Key messages

• The increasing and changing demands of complex patients (with chronic conditions and multimorbidity), combined with growing workloads and shortages of primary care providers, demand the reorganization of services for more patient-centred and more efficient care.
• Reorganizing health and social care services to integrate care requires that the health workforce adopt “skill-mix changes” including reskilling; a different approach to sharing tasks and roles; and improved coordination.
• Skill mix changes typically involve innovative re-allocation of tasks between professions; new supplementary roles; and/or the introduction of greater teamworking and flexibility.
• The most promising skill-mix innovations for improving integration of care of patients with complex needs are:
  1. Shifting tasks and roles to achieve new divisions of work with advanced practitioners (nurses and pharmacists) taking on management of aspects of care and coordinating processes in close collaboration with physicians.
  2. Relocation of care to other settings for example to nurse-led clinics or patients’ homes.
  3. Introduction of (an explicit) care coordination role with different professionals (case managers, patient navigators) developing shared care plans and monitoring patients’ health and well-being.
  4. Empowering patients and caregivers through specialist staff (educators, community health workers) who provide information and training to strengthen patients’ self-management and support behavioural change.
  5. Introduction of dedicated prevention roles in primary care with nurses, pharmacists, community health workers or patient navigators fostering health literacy, offering advice and counselling, and promoting healthy lifestyles.
  6. Establishment of teamwork and collaboration in multi-professional teams enabling different professions (GPs, specialists, nurses, therapists, social workers, community health workers, housing staff) to work together across sectoral boundaries to organize and coordinate joint care and link health and care services.
• Patient outcomes overall for people with chronic conditions and multimorbidity are positive following skill-mix innovations with (broadly) better adherence and patient engagement but evidence on the impacts on resource use is mixed.
• Policy makers can support the implementation of skill mix reforms and their sustainability (and at the same time foster surge capacities) by:

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  Making changes part of a system-wide process with careful consideration of the macro, meso (organisational) and micro (professional and patient) levels.

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  Taking context into account with close attention to national and local specifics.

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  Introducing adequate regulatory frameworks around (new) professional roles, scope of practice, education and training.

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  Providing sufficient multiannual funding, reimbursement for training and incentives.

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  Addressing the supply of qualified health professionals and joint workforce planning.

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  Coordinating governance structures and leadership and encouraging stakeholder involvement.

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  Monitoring and evaluating to learn lessons.

Contents

• Acknowledgements
• Acronyms
• Executive summary
• POLICY BRIEF
  • 1. Introduction: why this brief?
  • 2. Which skill-mix innovations can improve integrated care for individuals with chronic conditions and multimorbidity?
  • 3. What is the evidence on the impact of skill-mix innovations on health outcomes and resource use?
  • 4. What are the levers and barriers for implementing skill-mix innovations within integrated care?
  • 5. Conclusions
• References
• The Policy Brief Series

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What is a Policy Brief?