Integrated care is not only important for improving Americans’ health, but also as a worldwide goal, according to leaders from nine countries who gathered at APA Nov.
3–5 for talks and working groups on the topic. APA 2015
President Barry Anton, PhD, convened the global meeting to
address the challenges of providing integrated care and to learn
from each other.
“We brought together very unlike-minded people from
professions like epidemiology, business, sociology, technology,
geography, public health and mental health to find out what we
could learn from each other,” says Anton. “Some countries do
integrated care not only differently, but also better than we do.”
In addition to the 85 attendees, more than 400 viewers
from 42 countries tuned in via live Web stream, and dozens of
participants tweeted from the meeting.
Keynote speaker Reynaldo Holder, MD, of the Pan American
“Social justice is a matter of life and death,” he said.
Health Organization, launched the summit by pointing out that
many nations are facing similar health challenges, such as rising
costs, aging populations, climate change, a growing urban-rural
divide, and unequal access to health and mental health care. For
example, in the Americas, though many countries have seen
economic growth, “when you look at the distribution of that
Adewale Troutman, MD, associate dean for health equity
and community engagement at the University of South Florida,
urged participants to look closely at root causes of inequity.
“Downstream are things that continue to happen like school
[dropouts] and poverty. We have to go upstream and find causal
pathways” including racism and discrimination, he said.
Other barriers to care include fragmented health care
systems, competing provider groups and the high cost of
services, participants said. One way to provide more access to
care is through digital care and telehealth, said John Fortney,
PhD, of the University of Washington. A number of innovative
health-care delivery vehicles can help patients, he said, such as
waiting-room kiosks or hand-held devices that help record and
rate symptoms, which make for a more efficient visit and may
encourage more honest, “guilt-free” answers, he said.
Several countries and organizations are making notable
strides in integrated care. Among the best known organizations
is Cherokee Health Systems, which has 14 clinical sites in
Tennessee. Behavioral health consultants are key members
of primary-care teams and behavioral health and prevention
are part of every well-child checkup and prenatal care visit,
said Parinda Khatri, PhD, chief clinical officer. The group also
screens for and offers preventive treatment for
diabetes, a big problem in the community.
In the United Kingdom, the National
Association of Primary Care is helping to test the
model of community-based primary-care homes
that offer highly coordinated and personalized
care to as many as 50,000 patients each, said its
chairman, Nav Chana, MD. Another summit theme
Chana noted was the need to quantify well-being
and the value of preventive care, per the World
Health Organization dictum that good health is not
simply the absence of disease.
“We get excited about factors that cause disease
but very little about the factors that cause health,”
“In Norway, having psychologists in primary-care teams will
now be mandated by law, and will lead to more psychologists
on staff throughout the country’s public health system and in
more schools and communities. You need to be where people
are,” said Tor Hofgaard, PhD, president of the Norwegian
Psychological Association. “I often joke that we should have
psychologists at IKEA.”
Other nations’ integrated-care efforts are less established.
In China, for example, primary-care providers need more
training on how to provide mental health care for older people
in the country, which has just 25,000 psychiatrists to treat more
than a billion people, said Shulin Chen, MD, PhD, of Zhejiang
Reforming payment models is critical as well, and will help
achieve provider satisfaction along with the “triple aim” of
better patient experience and care quality and reduced cost,
A worldwide push for integrated care
Health-care leaders from around the world met at APA to discuss their goals, successes and barriers
to providing comprehensive care that integrates behavioral health and physical health.
“We brought together very unlike-minded
people from professions like epidemiology,
business, sociology, technology, geography,
public health and mental health to find out
what we could learn from each other.”
Barry Anton, APA 2015 president