Department of Psychiatry, University of Cambridge, Cambridge, UK.
Department of Psychology, University of Bath, Bath, UK.
J Child Psychol Psychiatry. 2023 Sep;64(9):1264-1279. doi: 10.1111/jcpp.13786. Epub 2023 Mar 20.
Children and young people (CYP) with comorbid physical and/or mental health conditions often struggle to receive a timely diagnosis, access specialist mental health care, and more likely to report unmet healthcare needs. Integrated healthcare is an increasingly explored model to support timely access, quality of care and better outcomes for CYP with comorbid conditions. Yet, studies evaluating the effectiveness of integrated care for paediatric populations are scarce.
This systematic review synthesises and evaluates the evidence for effectiveness and cost-effectiveness of integrated care for CYP in secondary and tertiary healthcare settings. Studies were identified through systematic searches of electronic databases: Medline, Embase, PsychINFO, Child Development and Adolescent Studies, ERIC, ASSIA and British Education Index.
A total of 77 papers describing 67 unique studies met inclusion criteria. The findings suggest that integrated care models, particularly system of care and care coordination, improve access and user experience of care. The results on improving clinical outcomes and acute resource utilisation are mixed, largely due to the heterogeneity of studied interventions and outcome measures used. No definitive conclusion can be drawn on cost-effectiveness since studies focused mainly on costs of service delivery. The majority of studies were rated as weak by the quality appraisal tool used.
The evidence of on clinical effectiveness of integrated healthcare models for paediatric populations is limited and of moderate quality. Available evidence is tentatively encouraging, particularly in regard to access and user experience of care. Given the lack of specificity by medical groups, however, the precise model of integration should be undertaken on a best-practice basis taking the specific parameters and contexts of the health and care environment into account. Agreed practical definitions of integrated care and associated key terms, and cost-effectiveness evaluations are a priority for future research.
患有躯体和/或精神健康合并症的儿童和青少年 (CYP) 往往难以及时获得诊断、获得专业精神卫生保健服务，并且更有可能存在未满足的医疗保健需求。综合医疗保健是一种越来越受关注的模式，旨在支持患有合并症的 CYP 及时获得服务、提高医疗保健质量并改善治疗结果。然而，评估综合护理对儿科人群有效性的研究却很少。
本系统综述综合评估了二级和三级医疗保健环境中针对 CYP 的综合护理的有效性和成本效益的证据。通过对电子数据库（Medline、Embase、PsychINFO、儿童发展与青少年研究、ERIC、ASSIA 和英国教育索引）进行系统搜索，确定了研究。
共有 77 篇描述 67 项独特研究的论文符合纳入标准。研究结果表明，综合护理模式，特别是系统护理和护理协调，可改善 CYP 获得医疗保健服务和患者体验。改善临床结局和急性资源利用的结果参差不齐，主要是因为所研究的干预措施和使用的结果测量指标存在异质性。由于研究主要集中在服务提供成本上，因此无法对成本效益做出明确结论。使用的质量评估工具将大多数研究评为弱。
针对儿科人群的综合医疗保健模式的临床有效性证据有限且质量中等。现有证据初步令人鼓舞，尤其是在医疗保健服务的获取和患者体验方面。然而，鉴于医疗保健专业团体缺乏特异性，应根据具体的参数和医疗保健环境的背景，以最佳实践为基础，开展特定的整合模式。综合护理的明确定义和相关关键术语，以及成本效益评估是未来研究的优先事项。
