Children's Health, Rees-Jones Center for Foster Care Excellence, Dallas, Texas, USA.
Department of Epidemiology, Human Genetics, and Environmental Sciences, UT Health School of Public Health, Dallas Campus, Dallas, Texas, USA.
Child Care Health Dev. 2022 Sep;48(5):869-879. doi: 10.1111/cch.13000. Epub 2022 Mar 28.
Paediatric integrated care (PIC), which involves primary care and behavioural health clinicians working together with patients and families, has been promoted as a best practice in the provision of care. In this context, behavioural health includes behavioural elements in the care of mental health and substance abuse conditions, chronic illness and physical symptoms associated with stress, and addressing health behaviours. Models of and contexts in which PIC has been applied vary, as do the outcomes and measures used to determine its value. Thus, this study seeks to better understand (1) what paediatric subpopulations are receiving integrated care, (2) which models of PIC are being studied, (3) what PIC outcomes are being explored and what measures and strategies are being used to assess those outcomes, and (4) whether the various models are resulting in positive outcomes. These questions have significant policy and clinical implications, given current national- and state-level efforts aimed at promoting integrated health care.
This study utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews to identify relevant articles published between January 1994 and 30 June 2020. The search utilized three databases: PubMed, PsycInfo and CINAHL. A total of 28 articles met the eligibility criteria for inclusion.
Overall, acceptability of PIC appears to be high for patients and providers, with access, screening and engagement generally increasing. However, several gaps in the knowledge base on PIC were uncovered, and for some studies, ascertaining which models of integrated care were being implemented proved difficult.
PIC has the potential to improve access to and quality of behavioural health care, but more research is needed to understand what models of PIC prove most beneficial and which policies and conditions promote cost efficiency. Rigorous evaluation of patient outcomes, provider training, institutional buy-in and system-level changes are needed.
儿科综合护理（PIC）涉及初级保健和行为健康临床医生与患者和家庭合作，已被推广为提供护理的最佳实践。在这种情况下，行为健康包括心理健康和物质滥用、慢性疾病和与压力相关的身体症状以及处理健康行为的护理中的行为要素。实施 PIC 的模式和背景各不相同，用于确定其价值的结果和措施也各不相同。因此，本研究旨在更好地了解：（1）哪些儿科亚人群正在接受综合护理，（2）正在研究哪些 PIC 模式，（3）正在探索哪些 PIC 结果，以及正在使用哪些措施和策略来评估这些结果，以及（4）各种模式是否会带来积极的结果。鉴于当前国家和州一级旨在促进综合医疗保健的努力，这些问题具有重要的政策和临床意义。
本研究利用系统评价和荟萃分析扩展的首选报告项目来确定 1994 年 1 月至 2020 年 6 月 30 日期间发表的相关文章。搜索使用了三个数据库：PubMed、PsycInfo 和 CINAHL。共有 28 篇文章符合纳入标准。
总体而言，PIC 对患者和提供者的可接受性似乎很高，通常会增加获得、筛查和参与的机会。然而，在 PIC 的知识库中发现了一些空白，并且对于一些研究，确定正在实施的综合护理模式证明是困难的。
PIC 有可能改善行为健康护理的可及性和质量，但需要更多的研究来了解哪种 PIC 模式最有益，以及哪些政策和条件可以提高成本效益。需要对患者结果、提供者培训、机构认可和系统层面的变化进行严格评估。
