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Renewing the expertise of health and social care professionals to provide integrated care: Evaluation of an intervention in a deprived Dutch neighbourhood

Jennifer van den Broeke, Maartje van der Aa, Wim Busschers, Karien Stronks, Thomas Plochg


Rationale, aims and objectives: Multimorbidity in deprived populations is associated with longer hospital stays, more avoidable admissions and complications, higher costs, and lower satisfaction with available services. While integrated care has been proposed as a solution, the expertise of professionals to deliver this type of care has received little attention. Our case study evaluates an intensive intervention in a deprived neighbourhood in the Netherlands, launched in 2008, to tackle multimorbidity and the expertise of health and social care professionals to cater to the population’s health needs.

Methods: Mixed-methods evaluation. Between 2009-2012 semi-structured interviews (n= 11), field observations, conversations, dialogue sessions and documentary review. In 2012 and 2013 quantitative before-and-after study with web-based questionnaire in the intervention and two control neighbourhoods (n= 86 at t0 and n=117 at t1).

Results: The intervention sought to develop professional expertise in population health orientation, generalism, and coaching. Activities were supported by management that emphasized learning by doing, working bottom-up with direct application in practice, and professionals enjoying discretion to experiment. The intervention’s widely supported mission brought cohesion to its activities. In the interviews, professionals reported becoming more adept at understanding the common causes behind patients’ complaints, unravelling their multiple problems, and encouraging them to be more active in addressing their own health and well-being. But this was not supported by the quantitative data measuring professionals’ attitudes.

Conclusion and practice implications: Neighbourhood interventions can strengthen professionals’ expertise in population health orientation, generalism and coaching, and the communication and collaboration skills necessary to employ them. Whether they can lead to more adequate responses to multimorbidity and more effective integrated care arrangements needs to be further researched.


Coaching, communication skills, deprived neighbourhood, expanded chronic care model, expertise, holistic attitude, integrated care, multi-morbidity, person-centered healthcare, population health orientation, primary care, public health, self-management

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