http://hdl.handle.net/10071/5864 2026-03-30T05:25:44Z 2026-03-30T05:25:44Z Matos, R. C. de. Nascimento, G. do. Fernandes, A. C. Matos, C. http://hdl.handle.net/10071/36332 2026-02-18T14:40:26Z 2025-01-01T00:00:00Z

Título próprio: The integration of social and health sectors in Scotland: An analysis from the prism of different public policy models Autoria: Matos, R. C. de.; Nascimento, G. do.; Fernandes, A. C.; Matos, C. Resumo: The integration of health and social care has been a key focus in Scotland, driven by demographic changes, rising healthcare costs, and the need for more efficient service delivery. The Public Bodies (Joint Working) (Scotland) Act 2014 sought to formalise this integration by restructuring governance and service provision to improve coordination between health and social care sectors. Despite these efforts, challenges remain in fully achieving the intended outcomes of the integration. This study analysed Scotland’s integrated health and social care through the theoretical frameworks of public choice, institutionalism, and functionalism. The objective was to examine policy drivers, structural mechanisms, and governance implications, providing insights into the broader impact of integrated care reforms. A qualitative research approach was employed, synthesising data from peer-reviewed literature, government publications, and policy documents. The findings on integration were systematically examined through the lens of each public policy model, allowing for a nuanced analysis of how Scotland’s approach to integration aligns with and diverges from these frameworks. A literature search was performed on PUBMED, Google Scholar, and Scottish government portals. While integration improved coordination and service delivery in some areas, limitations in funding allocation, workforce distribution, and governance autonomy limited its overall success. Scotland’s integrated care model demonstrates potential benefits in reducing service fragmentation and improving patient-centred care; however, persistent challenges such as funding constraints, workforce shortages, and governance conflicts indicate that integration alone is not sufficient to resolve systemic healthcare inefficiencies. This study provides a perspective on Scotland’s health and social care integration, offering valuable lessons for other European countries facing similar demographic and healthcare challenges.

2025-01-01T00:00:00Z Matos, R. C. de. Nascimento, G. do. Fernandes, A. C. http://hdl.handle.net/10071/36041 2026-01-20T10:53:54Z 2025-01-01T00:00:00Z

Título próprio: Integration of the social and health sectors in Scotland: Assessment of the first 5 years (2014–2018) Autoria: Matos, R. C. de.; Nascimento, G. do.; Fernandes, A. C. Resumo: In Western societies, the emergent societal challenges require changes in public policies to manage their consequences and to avoid a demise in public sectors. Public health is a coordinated system that engages the government and multiple stakeholders to protect and improve population health through prevention, policy, and community initiatives [1]. Moreover, it requires a clear framework that defines where leadership should be positioned and at what level it should function [2]. This is essential to develop, implement, and sustain efficient policies and face complex public tasks. In Scotland, during the last decade, there has been an increase of 25% in people over 75 years, the highest number of health and social care service users ever [3]. In 2011, the Scottish government published a manifesto stating it would deliver a single integrated health and social care system across Scotland [4]. To comply with a national health and social care integration (HASCI), in 2014, the government published the Health Care with Social Services: Public Bodies (Joint Working) Act 2014, with guiding norms for regional implementation [5]. HASCI requires health boards and local authorities to partner with the third sector, users, carers, and other key stakeholders. It motivates the creation of a more joined-up care experience for people with health and social care needs. To achieve a more integrated patient experience, health and social care providers often need to integrate at an organizational level [6]. This is critical to sustain the four key areas of HASCI [7], namely, (1) reduce hospital admissions; (2) move toward prevention; (3) promote more personalized health plans; and (4) enable individuals to live more independently [7]. In this sense, the integration of health and social policies is a process that can be achieved through many ways: pooling of funds, strategic planning, functional and organizational consolidations, joint commissioning, service colocation, joint programs, centralized case management and information systems, multidisciplinary teams, shared diagnostic procedures, and patient involvement [8]. Specifically, regarding the healthcare sector, there are four main types of integration: functional, organizational, professional, and clinical, which can occur either horizontally or vertically [9, 10], while most countries have introduced integration schemes to promote professional or clinical collaborations horizontally. This letter examines the integration of the social and health sectors in Scotland, focusing on the first 5 years of implementation following the Health and Social Care Integration policy framework (2014–2018). It specifically analyzes key policy measures and structural changes introduced to facilitate integration, assesses progress based on publicly available outcome data and official reports, identifies challenges and barriers affecting the effectiveness of integration, and discusses future steps to enhance coordination between health and social care services. By examining these early-stage impacts, policymakers, healthcare providers, and stakeholders can make informed decisions about necessary adjustments, ensuring that integration efforts lead to long-term improvements in care delivery. Additionally, understanding initial successes and shortcomings can help refine strategies for future policy development, optimize resource allocation, and enhance the overall effectiveness of integrated health and social care services.

