Table 1
State of implementation of components of integrated care for older adults.
| KEY COMPONENTS | STATE OF IMPLANTATION 17 YEARS AFTER THE 2004 REFORM | CHANGE MANAGEMENT APPROACH |
|---|---|---|
| Permanent concertation mechanism with regional partners and population responsibility | Local health networks (LHN) were implemented almost everywhere, but their operations vary a lot. Most LHNs work on small-scale interventions. The 2015 reform pushed concertation mechanisms to a minor role. Integrated governance within IHSSCs has in fact replaced this concertation mechanism in the minds of managers and policy makers. | Let it happen |
| Single access point | Established everywhere, except for FMG clients and all private organizations. | Make it happen |
| Standardized evaluation tool | Established everywhere since 2013, except for FMG clients and all private organizations. | Make it happen |
| Case classification system | Established everywhere since 2013, except for FMG clients and all private organizations. | Make it happen |
| Computerized clinical record | Partial implantation. | Help it happen |
| Individualised service plan | Clinically insignificant, in particular due to a delay in computerization, and the lack of reform of the funding model. | Let it happen |
| Case management | Partial implementation, experiencing many failures, the guideline was not published until 2015. | Let it happen |
| Integrated governance | Merged governance accomplished, but many clinical implementation issues | Make it happen |
| Integration of physicians | Organizational progress through the creation of FMGs, but the medical sector remains very person-dependent, and access has not been significantly improved for priority clienteles (mental health, chronic diseases and loss of functional autonomy). | Help it happen |