Challenges faced of integrated care

Challenges faced in the field of integrated health

Interview with Athanasios Zoutsos, Mayor of Pallini, Greece

What are the main challenges faced by Pallini in the field of integrated care?

The main challenges faced by Pallini in the field of integrated care can be identified at both national and local level. At national level, we should stress the lack of a nation-wide implemented patients files that would provide coherent and structured information on the physical, psychological and medical condition of the patient. This lack of information is an insurmountable handicap for policy planners when designing integrated care intervention and prevention programs matching to our citizens' needs.

Another challenge, also at national level is the treatment of patients. The National Health System in Greece is oriented towards treating the disease and not the patient. Patients visit directly the specialists, which they believe will help them confront the most acute of their health issues, but skip the step of the holistic evaluation of their physical, mental and psychological conditions. Thus, often advancing through their lives without ever identifying underlying conditions that may occur and lead to a deterioration of the patient’s quality of life. An additional consequence of the above mentioned facts is the waste of valuable financial and human resources in dealing with patients in an ad-hoc manner rather than in a structured and planned approach.

At local level, we face challenges in approaching people, especially the elderly, due to their self-imposed isolation as a reaction to an unfriendly and frustrating National Health System. These people often lack access to information channels and even social links, thus presenting the municipalities with the challenge of finding new ways to inform and approach them. In addition, even when the municipality finally reaches them, they feel insecure, they are cautious and unwilling to open-up to new ideas, activities and approaches. This mentality makes them reluctant to participate in new programs. The big challenge is to convince them to trust the local society and Authority. We believe that the caregivers can play a key-role in resolving both the issues mentioned above. Special attention should be given in approaching, informing, educating and sensitizing the caregivers, for they are the “Trojan horses” needed to pass through the walls of the self-imposed isolation and gain the trust of the elderly patients.

What have you learnt from the pilot sites? What positive experiences can you bring? (Study visit/ elderly views)

We acknowledged that we share common problems and challenges with all our partners. That's probably because the target population has common characteristics everywhere. Our partnership helped us to recognize and adopt good practices concerning organizational issues, communication and cooperation of different services, as well as the importance of combining the benefits of a structured NHS with the capacity of local government to integrate interventions spanning several different fields (health, sports and fitness, social actions, counseling). Thus providing, not only for the socialization of the senior citizens, but also for the effective implementation of integrated care programs.

What were the results of the confrontation with the other European partners involved?

Our cooperation with the other pilot cities helped us to develop a more comprehensive approach to our integrated care programs, allowed us to design new policies and to identify areas of concern at national and local level and formulate proposals regarding the resolution of the arising issues. It is necessary to have a comprehensive digital file for each patient at national level, focusing on the patient and not the disease. This will allow better policy design, as well as more efficient treatment. In addition, we should aim to improve the operational aspect of local government and central government services and facilitate their cooperation. We should also focus on the caregivers' training, in order to make them our facilitators. Our experience from the UHCE program will help us to develop more programs in the field of integrated care, combining different types of activities and services (e.g. primary health prevention programs, training programs, social inclusion programs).