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标题：Roles and Responsibilities in community Integrated Care- perceptions of providers and users in rural Romania
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作者：Manfred Zahorka ; Nicusor Fota ; Alina Negraru 等
期刊名称：International Journal of Integrated Care
电子版ISSN：1568-4156
出版年度：2016
卷号：16
期号：6
DOI：10.5334/ijic.2887
出版社：Utrecht University, Maastricht University, Groningen University
摘要：Background : Community Health and Social services are delivered in Romania following sectorial policies and there is little collaboration and coordination of services. In its National Strategy for Health 2014-2020 the Romanian Government addresses these discrepancies and paves the way towards better integration of services. The “Widening Access to Health and Social Services” program funded by the Swiss Government supports Romania to develop local solutions for setting up integrated health and social services for vulnerable population groups. Objective: The present study analyses provider and user perceptions of roles and responsibilities towards a better integration of community services with a stronger focus on people’s needs. Methods : Service providers, local authorities and household representatives were questioned using a mixed methods approach in seven rural Romanian communities. At the household level 700 individuals across 7 communities were interviewed on their service needs in terms of availability, access and perception of service quality as well as their perceived role in disease prevention and management. Specific population groups were addressed using focus group discussions. Key informant interviews asking similar questions were used to clarify the understanding of service providers and local authorities at community level. At the household level 700 individuals were interviewed on their service needs in terms of availability, access and perception of service quality as well as their perceived role in disease prevention and management. Similar questions were asked to population representatives Service providers using focus group discussions. In-depth interviews with health and social service providers and key informant interviews with the local authorities were used to clarify situation understanding at community level. Results : Although having a public mandate, local authorities generally do not perceive themselves to have a strong role in coordinating services related to health and wellbeing of their communities. The vertical organisation of health and social services and the difference in funding mechanism makes it difficult for local administration to find their role. In theory linking elements like community nursing fail to live up to expectations because of unclear functions and definition of tasks within the community administration. Service providers are strongly organised through their sectoral priorities with local NGOS and self-help initiatives not being part of the health/care network. There is weak understanding of community health priorities due to a lack of comprehensive analysis and joint intersectoral action is limited. Joint health assessments or community health profiles to determine service priorities are missing. Population perceptions depend on mobility, health insurance status and user needs. Ninety percent of the rural population are covered by health insurance. However, for the rural poor even the opportunity costs related to visiting service facilities are frequently too high. Separate service providers and the lack of a “one-stop-shop” may increase those costs. Health and social service related home visits are not complementary and information exchange between service providers is limited. Lessons Learned : Considering the limitation of resources on the service provider side as well as the lack of capacity for service users to cover opportunity costs for service utilisation there is an urgent need for improving the complementarity of available services, their coordination, outreach services to better focus on people’s needs. Community health assessment and priority setting, involving population representatives or self-help groups is essential to better define and coordinate services fitting to individual needs.
关键词：community-based integrated care ; health and social services integration ; local authorities ; capacity building