Project Title: Optimising Integrated Care Services (OptICS) for physical and mental health care: An investigation of integrated care for adults at risk of cardiovascular disease and living with mild to moderate mental health concerns

Short Project Title: Understanding the functionality of Integrated Care to optimise physical and mental health

Project Team: Angel Chater (PI – University of Bedfordshire – UoB/ University College London – UCL), Alison McKinlay (Lead researcher – UCL), Vivi Antonopoulou (UCL), Fabiana Lorencatto (UCL), Laura McGowan (Newcastle University – NU), Eunice Adwubi (Newcastle University – NU), Neil Howlett (UCL/UoB), David Osborn (UCL), Amy O’Donnell (NU), Mike Kelly (Cambridge/NU), Ivo Vlaev (Warwick), Emily Oliver (NU), Susan Michie (UCL), Falko Sniehotta (NU); Yannis Pappas (UoB), Gurch Randhawa (UoB), Emily Munro (UoB), Nasreen Ali (UoB), Fani Liapi (UoB)

Background

Integrated care allows for a joined-up pathway for those who may need more than one service, treatment or intervention. The benefits of integrated care include reduced patient waiting times, better health outcomes, higher levels of satisfaction with care (Liapi et al., 2022), and reduced cost to the health service (Desmedt et al., 2016). Despite growing evidence on the benefits of integrated care, the functions that help or hinder their effectiveness requires research. While it is not feasible to explore all facets of integrated care services and systems across the UK, academics and policymakers have identified specific clinical priorities that will form the focus of this project.

In the NHS Long-Term Plan (National Health Service, 2019), cardiovascular disease (CVD) has been identified as one of the key clinical conditions requiring urgent attention to save lives. CVD is one of the leading causes of preventable death, with an estimated 7.6 million people living with some form of heart and circulatory disease in the UK (British Heart Foundation, 2024). Factors that increase a person’s risk of CVD development include physical inactivity, smoking, obesity, diabetes, high blood pressure, high cholesterol and a family history of heart disease (National Health Service, 2022). Experiences of impaired mental health (MH) such as depression and anxiety are common among people at risk of developing CVD, alongside those with mental health concerns being more likely have CVD risk factors. This necessitates a more holistic and integrated approach to care provision to support a whole-system approach where people do not get ‘lost’ between services and ultimately can ‘tell their story once’ and receive optimal integrated intervention. As CVD and mild to moderate mental health concerns are complex long-term conditions that involve biological and psychosocial factors, the use of behavioural science and whole-systems thinking can help target elements of service provision requiring change.

This project will conduct a whole-systems analysis concerning the reduction of CVD risk factors and promotion of positive mental health and wellbeing, as an exemplar of how integrated care and integrated care services and systems may more effectively support the intersection of physical and mental health. Using behavioural systems mapping and a COM-B (Capability, Opportunity, Motivation–Behaviour) analysis, drawn from the Behaviour Change Wheel approach (Michie et al., 2011), this project aims to generate evidence to enact workforce and system transformation to optimise the delivery of integrated care.

Project aim

The aims of this project are to ask, ‘How is integrated care delivered across the UK?’ Alongside ‘What helps and what hinders integrated care?’ Behavioural and social science will be used to identify: ‘who’ is involved in successful delivery of integrated care (key people); ‘what’ they do in relation to integrated care (key behaviours); ‘why’ they do this (key influences on behaviour – COM-B diagnosis); and ‘how’ we can harness best practice (key intervention strategies – BCW approach) and champions (change-makers) across the system.

Specifically, the project will:

• Examine system-wide actors, behaviours and influences associated with Integrated Care in the UK, to better enable integration of physical and mental health service provision.
• Add to the evidence-base on integrated care using a whole-systems approach for use by policymakers, commissioners and those providing integrated care services.
• Explore the gaps in service provision, identify ways of optimising integrated care, and create a platform for key stakeholders to build on the work they do by establishing a training programme to enhance the use of behavioural and social science across the system and establish a network of Behaviour Change Champions to support implementation of recommended implementation strategies.

Methods

This study will deploy a pragmatic mixed-methods design with a phased approach to developing a better understanding of how Integrated Care works well for people at risk of developing CVD and living with mild to moderate mental health concerns/ low psychological wellbeing.

Timeline

This project began in January 2024 and will run until at least 2027.

Contact

For further information about this project or to register interest as a Behaviour Change Champion, please contact: PRUBaSS@ucl.ac.uk

Find out more about the project on NIHR

References

British Heart Foundation. (2024). UK Factsheet. https://www.bhf.org.uk/-/media/files/for-professionals/research/heart-statistics/bhf-cvd-statistics-uk-factsheet.pdf

Desmedt, M., Vertriest, S., Hellings, J., Bergs, J., Dessers, E., Vankrunkelsven, P., Vrijhoef, H., Annemans, L., Verhaeghe, N., Petrovic, M., & Vandijck, D. (2016). Economic Impact of Integrated Care Models for Patients with Chronic Diseases: A Systematic Review. Value in Health, 19(6), 892–902. https://doi.org/10.1016/j.jval.2016.05.001

Liapi, F., Chater, A. M., Pescheny, J. V., Randhawa, G., & Pappas, Y. (2022). Understanding the Experience of Service Users in an Integrated Care Programme for Obesity and Mental Health: A Qualitative Investigation of Total Wellbeing Luton. International Journal of Environmental Research and Public Health, 19(2), 817. https://doi.org/10.3390/ijerph19020817

Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6(1), 42. https://doi.org/10.1186/1748-5908-6-42

National Health Service. (2019). The NHS Long Term Plan. https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf

National Health Service. (2022). Cardiovascular disease. https://www.nhs.uk/conditions/cardiovascular-disease/

NHS England. (n.d). What are integrated care systems? https://www.england.nhs.uk/integratedcare/what-is-integrated-care/