Background:
This abstract is based on the article by Pereira and Feuerwerker (2023)¹, which highlights the dynamics, strengths, and challenges of care management in small municipalities. It examines care management experiences that can inform practices within Brazil's National Health System (SUS).

Approach:
A cartographic method was employed, emphasising the co-production of knowledge through interactions among various actors in SUS². From 2018 to 2020, the research explored both formal and informal health and intersectoral settings identified by managers and workers, reflecting on the diverse care strategies and arrangements. Field experiences informed the analysis, contextualised in the light of the micropolitics of work and of health care, giving visibility to the fields of dispute, challenges, and powers of small municipalities. articulated with the problematization on the axis of integrated care.

Results:
The study mapped key care management devices driven by health needs, shaping the management team's agenda through their actions at municipal and regional levels. Various organisational arrangements were identified, including: Multi-professional health teams as lenses for needs and management; Multi-professional teams using mental health as a catalyst for network care; The public prosecutor's office as a facilitator in mental health and social care; Shared home care between the municipal emergency room and primary care networks.

Implications:
Effective management arrangements are vital for prioritising care. The work environment is dynamic, influenced by established norms and dominant medical practices. This research reveals vibrant interactions and disruptive forces, highlighting devices that enhance networked care. To improve care management, it's essential to create systems that extend beyond service delivery and institutional roles.

1.Pereira PBA, Feuerwerker LCM. The world of work is not automatic: what can operate as a device for managing care in small municipalities? . Saúde Soc. [Internet]. 2024 May 10 [cited 2024 Oct. 30];32(4):e220849pt. Available from: https://www.revistas.usp.br/sausoc/article/view/225044

2.Lima F, Merhy EE. Produção de conhecimento, ciência nômade e máquinas de guerra: devires ambulantes em uma investigação no campo da saúde coletiva. In: Merhy EE, et al., editors. Avaliação compartilhada do cuidado em saúde: surpreendendo o instituído nas redes. Rio de Janeiro: Hexis; 2016. p. 18-21.

Background:

In co-creation with patients and multidisciplinary care teams we developed an integrated care solution for heart failure patients on the Viduet platform that is implemented in three European regions for the TIQUE-PCP project.

Approach:

TIQUE-PCP, a project funded by the European Union, seeked a groundbreaking, tech-driven, integrated care solution for Advanced Heart Failure that enables predictive, preventive and participatory care - ensuring qualitative care at the optimal location. Based on the input of caregivers from multidisciplinary care teams and patients, we developed an integrated care solution that can be used to empower patients. Using the concept of Viduet action plans, patients are supported to use the outcomes of home measurements and symptom trackers to recognize decompensation and take appropriate action. Healthcare professionals are also informed when symptoms of decompensation are detected.

We started in The Netherlands, where the Viduet platform was initially piloted in order to help chronic heart failure patients and their caregivers by designing a specific integrated carepath. During the projects, Viduet listened to the needs of several cardiologists, nurses, general practitioners and heart failure patients. With that input, a heart failure solution was created on the Viduet platform in which caregivers from different care levels collaborate around the patient via the Viduet platform. Patients can be easily referred between primary and secondary care organizations, which encourages multidisciplinary collaboration. Viduet helps healthcare providers spend their time as efficiently as possible by aligning the work of multiple levels of caregivers.

For TIQUE, Viduet will pilot the Viduet platform for integrated heart failure care in, Barcelona (Spain), Avellino (Italy), and Västerbotten (Sweden). With these pilots we will co-create tailored care pathways in collaboration with different local healthcare providers like medical specialists, nurses, homecare organizations and patients, ensuring the solution is customized to meet each region's unique needs. The platform will encourage different levels of healthcare providers to join forces to ensure the patients wellbeing.

Results:

In the Dutch pilots, the Viduet platform has reduced the need for in-person consultations through effective remote monitoring, and saved time across care teams by optimizing data-sharing and patient management. This efficiency allows healthcare providers to focus more directly on patient needs, improving overall care delivery and patient satisfaction. Patients feel more in control of their health, which encourages them to raise concerns earlier and take action to prevent further health decline.

For the TIQUE pilots, the heart failure care paths with Viduet will be tailored uniquely for each region, with customizations that address specific local needs. By collaborating closely with local healthcare organizations and patients, Viduet will ensure that the platform integrates seamlessly with each region's own care pathways, facilitating optimal support for heart failure management across diverse healthcare settings.

Implications:

In May, we expect to have included the patients into Viduet in all three countries, have received feedback from both patients and their different levels of caregivers and adjusted the platform to their particular needs. This validation process will help ensure the integrated care pathway becomes even more effective in each region.

Background: The rising prevalence of overweight and obesity among children and adults is an urgent public health challenge. The multidisciplinary Dutch national healthcare guideline ‘Overweight and Obesity in Adults and Children’ advises an integrated network approach as the most optimal organisational structure for overweight and obesity support and care. In recent years, two healthcare standards, the National model for integrated care for childhood overweight and obesity and the Model for integrated care for adults with overweight and obesity, have been developed and are being implemented nationally. Current models do not optimally support families where both generations (adult and child) need support and care. As the prevalence of obesity among multiple family members is high, municipalities are increasingly demanding a combined network approach. However, clear guidance on effectively integrating child and adult models in practice is lacking. Therefore, this study iteratively explores the development and early implementation of a combined integrated care approach for overweight and obesity in both children and adults within the family context.

