health-a conceptual framework. The International Journal of Health Planning and Management, 21 (1): 75-88. DOI: 10.1002/hpm.826
  7. Barsanti B., Bonciani M., Vola F., Pirisi L. (2015). Trade union or trait d’union? Setting targets for general practitioners: a regional case study. Paper presented at IRSPM conference 2015, University of Birmingham 30 March – 1 April 2015.
  8. Batenburg R., Eyck A. (2011). The growth and decline of health community centres in the Netherlands:
  9. a macro historical analysis. Journal of Management and Marketing in Healthcare, 4 (4): 242-246. DOI: 10.1179/1753304X11Y.0000000013
  10. Blount A. (2003). Integrated Primary Care: Organizing the Evidence. Families, Systems & Health, 21 (2): 121-123. DOI: 10.1037/1091-7527.21.2.121
  11. Boerma W.G.W. (2006). Coordination and Integration in European Primary Care. In: Saltman R.B., Rico A., Boerma W.G.W. (a cura di). Primary Care in the driver’s seat? New York: Open University Press.
  12. Boon H., Verhoef M., O’Hara D., Findlay B. (2004). From parallel practice to integrative health care: a conceptual framework. BMC Health Services Research, 1 (4): 15.
  13. Calinski T., Harabasz J. (1974). A dendrite method for cluster analysis. Communications in Statistics, 3 (1): 1-27. DOI: 10.1080/03610927408827101
  14. Calnan M., Hutten J., Tiljak H. (2006). The challenge of coordination: the role of primary care professionals in promoting integration across the interface. In: Saltman R.B., Rico A., Boerma W.G.W. (a cura di). Primary Care in the driver’s seat?. New York: Open University Press.
  15. Cameron A., Lart R., Bostock L., Coomber C. (2014). Factors that promote and hinder joint and integrated working between health and social care services: a review of research literature. Health and Social Care in the Community, 22 (3): 225-233. DOI: 10.1111/hsc.12057
  16. Campbell H., Hotchkiss R., Bradshaw N., Porteous M. (1998). Integrated care pathways. British Medical Journal, 316 (7125): 133-137. DOI: 10.1136/bmj.316.7125.133
  17. Carbone C., Corsalini E., Longo F., Ricci A. (2012). Scenari per lo sviluppo dei servizi territoriali: confronto tra modelli regionali di presa in carico della cronicità. In: Cantù E. (a cura di). L’aziendalizzazione della Sanità in Italia. Rapporto OASI 2012. Milano: Egea.
  18. Chevillard G., Mousquès J., Lucas-Gabrielli V., Bourgueil Y., Rican S., Salem G. (2013). Maisons et pôles de santé: places et impacts dans les dynamiques territoriales d’offre de soins en France. Document de travail-Working paper. DT n° 57 Novembre.
  19. Coburn A.F. (2001). Models for Integrating and Managing Acute and Long-Term Care Services in Rural Areas. Journal of Applied Gerontology, 20 (4): 386-408. DOI: 10.1177/073346480102000402
  20. Collins C., Hewson D.L., Munger R., Wade T. (2010). Evolving Models of Behavioral Health Integration in Primary Care. New York: Milbank Memorial Fund.
  21. Corsalini E. (2010). Trend internazionali. Breve sintesi delle tematiche rilevanti per l’assistenza territoriale in Europa. In: Corsalini E., Vendramini E.
  22. (a cura di). Integrare la rete dei servizi territoriali: contenuti, forme e risultati delle best practices in Italia. Milano: Egea.
  23. Corsalini E., Fattore G. (2012). L’assistenza sanitaria primaria in Europa: modelli, tendenze scenario per l’Italia. Mecosan, 82: 61-75.
  24. Corsalini E., Vendramini E. (a cura di) (2010). Integrare la rete dei servizi territoriali: contenuti, forme e risultati delle best practices in Italia. Milano: Egea.
  25. Curcetti C., Parisini L., Tassinari M.C. (2013). Le “Case della Salute” in Emilia-Romagna. Report conclusivo 2013. Regione Emilia-Romagna, Assessorato Politiche per la Salute, Direzione Generale Sanità e Politiche Sociali.
