Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium.
Osteoporos Int. 2023 May;34(5):841-865. doi: 10.1007/s00198-023-06678-x. Epub 2023 Jan 25.
Integrated Osteoporosis Care (IOC) has been emerging over the past decade. To support integrated care initiatives, the World Health Organisation (WHO) has developed the Integrated People Centred Health Services (IPCHS) framework, which consists of five interdependent strategies. Five electronic databases (PubMed, Embase, World of Science, CINAHL, and Scopus) were searched for relevant studies published from January 1, 2010 to December 2022. Initiatives implementing collaborative practices and at least two IPCHS strategies were included. Quality assessment was performed using the Effective Public Health Practice Project checklist. Seventy-six publications describing 69 implementations met the inclusion criteria; 90% of them were implemented at the hospital level, and over half focused on secondary fracture prevention. Three implementations captured all five IPCHS strategies, and half applied three. Substrategies targeting individuals as beneficiaries were frequently employed. Substrategies requiring fundamental shifts (e.g., systemic coordination and updating) were seldomly implemented. Substantive heterogeneity in substrategy operationalization was observed. Patient education, standardized care, team-based care, care coordinators, and health care provider training were commonly pursued. IOC interventions have focused mainly on secondary fracture prevention in a hospital setting and have been narrowly operationalized. Future implementation should: employ all five IPCHS strategies; better align programmes, providers, and regulatory frameworks, while adapting funding mechanisms; and operationalize broader and more innovative substrategies.Registration: This review has been registered at the international prospective register of systematic reviews PROSPERO (CRD42021250244).
综合骨质疏松症护理（IOC）在过去十年中逐渐兴起。为了支持综合护理倡议，世界卫生组织（WHO）制定了综合以人为本的卫生服务（IPCHS）框架，该框架由五个相互依存的策略组成。五个电子数据库（PubMed、Embase、World of Science、CINAHL 和 Scopus）被搜索以获取 2010 年 1 月 1 日至 2022 年 12 月期间发表的相关研究。纳入了实施协作实践和至少两项 IPCHS 策略的倡议。使用有效公共卫生实践项目清单进行质量评估。有 76 篇描述了 69 项实施情况的出版物符合纳入标准；其中 90%在医院层面实施，超过一半的重点是二级骨折预防。有 3 项实施涵盖了所有 5 项 IPCHS 策略，其中一半实施了 3 项。以个人为受益人的亚策略经常被采用。很少实施需要根本转变的亚策略（例如，系统协调和更新）。在亚策略的实施方面存在实质性的异质性。经常追求患者教育、标准化护理、基于团队的护理、护理协调员和医疗保健提供者培训。IOC 干预措施主要集中在医院环境中的二级骨折预防，并且操作范围狭窄。未来的实施应：采用所有五项 IPCHS 策略；更好地协调方案、提供者和监管框架，同时调整供资机制；并实施更广泛和更具创新性的亚策略。注册：本综述已在国际前瞻性系统评价注册库 PROSPERO（CRD42021250244）中注册。