Approach: After the formation of a project group (Stage 1), establishment of a learning community (LC) took place (Stage 2). Five municipalities were selected to participate in the LC based on factors such as geographical spread, relationships with various national health insurers, their willingness and local support to adopt both integrated care models, and financial resources to participate in this project. Three municipalities were working with both models, one had been implementing the children’s model, and one was going to start with both models.

Results: By analysing existing integrated care models, we identified differences and similarities between the adult and children’s models (Stage 3), among others, this included theoretical and operational differences. The LC sessions subsequently helped identify implementation challenges (Stage 4), including challenges regarding financial resources, capacity, policy integration, procedures, and ICT compatibility. We then co-created an implementation plan with the municipalities (Stage 5) to execute a pilot (Stage 6). In this pilot, we will identify key implementation barriers and facilitators (Stage 7) and link the barriers to theory of the Consolidated Framework for Implementation Research (CFIR) (Stage 8) to identify tailored strategies for practice (Stage 9). We will differentiate between guideline content-specific barriers to focus on evidence-based guideline content-specific solutions, and implementation-specific barriers by selecting evidence-based strategies, with the help of the CFIR-ERIC matching tool and input from the municipalities. Finally, we will identify key principles and lessons learned for realising a combined integrated care approach within the family context (Stage 10).

Implications: This study underscores the need for a combined approach to effectively offer support and care for obesity in both children and adults within one family. The initial results show the potential of supporting entire families rather than individuals in isolation, using a combined approach. Achieving this requires cross-sector collaboration and local adjustments to existing policies and funding mechanisms to facilitate combined care. The next steps involve expanding this approach to a greater number of families within the current municipalities and other municipalities to refine the combined integrated care approach continuously.

Background: In Portuguese healthcare contexts, despite the benefits of cardiac rehabilitation programs for recovery after a myocardial infarction, these programs remain undeveloped, with low patient participation. One contributing factor is the limited focus on a person-centred care practices, which prioritize recovery through patients’ experiences of their condition and aim to enhance their self-efficacy.
Approach: A person-centred care (PCC) intervention originally implemented in Sweden to enhance patient’s self-efficacy was adapted to the Portuguese healthcare context through a co-creation process involving stakeholders (providers and users) from a cardiology department, alongside researchers. Implementation outcomes (i.e., acceptability, appropriateness, and feasibility) were assessed through stakeholders’ personal narratives about the PCC intervention, collected via semi-structured focus group discussions. Data analysis was conducted using deductive content analysis.
Results: Focus group discussions were conducted with registered nurses, physicians, and patients who had experienced a myocardial infarction. Preliminary results indicated that the PCC intervention was well-accepted and deemed appropriate and feasible by both patients and healthcare professionals. Patients with myocardial infarction perceived that the Person-centred care intervention to promote self-efficacy in patients following a myocardial infarction (P2MIR) could increase their engagement in recovery and decrease unplanned healthcare, while healthcare professionals agreed it would support their clinical practice. Both considered that it would improve healthcare integration. Adaptations identified by both groups informed the co-design of the final Portuguese version of the selected PCC intervention. Patients joined the project advising council, with the aim of acting as co-researchers during the subsequent implementation and disseminating phases.
Implications: The P2MIR was successfully developed, preserving the core components of the original intervention while tailoring to the specificities of the new context, thus increasing its potential success in real-world implementation. A pilot study involving the advising council will be co-produced at the hospital setting to evaluate P2MIR impact on PCC perspectives among both groups, as well as its effect on patient recovery following a myocardial infarction.

Background: The EU funded Project Laurel aims to understand regional differences in integrated long-term care (I-LTC) provisions in Europe, along with the associated support solutions. The Laurel project's primary objective is to develop actionable policies that can effectively respond to the challenges of growing demand, economic constraints, accessibility, affordability, workforce shortages, and the need for systemic reforms in LTC. By identifying innovative, person-centred solutions that emphasise home and community-based services, the project is seeking to enhance the quality of care while reducing territorial and gender disparities.

Approach: An overarching framework was developed based on a rapid review. The The European framework for long-term integrated care services (FLINT) was subsequently refined and validated through surveys and focus group interviews (FGIs) involving, among others, patient representatives, health and social care workers, researchers, and policy makers. Thereafter, a field study was conducted in which FLINT was applied to characterize various I-LTC practices across different regions in Europe.

Results: FLINT covers 34 items grouped into 6 interrelated domains (people, unpaid care workforce and communities; paid care workforce and service delivery; organisation of care; ICT and ICT systems; finance; governance) and classified according to micro-, meso- and/or macro-level. As a result of the field study, policy recommendations to enhance quality of LTC were formulated.

Implications: The presentation will start with a short explanation of Project Laurel including FLINT, followed by presenting the results of the field study and the resulting policy recommendations. The presentation is deemed relevant for both professionals and non-professionals in the field of I-LTC. Time will be reserved for discussion and questions.