  26. Damiani G., Colosimo S.C., Cosentino M., Anselmi A., Farelli V., Errico A., Ricciardi W. (2011). Lo sviluppo dell’assistenza primaria e il valore dell’integrazione per il distretto. Monitor, 27: 141-151.
  27. De Bakker D.H., Groenewegen P.P. (2009). Primary care in the Netherlands: current situation and trends. Italian Journal of Public Health, 6 (2): 128-135.
  28. Fabbris L. (1997). Statistica multivariata. Analisi esplorativa dei dati. Milano: McGraw-Hill.
  29. Farné M., Polimeni J., Chierici F., Macchia A., D’urso A. (2014). La creazione delle Aggregazioni Funzionali Territoriali (AFT) nella ASL 2 di Lucca: il risultato di una lunga esperienza di innovazione per il governo della Medicina Generale. Mecosan, 92: 77-99. DOI: 10.3280/mesa2014-092005
  30. Freeman T., Peck E. (2006). Evaluating partnerships: a case study of integrated specialist mental health services. Health & Social Care in the Community, 14 (5): 408-417. DOI: 10.1111/j.1365-2524.2006.00658.x
  31. Frost N. (2005). Professionalism, partnership and joined-up thinking: a research review of front-line working with children and families. Research in practice. Disponibile al sito: http://lx.iriss.org.uk/sites/default/files/resources/Professionalism_partnership%20and%20joined%20up%20thinking.pdf.
  32. Gibb C., Morrow M., Clarke C., Cook G., Gertig P., Ramprogus V. (2002). Transdisciplinary working: evaluating the development of health and social care provision in mental health. Journal of Mental Health, 11(3): 339-350. DOI: 10.1080/09638230020023714
  33. Ginsburg S. (2008). Colocating Health Services: a way to improve coordination of children’s health care? Commonwealth Fund pub, 1153 (41): 1-12. Disponibile al sito: http://www.commonwealthfund.org/usr_doc/Ginsburg_Colocation_Issue_Brief.pdf?section=4039.
  34. Goodwin N., Perry C., Dixon A., Ham C., Smith J., Davies A., Rosen R., Dixon J. (2012). Integrated Care for Patients and Populations: Improving Outcomes by Working Together. London: The King’s Fund.
  35. Gregory S. (2009). General practice in England: An overview. London: The King’s Fund.
  36. Grone O., Garcia-Barbero M. (2001), Integrated care: a position paper of the WHO European Office for Integrated Health Care Services. International Journal of Integrated Care, 1: e21. Disponibile al sito: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525335/.
  37. Guzzanti E. et al. (2009). L’assistenza primaria in Italia: dalle condotte mediche al lavoro di squadra. La proposta del Gruppo Indipendente per lo Studio dell’Assistenza Primaria. Roma: Edizioni Iniziative Sanitarie.
  38. Hill T., Westbrook R. (1997). SWOT Analysis: It’s Time for a Product Recall. Long Range Planning, 30 (1). DOI: 10.1016/s0024-6301(96)00095-7
  39. Horvitz-Lennon M., Kilbourne A.M., Pincus H.A. (2006). From silos to bridges: meeting the general health care needs of adults with severe mental illnesses. Health Affairs, 25 (3): 659-69. DOI: 10.1377/hlthaff.25.3.659
  40. Hultberg E.L., Lonnroth K., Allebeck P. (2003). Co-financing as a means to improve collaboration between primary health care, social insurance and social service in Sweden: a qualitative study of collaboration experiences among rehabilitation partners. Health Policy, 64: 143-152. DOI: 10.1016/S0168-8510(02)00145-8
  41. Imison C., Naylor C., Maybin J. (2008). Under One Roof: Will polyclinics deliver integrated care? London: The King’s Fund.
  42. Jakobsson B., Schuldt Haard U., Bergroth A., Selander J., Ekholm J. (2002). Improved cooperation in vocational rehabilitation with systematic rehabilitation group meetings. Disability and Rehabilitation, 24 (14): 734-740. DOI: 10.1080/09638280210124329
  43. Kisely S., Duerden D., Shaddick S. et al. (2006). Co-location of Health Care for Adults with Serious Mental Illness and HIV Infection. Community Mental Health Journal, 42 (4): 345-61.
