Reilly S, Challis D, Burns A, Hughes J
PSSRU, School of Psychiatry and Behavioural Sciences University of Manchester, Manchester, UK.
Int J Geriatr Psychiatry. 2003 Oct;18(10):887-93. doi: 10.1002/gps.942.
This paper seeks to address whether integrated structures are associated with more integrated forms of service. Northern Ireland has one of the most structurally integrated and comprehensive models of health and personal social services in Europe. Social and health services are jointly administered and this arrangement should, in theory, promote collaborative working and interdisciplinary arrangements.
The study employed a cross-sectional survey of consultants in old age psychiatry in England and Northern Ireland. Potential respondents were sourced from the UK Royal College of Psychiatrists membership list and locally collected information.
A self-administered postal questionnaire. Along with general service arrangements, the domains measured reflect core policy issues for older people's services. Under particular scrutiny in this study were the degree of integration of health and social service provision, as well as inter-professional team working.
The integrated health and social care services in Northern Ireland do appear to provide more integrated patterns of working, primarily in managerial arrangements and in the location of staff. There was no evidence of the impact of integration on practice in areas such as: assessment, referral and medical screening. The factors found to be associated with greater integration of health and social care in the prediction model fell into three categories: provision of specialist services; provision of outreach activities; and shared policies by which the whole team worked.
Health and personal social services in Northern Ireland have a distinct advantage over their counterparts in comparable areas of England. The results indicate that integrated structures in old age psychiatry services are associated more with integrated management systems and less with integrated practice-related activities. Further research is required on the effectiveness and cost effectiveness of integrating services in general. It is important that future intervention studies systematically measure the component parts, nature and extent of integration and their individual and joint contribution to the effectiveness and efficacy of services.
本文旨在探讨整合结构是否与更整合的服务形式相关联。北爱尔兰拥有欧洲结构最整合、最全面的健康与个人社会服务模式之一。社会和健康服务由联合管理，从理论上讲，这种安排应能促进协作工作和跨学科安排。
该研究对英格兰和北爱尔兰老年精神病学顾问进行了横断面调查。潜在受访者来自英国皇家精神病医师学院成员名单以及当地收集的信息。
一份自我填写的邮政问卷。除了一般服务安排外，所测量的领域反映了老年人服务的核心政策问题。本研究特别关注的是健康和社会服务提供的整合程度以及跨专业团队合作情况。
北爱尔兰整合的健康和社会护理服务似乎确实提供了更整合的工作模式，主要体现在管理安排和工作人员的配置方面。没有证据表明整合对评估、转诊和医学筛查等领域的实践有影响。在预测模型中发现与健康和社会护理更大程度整合相关的因素分为三类：提供专科服务；开展外展活动；以及整个团队遵循的共享政策。
北爱尔兰的健康与个人社会服务相对于英格兰类似地区具有明显优势。结果表明，老年精神病学服务中的整合结构更多地与整合管理系统相关，而与整合的实践相关活动关联较少。总体而言，需要进一步研究服务整合的有效性和成本效益。重要的是，未来的干预研究应系统地衡量整合的组成部分、性质和程度，以及它们对服务有效性和功效的个体和共同贡献。
