Taking big steps by starting small: Lessons learned from pilot-testing the TARGET integrated care program

Context and stakeholders: Integrated care is considered a promising alternative care model to deal with the rising demands for care and – related to that – high work pressure. The TARGET program is an initiative to provide primary care professionals with the required knowledge, skills and confidence to implement integrated care in practice. TARGET was developed by combing scientific insights with practice-based experiences, preferences and needs. Different steering groups including care professionals, patient representatives, policy makers and health insurers co-created and improved the program. In this pilot study, frontrunner general practices were invited to implement the program in practice for the first time. Aims were to assess feasibility and acceptability of TARGET for professionals and patients. Secondly, this study helped to derive lessons for both professionals and supporting networks of professionals about how to make integrated care successful in practice. Methods and results: Between August 2020 and February 2021, the TARGET program was pilot-tested in seven general practices. The program consists of three main components, of which the first two were studied: a population segmentation tool to identify patients with complex care needs, a person-centred needs assessment to get a holistic view of patients’ needs, and network support to enhance cooperation and referral. The components were accompanied by tools, trainings and meetings with peers. In this study, we reviewed the program through non-participant observations and interviews with professionals and patients. Results shows that the program is considered feasible and acceptable by most professionals and patients. For instance, the trainings, tools and peer meetings helped professionals to – amongst others – acquire new conversational skills. The program was considered acceptable as well: TARGET enabled meaningful patient-doctor interactions and a comprehensive, positive focus on health, which aligned well with the values of both professionals and patients. Practices were generally positive about continuation of TARGET. However, not all practices implemented the program with full team commitment and adequate network relations were sometimes lacking. Lessons learned and next steps: Tools, trainings and peer meetings are crucial to make a transformation to integrated primary care. Furthermore, developing and improving this ‘equipment’ in co-creation with professionals, policy makers and health insurers is key to ensure feasibility and acceptability in practice. Starting small with the implementation of integrated care is above all helpful to take big steps in the end: it enables improvement of tools and the implementation strategy. For instance, to enhance team commitment to the program, practices should be supported to tailor the program to their needs. By using a ‘practice development plan’, practices are currently encouraged to develop a practice-wide vision on their practice, as a foundation for tailoring the program. In addition, practices should be offered inspiring ‘best practices’ about network enhancement, to enable adequate referral and lower work pressure in primary care. The implementation of TARGET has steadily increased: since October 2023, more than 100 practices use the program. This enables evaluation of ‘how, why and under what circumstances’ the TARGET program leads to changes in the Quadruple Aim.