  44. Kodner D.L., Spreeuwenberg C. (2002). Integrated care: meaning, logic, applications, and implication – a discussion paper. International Journal of Integrated Care, 14 (2): e12. Disponibile al sito: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1480401/.
  45. Kringos D.S., Boerma W.G.W., Hutchinson A., Saltman R.B. (2015). Building primary care in a changing Europe. Observatory Studies Series 38, Copenhagen: WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies.
  46. Lawn S., Lloyd A., King A., Sweet L., Gum L. (2014). Integration of primary health services: being put together does not mean they will work together. BMC Research Notes, 7 (1): 66. DOI: 10.1186/1756-0500-7-66
  47. Lemieux-Charles L., McGuire W.L. (2006).
  48. What do we know about health care team effectiveness? A review of the literature. Medical Care Research and Review, 63 (3): 263-300. DOI: 10.1177/1077558706287003
  49. Lenihan P., Iliffe S. (2001). Community-oriented primary care: a multidisciplinary community-oriented approach to primary care? Journal of Community & Applied Social Psychology, 11 (1): 11-18. DOI: 10.1002/casp.605
  50. Leutz W. (2005). Reflections on integrating medical and social care: five laws revisited. Journal of Integrated Care, 13 (5): 3-12. DOI: 10.1108/14769018200500034
  51. Longlett S.K., Kruse J.E., Wesley R.M. (2001). Community-Oriented Primary Care: Historical Perspective. Family Practice and the Health Care System, 14 (1): 54-63.
  52. Lloyd J., Wait S. (2005). Integrated Care: A guide for policymakers. London: Alliance for Health and the Future.
  53. Miller B.F., Petterson S., Burke B.T., Phillips R.L. Jr, Green L.A. (2014). Proximity of providers: Colocating behavioral health and primary care and the prospects for an integrated workforce. American Psychologist, 69 (4): 443-51. DOI: 10.1037/a0036093
  54. Nolte E., Knai C., Mckee M. (2008). Managing chronic conditions: experience in eight countries. Observatory Studies Series 15, Copenhagen: WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies.
  55. Oandasan I.F., Gotlib Conn L., Lingard L., Karim A., Jakubovicz D., Whitehead C., Miller K.L., Kennie N., Reeves S. (2009). The Impact of Space and Time on Interprofessional Teamwork in Canadian Primary Health Care Settings: Implications for Health Care Reform. Primary Health Care Research and Development, 10 (2): 151-162. DOI: 10.1017/s1463423609001091
  56. OECD (2011). Doing Better for Families, OECD Publishing. Pirraglia P.A., Rowland E., Wu W.C., Friedmann P.D., O’Toole T.P., Cohen L.B., Taveira T.H. (2012). Benefits of a Primary Care Clinic Co-Located and Integrated in a Mental Health Setting for Veterans With Serious Mental Illness. Preventing Chronic Diseases, 9: e51. DOI: 10.5888/pcd9.110113
  57. Rumball-Smith J., Wodchis W.P., Koné A., Kenealy T., Barnsley J., Ashton T. (2014). Under the same roof: co-location of practitioners within primary care is associated with specialized chronic care management. BMC Family Practice, 15 (1): 149. DOI: 10.1186/1471-2296-15-149
  58. Rutter D., Tyrer P., Emmanuel J., Weaver T., Byford S., Hallam A., Simmonds S., Ferguson B. (2004). Internal vs. external care management in severe mental illness: randomized controlled trial and qualitative study. Journal of Mental Health, 13 (5): 453-466. DOI: 10.1080/09638230400006759
  59. Saltman R.B., Rico A., Boerma W.G.W. (eds.) (2006). Primary care in the driver’s seat? Organizational reform in the European primary care. Maidenhead: Open University Press.
  60. Shackelford J.R., Sirna M., Mangurian C., Dilley J.W., Shumway M. (2013). Descriptive analysis of a novel health care approach: reverse colocationprimary care in a community mental health “home”. The Primary Care Companion for CNS Disorders, 15 (5): PCC.13m01530. DOI: 10.4088/PCC.13m01530
  61. Shaw S., Rosen R., Rumbold B. (2011). What is integrated care? London: The Nuffield Trust. Smith P.G., Reinertsen D.G. (1998). Developing products in half the time: new rules, new tools. John Wiley & Sons.
