a Department of Geriatric Medicine , Radboud University Medical Center, Radboud UMC Alzheimer Centre , Nijmegen , The Netherlands.
d Department of Primary and Community Care , Radboud University Medical Center, Radboud Institute for Health Sciences , Nijmegen , The Netherlands.
Eur J Gen Pract. 2019 Jan;25(1):7-18. doi: 10.1080/13814788.2018.1515907. Epub 2018 Nov 26.
Leaders are needed to address healthcare changes essential for implementation of integrated primary care. What kind of leadership this needs, which professionals should fulfil this role and how these leaders can be supported remains unclear.
To review the literature on the effectiveness of programmes to support leadership, the relationship between clinical leadership and integrated primary care, and important leadership skills for integrated primary care practice.
We systematically searched PubMed, CINAHL, Embase, PsycINFO until June 2018 for empirical studies situated in an integrated primarycare setting, regarding clinical leadership, leadership skills, support programmes and integrated-care models. Two researchers independently selected relevant studies and critically appraised studies on methodological quality, summarized data and mapped qualitative data on leadership skills.
Of the 3207 articles identified, 56 were selected based on abstract and title, from which 20 met the inclusion criteria. Selected papers were of mediocre quality. Two non-controlled studies suggested that leadership support programmes helped prepare and guide leaders and positively contributed to implementation of integrated primary care. There was little support that leaders positively influence implementation of integrated care. Leaders' relational and organizational skills as well as process-management and change-management skills were considered important to improve care integration. Physicians seemed to be the most adequate leaders.
Good quality research on clinical leadership in integrated primary care is scarce. More profound knowledge is needed about leadership skills, required for integrated-care implementation, and leadership support aimed at developing these skills.
需要领导者来应对实施综合初级保健所必需的医疗保健变革。这种领导需要什么样的领导，哪些专业人员应该担任这个角色，以及如何支持这些领导者，目前还不清楚。
综述支持领导的方案的有效性、临床领导与综合初级保健之间的关系以及综合初级保健实践所需的重要领导技能方面的文献。
我们系统地检索了 PubMed、CINAHL、Embase 和 PsycINFO 数据库，以获取 2018 年 6 月之前在综合初级保健环境中关于临床领导、领导技能、支持方案和综合保健模式的实证研究。两位研究人员独立选择相关研究，并对研究方法的质量进行批判性评估，总结数据并对领导技能的定性数据进行映射。
在确定的 3207 篇文章中，根据摘要和标题选择了 56 篇，其中 20 篇符合纳入标准。所选论文质量中等。两项非对照研究表明，领导支持方案有助于培养和指导领导者，并对综合初级保健的实施产生积极影响。几乎没有证据表明领导者会积极影响综合保健的实施。领导者的关系和组织技能以及流程管理和变革管理技能被认为对改善保健整合很重要。医生似乎是最合适的领导者。
综合初级保健中临床领导的高质量研究很少。需要更深入地了解实施综合保健所需的领导技能以及旨在培养这些技能的领导支持。