2025-01-01T00:00:00Z Matos, R. C. de. Nascimento, G. Fernandes, A. C. Matos, C. http://hdl.handle.net/10071/36013 2026-01-19T13:10:43Z 2025-01-01T00:00:00Z

Título próprio: Health and social care integration: Insights from international implementation cases Autoria: Matos, R. C. de.; Nascimento, G.; Fernandes, A. C.; Matos, C. Resumo: The integration of health and social care is increasingly recognized as essential to address population ageing, the rise in chronic diseases, and persistent health inequities. Across Europe, diverse models have been developed to improve service coordination, resource efficiency, and person-centered care. This paper aims to explore international experiences in integrating health and social care, identify common strategies and challenges, and provide insights to inform policy development in countries where integration remains incipient, with a focus on Portugal. A qualitative comparative approach was employed. A systematic literature review was conducted across PUBMED, MEDLINE, and Google Scholar, including peer-reviewed articles, policy reports, and government documents. Thematic analysis was used to identify integration models, enablers, and barriers across different countries. Different models reveal that joint governance, pooled funding, strong community involvement, and digital innovation are key enablers of integration. However, common challenges persist, including fragmented governance, inconsistent implementation, and financial sustainability. In Portugal, structural separation between the health and social sectors continues to limit strategic alignment. Successful integration depends on political commitment, shared vision, and active stakeholder collaboration. European models offer adaptable lessons for Portugal and similar systems, especially regarding intersectoral coordination and preventive care. Integrating health and social care is vital for building resilient, equitable systems. Portugal must adopt a cohesive national strategy; strengthen local implementation; and embrace person-centered, sustainable solutions to ensure long-term impact. Integrating the health and social sectors is indispensable in navigating the ever-evolving healthcare landscape and promoting holistic well-being.

2025-01-01T00:00:00Z Teixeira, B. N. Leitão, A. Nascimento, G. Campos-Fernandes, A. Cercas, F. http://hdl.handle.net/10071/32611 2024-11-11T12:22:20Z 2024-01-01T00:00:00Z

Título próprio: Can ChatGPT support clinical coding using the ICD-10-CM/PCS? Autoria: Teixeira, B. N.; Leitão, A.; Nascimento, G.; Campos-Fernandes, A.; Cercas, F. Resumo: Introduction: With the growing development and adoption of artificial intelligence in healthcare and across other sectors of society, various user-friendly and engaging tools to support research have emerged, such as chatbots, notably ChatGPT. Objective: To investigate the performance of ChatGPT as an assistant to medical coders using the ICD-10-CM/PCS. Methodology: We conducted a prospective exploratory study between 2023 and 2024 over 6 months. A total of 150 clinical cases coded using the ICD-10-CM/PCS, extracted from technical coding books, were systematically randomized. All cases were translated into Portuguese (the native language of the authors) and English (the native language of the ICD-10-CM/PCS). These clinical cases varied in complexity levels regarding the quantity of diagnoses and procedures, as well as the nature of the clinical information. Each case was input into the 2023 ChatGPT free version. The coding obtained from ChatGPT was analyzed by a senior medical auditor/coder and compared with the expected results. Results: Regarding the correct codes, ChatGPT’s performance was higher by approximately 29 percentage points between diagnoses and procedures, with greater proficiency in diagnostic codes. The accuracy rate for codes was similar across languages, with rates of 31.0% and 31.9%. The error rate in procedure codes was substantially higher than that in diagnostic codes by almost four times. For missing information, a higher incidence was observed in diagnoses compared to procedures of slightly more than double the comparative rates. Additionally, there was a statistically significant excess of codes not related to clinical information, which was higher in procedures and nearly the same value in both languages under study. Conclusion: Given the ease of access to these tools, this investigation serves as an awareness factor, demonstrating that ChatGPT can assist the medical coder in directed research. However, it does not replace their technical validation in this process. Therefore, further developments of this tool are necessary to increase the quality and reliability of the results.

2024-01-01T00:00:00Z