title: [Factors facilitating and impairing implementation of integrated care].
abstract: BACKGROUND
  Better integration of healthcare is the focus of many current reforms in Western countries. The goal is to reduce fragmentation of health and social care delivery for patients with chronic diseases. In France, Alzheimer autonomy integration experimentations (Maison Autonomie Intégration Alzheimer [MAIA]) were introduced as part of the 2008-2012 National Alzheimer Plan. To date, implementation of such organizations remains challenging. It is thus paramount to identify factors obstructing, and on the contrary facilitating, implementation of integrated care.
  
  
  METHODS
  After an in-depth literature review of qualitative studies published from January 1995 to December 2010. We selected 10 qualitative studies on health care professionals' perceptions of barriers and facilitators to the implementation of integrated care.
  
  
  RESULTS
  Barriers and facilitating factors linked to the implementation of integrated care were identified at several levels: leadership; collaboration between services and clinicians; and funding and policy making. The operative strategy applied to change care delivery and the role of the leading pilot are key elements during the implementation phase.
  
  
  CONCLUSIONS
  Strong leadership and active involvement of a broad spectrum of professionals from clinical practitioners to healthcare managers is crucial for a successful implementation of integrated care services.
authors.affiliation: EA 2506 laboratoire santé-environnement-vieillissement, université Versailles St-Quentin, hôpital Sainte-Perine, 49 rue Mirabeau, Paris, France. matthieu.destampa@spr.aphp.fr
authors.forename: M
authors.initials: M
authors.lastname: de Stampa
authors.forename: I
authors.initials: I
authors.lastname: Vedel
authors.forename: H
authors.initials: H
authors.lastname: Trouvé
authors.forename: O Saint
authors.initials: OS
authors.lastname: Jean
authors.forename: J
authors.initials: J
authors.lastname: Ankri
authors.forename: D
authors.initials: D
authors.lastname: Somme
mesh_terms: D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005378:Financial Support; D005602:France; D018166:Health Care Reform; D006284:Health Plan Implementation; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D007857:Leadership