The second national workshop in Vilnius was aimed to look at integrated care models in various municipalities (not just Vilnius). It took place on April 18, 2018, in Vilnius, Lithuania.
One expert of the Republican centre for addictive disorders introduced an overview on health services for people who inject drugs (PWID) in Lithuania (the systematic analysis) and a second expert shared experiences – practices when trying to apply case management model in combining drug addiction treatment (like OST) with HIV/TB/HCV and other treatments in Vilnius. The NGO representative shared experiences of integrating harm reduction services with other health services – challenges to linkage to care (in Vilnius and Klaipeda). Some doctors discussed issues when treating HIV, TB and HCV patients with addictions (for example adherence to treatment and issues faced when managing DOTS). Furthermore, the participants discussed key issues in providing treatment and other social services for PWID with children. Lastly we learned about a labour exchange practice in Kaunas where they integrate addiction treatment and other health services with employment services. During the following working group session, the key task was to brainstorm on an ideal model of integrated care and identify what needs to change - specific tasks/strategies that could help us now (not sometime in the future) to work more effectively. An ideal model would include the following features:
- Patient level
24 hour services; help without any restrictions (you can still use substances and get help); ensuring continuous services; easy referral; providing good quality services; ability to remain in treatment within the health system.
- Family members and others
Enough information; support from social services; working with motivation; addressing stigma issues, legal constrains.
- Institutional level, specialists
Accessibility of services; good monitoring system; information exchange – sharing experiences, learning from each other; being able to share patient’s data (data protection issues); less bureaucracy; less documentation; more training.
- Public - politics
Better monitoring/information systems.
What needs to change?
NGOs could have/take on more responsibility and more tasks. They could be contracted to perform services that cannot be done by public entities. More standardized services but aiming to provide individualized care. Not aiming at providing more services, but aiming to prove good integration of services.
Recommendations/Conclusions:
During the group work, participants identified that it is very unlikely that services will be provided in the same location – most likely we need to improve our referral paths and practices. It was suggested that an infographic could be produced that shows different patient referral paths within the health care system. This infographic could be used by specialists, especially social workers, who are involved in case management across different fields and institutions. Together with WP7 packet leaders, it was agreed that this type of infographic will be produced as the post-event publication.