Murtagh Sara, McCombe Geoff, Broughan John, Carroll Áine, Casey Mary, Harrold Áine, Dennehy Thomas, Fawsitt Ronan, Cullen Walter
School of Medicine, University College Dublin, Ireland.
School of Nursing Midwifery and Health Systems, University College Dublin, Ireland.
Int J Integr Care. 2021 Feb 9;21(1):4. doi: 10.5334/ijic.5508.
In Ireland, as in many healthcare systems, health policy has committed to delivering an integrated model of care to address the increasing burden of chronic disease. Integrated care is an approach to healthcare systems delivery that aims to minimise fragmentation of patient services and improve care continuity. To this end, how best to integrate primary and secondary care is a challenge. This paper aims to undertake a scoping review of empirical work on the integration of primary and secondary care in relation to chronic disease management.
A search was conducted of 'PubMed', 'Cochrane Library' and 'Google Scholar' for papers published between 2009-2019 using Arksey and O'Malley's framework for conducing scoping reviews.
Twenty-two studies were included. These reported research from a wide range of healthcare systems (most commonly UK, Australia, the Netherlands), adopted a range of methodologies (most commonly randomised/non-randomised controlled trials, case studies, qualitative studies) and among patients with a range of chronic conditions (most commonly diabetes, COPD, Parkinson's disease). No studies reported on interventions to address the needs of whole populations. Interventions to enhance integration included multidisciplinary teams, education of healthcare professionals, and e-health interventions. Among the effectiveness measures reported were improved disease specific outcomes, and cost effectiveness.
With healthcare systems increasingly recognising that integrated approaches to patient care can enhance chronic disease management, considerable literature now informs how this can be done. However, most of the research published has focussed on specific diseases and their clinical outcomes. Future research should focus on how such approaches may improve health outcomes for populations as a whole.
与许多医疗体系一样，爱尔兰的卫生政策致力于提供综合护理模式，以应对日益加重的慢性病负担。综合护理是一种医疗体系服务方式，旨在尽量减少患者服务的碎片化，提高护理的连续性。为此，如何最好地整合初级和二级护理是一项挑战。本文旨在对有关慢性病管理中初级和二级护理整合的实证研究进行范围综述。
使用阿克西和奥马利进行范围综述的框架，在“PubMed”“Cochrane图书馆”和“谷歌学术”中检索2009年至2019年发表的论文。
纳入了22项研究。这些研究报告了来自广泛医疗体系（最常见的是英国、澳大利亚、荷兰）的研究，采用了一系列方法（最常见的是随机/非随机对照试验、案例研究、定性研究），涉及患有一系列慢性病的患者（最常见的是糖尿病、慢性阻塞性肺疾病、帕金森病）。没有研究报告针对全体人群需求实施的干预措施。加强整合的干预措施包括多学科团队、医护人员教育和电子健康干预措施。报告的有效性指标包括特定疾病结局改善和成本效益。
随着医疗体系越来越认识到患者护理的综合方法可以加强慢性病管理，现在有大量文献说明了如何做到这一点。然而，已发表的大多数研究都集中在特定疾病及其临床结局上。未来的研究应关注这些方法如何改善整个人群的健康结局。
