Care coordination during and beyond the coronavirus: Learning together and faster to strengthen health systems

During the opening of the European Public Health Week on 11 May 2020, the WHO Regional Director for Europe, Dr. Hans Kluge, emphasized the importance of public health at the moment in which the world is facing the greatest public health challenge of modern times. He called for “strong and integrated management of public health services, primary care services, and management of hospitals and long-term care facilities”, amongst others, as well as “that countries work together, learn from each other and coordinate efforts” in their endeavours to deal with this most severe situation. ¹

Five months later the coronavirus is continuing its spread across the world, with more than 38 million confirmed cases in 189 countries and more than one million deaths. While the number of coronavirus cases is increasing in various counties including Israel, Peru, Canada, Russia, most European countries and Indonesia, in Latin America and the Middle East there are signs cases may now be levelling off. Meanwhile, the true extent of the pandemic in Africa is not known, as testing rates are low. ²

With multiple countries facing a resurgence and vaccines and new treatments undergoing clinical trials, it is indeed crucial to learn from each other and coordinate efforts. The International Journal of Care Coordination invited authors to share experiences and lessons in the strengthening of health systems and the rapid reorganising of service delivery into new health ecosystems to respond to COVID-19 with a focus on coordination of such initiatives. ³

This double issue presents three highly relevant COVID-19 related papers. Wagner discusses the vulnerability of nursing home residents in the US to COVID-19 and points out that understaffing of registered nurses may increase the risk of larger outbreaks. ⁴ Pelizzola takes us to Ferrara, Italy, to describe diabetes care before, during, and after COVID-19 and to point out the opportunities for E-health to customize monitoring and assistance. ⁵ Van der Velden et al. describe how the innovative TeleCheck-AF approach aims to contribute to the strengthening of various health systems in Europe in maintaining management of atrial fibrillation, whilst keeping patients out of the hospital, during the pandemic and beyond. ⁶

Care coordination beyond the pandemic may be more effective and efficient when we create new health ecosystems to respond to health challenges in a truly integrated fashion. A perhaps somewhat provoking contribution comes from Hendriks who discusses whether integrated care initiatives in atrial fibrillation are truly integrating in light of international practice guidelines. ⁷ In their review of reviews, Wankah et al. identify and synthesize knowledge on challenges in the measurement of integrated care models and use this for a descriptive analysis of such a model for older adults in Quebec, Canada. ⁸ It will be interesting to see how this is going to play out with new international practice guidelines about to be released soon.

As healthcare providers are essential for the coordination of healthcare services, their experiences and perspectives are important resources to further improve health outcomes. Okoh et al. report on the application of a transdisciplinary approach to care in a typical Nigerian geriatric unit. As such an approach is currently in its infant state, a lot can be learned from the perceptions of healthcare professionals as presented in this case study. ⁹ In their paper on the attitudes and perspectives of physicians regarding the uptake of psychosocial aspects and/or patient preference during multidisciplinary team meetings in oncology, Baes et al. point out how such team meetings can be optimised. ¹⁰ To ensure the provision of patient-centred and culturally coordinated care by Iranian nurses, Firoozi et al. show that nurses can improve to meet the healthcare needs of diverse populations. ¹¹ In order to describe and explore how physical therapists working within inpatient rehabilitation units in Nigeria prepare older adults with a hip fracture and mobility limitations for transfer to their home in the community, Kalu et al. designed a qualitative study. Since physiotherapists in Nigeria are not actively involved in care transition that focuses on improving physical functioning during the hospital-to-home transition of older adults, their understanding of their new role is crucial. ¹²

Sharing experiences and lessons in the strengthening of health systems and the rapid reorganising of service delivery into new health ecosystems to respond to health threats is and will remain important. This double issue of the International Journal of Care Coordination illustrates that the lessons learned about the coordination of initiatives to respond to COVID-19 are not only important as multiple countries are facing a resurgence but may also accelerate the coordination of service delivery for people beyond the pandemic. We kindly invite you to submit your work to contribute to our shared learning.