Integration of Patient Self-care into Integrated Care: From users to shapers -the Sweden Co-Care project and patient integrated pathways

Abstract

Most care is provided by patients to themselves and their family. Healthcare systems around the world have been responding to the demand for better organization of models of patient centered integrated care (PCIC). Models of integrated care may enhance patient satisfaction and increase perceived quality of care. The Karolinska University Hospital (KUH) organisational redesign includes patients as active partners by involving patients at all levels in the organization. KUHs and KI Co-Care programme (CCP) aims to address patients' needs across the whole care continuum, both within the clinical appointment and during the times between clinical care delivery. One core in the organization model at KUH is the requirement of a patient representative within the flow management team where the patients are involved as equal participants in building and designing KUHs patient centred integrated care pathways. The results of this is the completion of several strategies for PCIC. Our session describes the CCP, and the experiences of patients in building, contributing and implementing PCIC pathways and the many roles expert and peer patients play in clinical care and in different health care projects and teams. We summarise patient’s and professional’s experience of the value of embedding integrated care across the health care system and conclude with recommendations and implications for shaping true patient centred integrated care in different settings with, and for, different patients.

Keywords

• co-care
• multidiciplinary team that include patient and significant others
• informal and formal care i collaboration