Reilly Siobhan, Challis David, Donnelly Michael, Hughes Jane, Stewart Karen
Personal Social Services Research Unit, School of Medicine, University of Manchester, Manchester, UK.
J Health Serv Res Policy. 2007 Oct;12(4):236-41. doi: 10.1258/135581907782101633.
To explore whether integrated structures are associated with more integrated and differentiated forms of care management in mental health services.
Cross-sectional postal survey of care management arrangements in local authority social services departments in England (n=101) and health and social services Trusts in Northern Ireland (NI) (n=11).
Some, but not all, indicators showed more evidence of integrated practice in NI mental health and social services. This included: greater involvement of health care staff in care management; greater multidisciplinary working and a more integrated approach to assessment and care planning processes; a more differentiated approach to care management, including greater targeting of care management resources; a closer link between care management and specialist provision; and overall more integrated practice.
This study concurs with previous research showing that structurally integrated health and social services in NI are more conducive towards, although insufficient to secure, integrated working. As the nature, type of services and ways of working appear to be broadly similar in England and NI, this may imply that greater structural integration per se may not lead to better service outcomes.
探讨综合结构是否与精神卫生服务中更综合、更具差异化的护理管理形式相关。
对英格兰地方政府社会服务部门（n = 101）和北爱尔兰（NI）卫生与社会服务信托机构（n = 11）的护理管理安排进行横断面邮政调查。
部分而非全部指标显示，NI精神卫生和社会服务中的综合实践有更多证据。这包括：医护人员更多地参与护理管理；更多的多学科协作以及评估和护理计划流程采用更综合的方法；护理管理采用更具差异化的方法，包括更有针对性地分配护理管理资源；护理管理与专科服务之间联系更紧密；以及总体上更多的综合实践。
本研究与先前的研究一致，表明NI中结构上整合的卫生和社会服务更有利于（尽管不足以确保）整合工作。由于英格兰和NI的服务性质、类型和工作方式似乎大致相似，这可能意味着更大程度的结构整合本身可能不会带来更好的服务结果。
