Formative Evaluation of the Central Coast Integrated Care Program (CCICP), NSW Australia.

INTRODUCTION: Integrated care has been posited as an important strategy for overcoming service fragmentation problems and achieving the Quadruple Aim of health care. This paper describes the Central Coast Integrative Care Program (CCICP) a complex, multi-component intervention addressing 3 target populations and more than 40 sub-projects of different scale, priority and maturity. Details are provided of the implementation including activities undertaken for each target population, in the context of the Central Coast Local Health District (CCLHD) strategies and priorities. Key lessons are drawn from the formative evaluation. METHODS: A mixed methods approach to the formative evaluation was taken. Key stakeholders, professional staff with an in-depth knowledge of the program, were invited to complete surveys (n = 27) and semi-structured interviews (n = 23). The evaluation employed co-design principles with dialogue between CCICP partners and researchers throughout the process and sought to achieve a shared understanding of the dynamic context of the program, and the barriers and enablers for the various interventions. KEY LESSONS AND CONCLUSION: Seven interdependent key lessons have been identified. These distil down to the setting of clear objectives aligning with all the goals of partners, developing strong relationships, leadership at multiple levels and communication and the building of a common language.

Integrated models or mayhem? Lessons learnt from three integrated primary health care entities in regional New South Wales.

While "integration" may be a policy imperative at present, the reality of integrating services whilst managing the business of service delivery and best patient outcomes is both challenging and unfamiliar territory for most general practitioners. Recent policy changes in general practice have challenged traditional financial and governance models. This paper reviews three integrated general practice entities, all under the auspice of the University of Newcastle, for commonalities and concerns. A model was conceptualised and key factors identified and discussed. These factors included careful selection of partners, elucidation of the level of integration and the need for a lead champion to promote the changed environment. The financial and clinical governance systems needed to be clearly delineated, including the type and priority of service delivery intended. Integration is not a blanket solution but may be useful for patients with chronic and complex health problems. Being resource-intense, it may not be available or appropriate for all. The practical realities of workforce however, and the political and funding environment are likely to dictate how GP practices in the future embrace integration.