  62. Starfield B. (1991). Primary care and health. A cross-national comparison. Journal of the American Medical Association, 266 (16): 2268-2271. DOI: 10.1001/jama.266.16.2268
  63. Starfield B. (1992). Primary care: concept, evaluation, and policy. New York Oxford: University Press.
  64. Starfield B., Shi L. (2002). Policy relevant determinants of health: an international perspective. Health Policy, 60 (3): 201-18. DOI: 10.1016/s0168-8510(01)00208-1
  65. Starfield B., Shi L., Macinko J. (2005). Contribution of primary care to health systems and health. Milbank Quarterly, 83 (3): 457-502. DOI: 10.1111/j.1468-0009.2005.00409.x
  66. Sullivan G., Kanouse D., Young A.S., Han X., Perlman J,, Koegel P. (2006). Co-location of Health Care for Adults with Serious Mental Illness and HIV Infection. Community Mental Health Journal, 42 (4): 345-61. DOI: 10.1007/s10597-006-9053-8
  67. Suter E., Oelke N.D., Adair C.E., Armitage G.D. (2009). Ten Key Principles for Successful Health Systems Integration. Healthcare quarterly (Toronto, Ont.), 13: 16-23. DOI: 10.12927/hcq.2009.21092.SysonG.,BondJ.(2010).IntegratinghealthandsocialcareteamsinSalford.JournalofIntegratedCare,18(2):17-24.DOI:10.5042/jic.2010.0132
  68. Tozzi V.D. (2011). Dinamiche di cambiamento per la rete dei servizi territoriali. Monitor, 27: 128-141. Turco L. (2007). La Casa della Salute, luogo di ricomposizione delle cure primarie e della continuità assistenziale. Roma: Ministero della Salute. Valentijn P., Schepman S., Opheij W., Bruijnzeels M. (2013). Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. International Journal of Integrated Care, 13: e010. Disponibile al sito http://www.ijic.org/index.php/ijic/article/view/886/1978.
  69. van Raak A., Mur-Veeman I., Hardy B., Steenbergen M., Paulus A. (eds) (2003). Integrated Care in Europe: Description and Comparison of Integrated Care in Six EU Countries. Maarssen: Elsevier. Veneziano M.A., Specchia M.L. (2010). Il sistema sanitario spagnolo. Salute internazionale, disponibile al sito: http://www.saluteinternazionale. info/2010/12/il-sistema-sanitario-spagnolo/#biblio.
  70. Ward J.H. (1963). Hierachical grouping to optimize an objective function. Journal of the American Statistical Association, 58: 236-244. DOI: 10.2307/2282967
  71. Weiss M., Schwartz B.J. (2013). Lessons learned from a colocation model using psychiatrists in urban primary care settings. Journal of Primay Care and Community Health, 4 (3): 228-34. DOI: 10.1177/2150131912468449
  72. Wistow G., Dickinson H. (2012). Integration: work still in progress. Journal of Health Organization and Management, 26 (6): 676-684. DOI: 10.1108/14777261211275881
  73. WHO (1978). Declaration of Alma-Ata. Geneva: World Health Organization.
  74. WHO (2000). The world health report 2000. Health systems: improving performance. Geneva: World Health Organization.
  75. WHO (2008). The World Health report 2008: primary health care now more than ever. Geneva: World Health Organization.

  • Innovatori, indecisi, bisognosi o autonomi. I medici di medicina generale tra integrazione e accountability Sara Barsanti, Manila Bonciani, Federico Vola, Luca Pirisi, in MECOSAN 98/2016 pp.9
    DOI: 10.3280/MESA2016-098002

Manila Bonciani, Sara Barsanti, Daniela Matarrese, Esperienze di integrazione nell’assistenza primaria basate sulla co-location dei servizi: quali prospettive per il modello della Casa della Salute? in "MECOSAN" 96/2015, pp 81-121, DOI: 10.3280/MESA2015-096005