Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland.
Faculty of Health Sciences, Curtin University, Perth, Australia.
PLoS One. 2018 Oct 11;13(10):e0205533. doi: 10.1371/journal.pone.0205533. eCollection 2018.
Integrated care is recognised as an important enabler to healthy ageing, yet few countries have managed to sustainably deliver integrated care for older people. We aimed to gather global consensus on the key actions required to realign health and long-term systems and integrate services to implement the World Health Organization (WHO) Integrated Care for Older People (ICOPE) approach.
A two-round eDelphi study, including a global consultation meeting, was undertaken to identify, refine and generate consensus on the actions required across high-, middle- and low-income countries to implement the WHO ICOPE approach. In round 1, a framework of 31 actions, empirically derived from previous WHO evidence reviews was presented to panellists to judge the relative importance of each action (numeric rating scale; range:1-9) and provide free-text comments concerning the scope of the actions. These outcomes were discussed and debated at the global consultation meeting. In round 2, a revised framework of 19 actions was presented to panellists to measure their extent of agreement and identify 'essential' actions (five-point Likert scale; range: strongly agree to strongly disagree). A threshold of ≥80% for agree/strongly agree was set a priori for consensus.
After round 1 (n = 80 panellists), median scores across 31 actions ranged from 6 to 9. Based on pre-defined category thresholds for median scores, panellists considered 28 actions (90·3%) as 'important' and three (9·7%) as 'uncertain'. Fifteen additional actions were suggested for inclusion based on free-text comments, creating 46 for consideration at the global consultation meeting. In round 2 (n = 84 panellists), agreement (agree or strongly agree) ranged from 84·6-97·6%, suggesting consensus. Fourteen (73·7%) actions were rated as essential.
Fourteen essential actions and five important actions are necessary at system (macro; n = 10) and service (meso; n = 9) levels to implement community-based integrated care for older people.
综合护理被认为是实现健康老龄化的重要手段，但很少有国家能够可持续地为老年人提供综合护理。我们旨在就重新调整卫生和长期护理系统以及整合服务以实施世界卫生组织（WHO）老年人综合护理（ICOPE）方法所需的关键行动达成全球共识。
采用两轮电子德尔菲研究，包括一次全球协商会议，以确定、完善和就实施 WHO ICOPE 方法在高、中、低收入国家所需的行动达成共识。在第一轮中，向小组成员提出了一个由 31 项行动组成的框架，这些行动是根据之前的 WHO 证据审查经验得出的，供小组成员判断每项行动的相对重要性（数字评分量表；范围：1-9），并就行动范围提供自由文本评论。这些结果在全球协商会议上进行了讨论和辩论。在第二轮中，向小组成员提出了一个经过修订的 19 项行动框架，以衡量他们的一致程度并确定“必要”行动（五点李克特量表；范围：非常同意到非常不同意）。事先设定了≥80%的同意/强烈同意作为共识的阈值。
第一轮（n=80 名小组成员）后，31 项行动的中位数得分范围为 6 至 9。根据中位数得分的预定义类别阈值，小组成员认为 28 项行动（90.3%）为“重要”，3 项行动（9.7%）为“不确定”。根据自由文本评论，还建议纳入 15 项额外行动，共 46 项在全球协商会议上审议。第二轮（n=84 名小组成员）的同意率（同意或强烈同意）范围为 84.6-97.6%，表明达成共识。14 项行动（73.7%）被评为必不可少。
实施以社区为基础的老年人综合护理需要在系统（宏观；n=10）和服务（中观；n=9）层面上采取 14 项必要行动和 5 项重要行动。
