Individual determinants of integrated care for indigent patients: an experimental study in Brussels: Pierre Smith

Background

In metropolitan area, socially deprived patients with chronic disease undergo the fragmentation of health and social care services because of their complex needs. Integration of health and social care would benefit these patients, however, it is not feasible or appropriate to integrate all the services for all vulnerable patients. This study aims at identifying the individual determinants of deprived patients ‘preferences in integration of health and social care.

Methods

In Brussels, 236 stakeholders were recruited and randomly assigned to 1of 8 clinical vignettes in which the experimental condition consisted of health and social individual determinants (health insurance, housing and psychiatric comorbidity). Stakeholders were policymakers, health and social care professionals and beneficiaries. We identified preferences in integrated care based on individual determinants and degree of vulnerability of clinical vignettes.

Results

The fully integrated model was significantly preferred in the absence of health insurance (χ2 = 10.71, p < 0.01) and in the absence of housing (χ2 = 6.29, p < 0.05). No significant result was found for the influence of psychiatric comorbidity. In the most unfavorable condition (no housing, no insurance and a psychiatric problem), the fully integrated model was preferred while, in the opposite most favorable condition, no integration was deemed necessary.

Conclusions

For uninsured or homeless persons, the evidence supports the need for a fully integrated model of care. Moreover, the degree of vulnerability of a person is linked to the preferences towards a fully integrated model. Social determinants have a greater influence on preferences than health determinant. Therefore, the implementation of specific integrated pathway should be based on social determinants.

Key messages:

• For socially deprived patients, integration of health and social care must take into account both their degree of vulnerability and their social determinants.

• The implementation of specific integrated pathway for socially deprived patients should be based on their individual social determinants.