Prise de position de la Société française de gériatrie et gérontologie sur le concept d’intégration : Première partie

The concept of integrated services delivery, although dating from the 1990s, has only recently appeared in the French public health policy. To clarify the concept and its adaptation to the reality of the French systems of healthcare and social services, the French Society of Geriatrics and Gerontology established an interdisciplinary working group. This article reports the group's findings according to three axes: the definition of integration, the objectives of this organizational approach and the means needed to achieve them. Analysis of the literature indicated that integration is a process that aims to overcome the fragmentation of services for vulnerable people. This process requires a multilevel approach, particularly concerning how to modify public policies and financing systems. Notably, all relevant levels need to develop shared processes, tools, resources, finance, interventions and feed-back on the latter. Indeed, this sharing is the ultimate proof of evolution towards integration. In this first part of the position paper, its authors analyzed integrated care definitions used in international literature in view of designing the most important components of integrated care. The examination of this concept must be articulated with the idea of "coordination" which has been the cornerstone of the majority of public policies applied to the field of geriatrics and gerontology since the 1960s in France. The components of integrated care highlight that it is an ambitious process leading to real systemic modification. The authors also have proposed to open up a dialogue between citizens' aspirations and integrated care objectives with the aim to verify that the latter respond to the needs as expressed by the targeted group. Le concept d’intégration des soins et des services, bien que datant des années 1990 n’est que récemment apparu dans les politiques publiques en France. Afin de clarifier le concept et son adaptation à la réalité du système de soins et de services français, la Société française de gériatrie et de gérontologie a mandaté un groupe de travail interdisciplinaire. Les travaux de ce groupe sont synthétisés selon trois axes : la définition de l’intégration, les objectifs poursuivis par cette orientation organisationnelle et les moyens à mettre en œuvre. Il se dégage de l’analyse de la littérature que l’intégration est un processus qui vise à dépasser les frontières de la fragmentation des systèmes de services répondant à des populations en si