Innovative health care approaches for patients with multi-morbidity in Europe: The availability and impact of integrated care programmes including care pathways, and/or addressing poly-pharmacy and patient adherence for patients with multiple chronic conditions in 31 European countries.

This report provides a descriptive overview of integrated care programmes for patients with multi-morbidity that have been developed and implemented in EU Member States and other European countries. Healthcare systems in European countries are facing multiple challenges, such as an ageing population, an increase in people suffering from multi-morbidity, and limited financial and human resources for care. Furthermore, most care for patients suffering from multi-morbidity is fragmented and disease-specific. To improve quality (in terms of clinical outcomes and quality from the patient perspective) and sustainability (in terms of financial and human resources) of care, reforming the way healthcare is provided to patients with multi-morbidity is essential. Integrated care has the potential to respond to the challenge of providing good qualitative and sustainable care to patients with multi-morbidity. Integrated care is patient-centred, proactive and well-coordinated multidisciplinary care, using new technologies to support patients’ self-management and improve collaboration between caregivers. Integrated care programmes for patients with multi-morbidity in Europe This report shows that integrated care programmes are seen as key for the improvement of care for multi-morbid patients in Europe. We traced 119 care programmes targeting patients with multi-morbidity that can be characterised as integrated care programmes. Most integrated care programmes within healthcare for patients with multi-morbidity can be found in Spain (n=22), and are, irrespective of the country, (planned to be) implemented on a local or regional level (n=94). The integrated care programmes share the following common elements: patient-centeredness, an emphasis on coordination of care, improvement of collaboration between (multidisciplinary) caregivers and a focus on outcomes. These programmes involve different disciplines (professional caregivers and/or informal carers) and organisations, and many programmes include the assignment of a case manager for patients. Many care programmes include a care pathway (n=76), address poly-pharmacy (n=62) and/or patient adherence (n=67). A substantial number of integrated care programmes specifically focus on frail elderly (n=47). Lack of evidence from integrated care programmes addressing multi-morbidity Little is known about the outcomes or effectiveness of integrated care programmes for patients with multi-morbidity. This is mainly because many of these integrated care programmes have recently started and are not thoroughly evaluated yet. The one controlled study conducted in a European country that we identified did not reveal evidence for a beneficial effect of integrated care on patient outcomes. However, in the few studies (n=6) that have been evaluated (in non-controlled designs) in European countries positive associations were found between participation in integrated care programmes and multi-morbidity patients’ quality of life, patient’ satisfaction with the care received, better care planning and referral for patients as well as more appropriate prescribing of medicines and/or a decrease in hospital care utilisation or outpatient visits. So far, it is unknown which (sub)groups of patients benefit the most from integrated care programmes. In this respect, further research is needed. We conclude that in many European countries developments exist to reform healthcare delivery for patients with multi-morbidity by developing and implementing integrated care programmes. So far, evidence of their potential to improve patient outcomes, decrease healthcare utilisation and costs is lacking. (aut. ref.