How to Improve Integrated Care for People with Chronic Conditions: Key Findings from EU FP-7 Project INTEGRATE and Beyond.

BACKGROUND: Political and public health leaders increasingly recognize the need to take urgent action to address the problem of chronic diseases and multi-morbidity. European countries are facing unprecedented demand to find new ways to deliver care to improve patient-centredness and personalization, and to avoid unnecessary time in hospitals. People-centred and integrated care has become a central part of policy initiatives to improve the access, quality, continuity, effectiveness and sustainability of healthcare systems and are thus preconditions for the economic sustainability of the EU health and social care systems. PURPOSE: This study presents an overview of lessons learned and critical success factors to policy making on integrated care based on findings from the EU FP-7 Project Integrate, a literature review, other EU projects with relevance to this study, a number of best practices on integrated care and our own experiences with research and policy making in integrated care at the national and international level. RESULTS: Seven lessons learned and critical success factors to policy making on integrated care were identified. CONCLUSION: The lessons learned and critical success factors to policy making on integrated care show that a comprehensive systems perspective should guide the development of integrated care towards better health practices, education, research and policy.

Exercise therapy improves both mental and physical health in patients with major depression.

PURPOSE: to present clinical guidelines for exercise therapy in depressed patients derived from recent meta-analyses. METHOD: four meta-analyses on effects of physical exercise on mental and physical in depression were analysed. RESULTS: For mild to moderate depression the effect of exercise may be comparable to antidepressant medication and psychotherapy; for severe depression exercise seems to be a valuable complementary therapy to the traditional treatments. Depression is associated with a high incidence of co-morbid somatic illnesses, especially cardiovascular diseases, type 2 diabetes and metabolic syndrome. Exercise is extremely powerful in preventing and treating these diseases. Physical exercise is an outstanding opportunity for the treatment of patients who have a mix of mental and physical health problems. Exercise therapy also improves body image, patient s coping strategies with stress, quality of life and independence in activities of daily living in older adults. CONCLUSIONS: Physical therapists should be aware, that several characteristics of major depression (e.g. loss of interest, motivation and energy, generalised fatigue, a low self-worth and self-confidence, fear to move, and psychosomatic complaints) and physical health problems interfere with participation in exercise. Therefore, motivational strategies should be incorporated in exercise interventions to enhance the patients' motivation and adherence in exercise programs. Implications for Rehabilitation For mild to moderate depression, the effect of exercise may be comparable with antidepressant medication and psychotherapy; for severe depression, exercise seems to be a valuable complementary therapy to the traditional treatments. Exercise therapy also improves physical health, body image, patient's coping strategies with stress, quality of life, and independence in activities of daily living in older adults. Motivational strategies should be incorporated in exercise interventions to enhance the patients' motivation.