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General principles and approaches to integration

Fragmented health services create barriers to access, quality care and positive health outcomes, especially for marginalized or vulnerable populations. An integrated approach addresses fragmentation and enables development of a wholistic1 and coordinated service delivery model.

An integrated approach recognizes that hepatitis C prevention, testing, treatment and care services (including ongoing care services after completion of hepatitis C treatment) are mutually reinforcing aspects of a comprehensive and effective response to hepatitis C.

Although integrated program models are operationalized in a variety of ways to address the needs of specific communities and geographies, integrated programs tend to share two principles:

  • They are client centred.
  • They are committed to health equity.

Generally, there are two broad approaches to integration: service integration and program collaboration.2 Most models combine elements of both approaches.

  • Service integration provides service users with seamless access to programs through a one-stop-shop approach. This approach aims to make it easier for service users to access services by providing a single point of entry. Most service integration models include some degree of health navigation, case management and referrals.
  • Program collaboration is based on partnerships and collaboration across existing programs and services. Program collaboration can reduce duplication of services and increase participation in service delivery from a variety of programs and organizations. It may be most useful in settings with limited resources, where community organizations develop strong linkages with other community-based and medical programs and services to provide navigation across the continuum of care.

Integrated hepatitis C program models are client centred: a demand-driven model of care

Integrated hepatitis C programs are designed to meet the needs of clients first and foremost. The demands and needs of clients are the foundation upon which such programs are built.

In an integrated model, service users are not required to navigate a complicated and fragmented healthcare system on their own to access the information and services they require. An integrated hepatitis C model is designed to facilitate access to the full continuum of prevention, testing, treatment and care services and ensure that service users are supported throughout their journey. An integrated model facilitates linkages and engagement; each service acts as a gateway to other services.

Many integrated models recognize that addressing hepatitis C can be about more than clearing the virus; it can also be about empowerment, validation, and building bridges to other long-term health and life goals.

Integrated hepatitis C models are committed to health equity: serving the underserved

While fragmented health services are not user-friendly for anyone, marginalized or vulnerable populations tend to have the greatest difficulty navigating them. Fragmented services require the service user to take a primary role in communications between health providers, which is difficult for clients who do not speak English as a first language or who face other communication barriers. For marginalized individuals who use injection drugs and other people who may face stigma and discrimination by healthcare providers, it can be daunting to deal with multiple service providers and face judgement in a variety of settings.

Integrated hepatitis C program models are designed to reduce the numbers of individuals who fall through the cracks of a fragmented system. Given the two-stage diagnostic process and slowly progressing nature of hepatitis C infection, it is common for clients to be lost to care. This is especially problematic in terms of health equity because those who fall through the cracks tend to be the most marginalized or vulnerable. In providing seamless, coordinated and wholistic health services, integrated models can enable clients with multiple and complex needs to access health systems more easily without having to build relationships and communicate with multiple service providers.

Notes

  1. Wholistic is the preferred spelling, reflecting the whole person and physical, spiritual and emotional wholeness.
  2. Belani H, Chorba T, Fletcher F, et al. Integrated prevention services for HIV infection, viral hepatitis, sexually transmitted diseases and tuberculosis for people who use drugs illicitly: Summary guidance from CDC and the U.S Department of Health and Human Services, recommendations and reports. Nov. 2012/ 61 (RR05); 1–40. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6105a1.htm[