Techniques and methods for operationalizing integration
Integrated hepatitis C programming is operationalized in a variety of ways. There are a number of approaches to integrating prevention, testing, treatment and care, and many provide seamless transition between services. The methods described below are examples of program collaboration approaches; other methods are service integration approaches, and still others are combinations of both.
Health system navigators
Health navigators help clients overcome barriers to care by providing one-to-one support, education, guidance, accompaniment, referrals and advocacy for individuals along their health journey. They help to bridge services and support clients as they weave their way through systems with greater ease. The goal of health navigators is to build the capacity of clients to manage their own care and to make informed decisions about their health. Health navigation falls under the broader program collaboration approach. Health navigators can be peers or other individuals with the communication, advocacy and relationship-building skills to support clients. ASK Wellness Centre’s Chronic Health Navigation Program is an example of how health navigators provide integrated hepatitis C services to clients.[fn]CATIE. Chronic Health Navigation Program. Programming Connection. 2014. Available from: http://www.catie.ca/en/pc/program/chronic-health-nav[/fn]
Services coordination
Services coordination is a model that follows a program collaboration approach through which separate, independent organizations link their services through intentional communications strategies and shared case management.[fn]Flexhaugh M, Noyes S, Phillips R. Integrated models of primary care and mental health and substance use care in the community: Literature review and guiding document. British Columbia Ministry of Health. August 2012. Available from: http://www.health.gov.bc.ca/library/publications/year/2012/integrated-models-lit-review.pdf[/fn] It is supported by various virtual and telephone-based technologies, along with shared scheduling and clear referral systems. This model can be most useful in providing speciality care in geographically remote areas. Technologies such as “Doc in a box,” with which service providers and clients at a primary care setting can connect with specialists through online technologies, enable independent service providers to collaborate and promote team communications across physical distances. The Ottawa Hospital and Regional Hepatitis Program’s Telemedicine Program is an example of a services coordination model – it provides care and treatment to people remotely through the Ontario Telemedicine Network.
Centralized services
Through a centralized services approach, primary care and/or specialty care providers and a range of other health and social service providers all work together in a central location. Coordination and transition between services is aided by proximity of services.[fn]Ibid[/fn] Service providers can be physically present within a specialty clinic or specialty services can be offered within a primary care setting, such as a community health centre. Primary care and specialty care services can also be situated within non-health-related organizations, including settlement centres and community centres. Through this approach, services may remain independent, or they may follow a shared care model through which collaboration occurs because of the proximity of and relationships between providers, and because there is an organizational commitment to collaboration. The Calgary Urban Project Society’s hepatitis C clinic in Alberta is one example of centralized services approach. The clinic is located within a community health centre that also offers a range of other services to clients.
Decentralized services
A decentralized services model involves a specialized outreach team providing on-site services in a range of settings and also linking clients with a more comprehensive hub of services within a home organization. Many decentralized service approaches are led by a nurse who is connected to a home institution. The North End Community Health Centre, Hepatitis C Education and Support Program in Halifax, Nova Scotia, is an example of a decentralized services approach: it is housed in the North End Community Health Centre, but its core team spends 90% of its time in outreach settings.
Combined approach
A combined approach brings program collaboration and services integration together to some degree. It involves several service providers coming together to develop an integrated program with a unified mandate and service-delivery approach. Service providers bring a range of services into one location (service integration) and create a program mandate and shared vision/mission (program collaboration) amongst program collaborators who may be located in different settings. For example, the Toronto Hepatitis C Program is a partnership between South Riverdale Community Health Centre, Regent Park Community Health Centre and Sherbourne Health Centre. The program provides integrated, inter-professional services, which enables clients to access all of the services they require from one program.