Integrated services in rehabilitation medicine II. International experiences and lessons

International experiences and lessons

Abstract

Provision of hospital-based rehabilitation services are typical for Hungary. According to World Health Organization and key international professional organizations this is not inevitable. International literature provides rich sources of possibilities and collected experiences of community-based rehabilitation care. Developments had been continuously followed by authors. Additionally, review of contemporary publications for collecting information on the possibilities and conditions of establishing integrated rehabilitation care was performed: targeted search of literature in PubMed database and narrative reporting on findings of selected publications based on screening of titles and abstracts, finally full texts. Systematic data analysis has not been completed. Extensive publication activity on integrated rehabilitation care can be seen, yet no widely accepted definition of the concept could be detected. Definition of applicable components in the given environment get more attention. Integrated care model targets populations with more frequently occurring disabilities or disabilities likely to develop, most frequently at frail elderly persons. Well managed vertical coordination between care levels, and horizontal coordination between sites including local social care services is needed. Communication among members of multidisciplinary teams of providers, and between professionals and clients are equally important components. Inclusion of both providers and service users together with their informal care providers in service-planning is essential. At initiating new systems provision of adequate resources, most importantly the presence of the multidisciplinary team members is vital. Continuing education of available professionals may also be needed. Continuous monitoring of the care process is necessary, including the evaluation by users. Although some favourable cost/benefit data are known, only few clear outcomes on efficiency have been reported. Restriction of resources, increasing burden of the population, lock of once launched initiatives are characteristic unfavourable features at developing integrated care in countries of Central-Easter Europe including Hungary. Authors regard as limitation of their study that only narrative reporting of findings were performed, without systematic data analysis. Selected publications had heterogeneity in social political systems and in study methodology making evaluation of results difficult. Yet, well recognizable tendencies have been identified and are presented after critical evaluation. Joint strategic goals have been developed for surmounting the difficulties. Triple goal of development of integrated rehabilitation services are the improvement of health condition of the affected population, good acceptance of the programme by users as requirement of their active participation, and achievement of favourable cost/benefit outcomes. Conditions of achieving those goals are the inclusion of effected participants (users and professionals) in planning and monitoring the outcomes, assurance of needed resources at the care transformation including funding, and careful management of appropriate communication and co-ordination.