Department of Family Practice, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
Centre for Clinical Epidemiology and Evaluation (C2E2), Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
BMJ Open. 2023 Jul 11;13(7):e067576. doi: 10.1136/bmjopen-2022-067576.
Clinical (service) integration in primary care settings describes how comprehensive care is coordinated by family physicians (FPs) over time across healthcare contexts to meet patient care needs. To improve care integration and healthcare service planning, a systematic approach to understanding its numerous influencing factors is paramount. The objective of this study is to generate a comprehensive map of FP-perceived factors influencing clinical integration across diseases and patient demographics.
We developed the protocol with the guidance of the Joanna Briggs Institute systematic review methodology framework. An information specialist built search strategies for MEDLINE, EMBASE and CINAHL databases using keywords and MeSH terms iteratively collected from a multidisciplinary team. Two reviewers will work independently throughout the study process, from article selection to data analysis. The identified records will be screened by title and abstract and reviewed in the full text against the criteria: FP in primary care (population), clinical integration (concept) and qualitative and mixed reviews published in 2011-2021 (context). We will first describe the characteristics of the review studies. Then, we will extract qualitative, FP-perceived factors and group them by content similarities, such as patient factors. Lastly, we will describe the types of extracted factors using a custom framework.
Ethics approval is not required for a systematic review. The identified factors will help generate an item bank for a survey that will be developed in the Phase II study to ascertain high-impact factors for intervention(s), as well as evidence gaps to guide future research. We will share the study findings with various knowledge users to promote awareness of clinical integration issues through multiple channels: publications and conferences for researchers and care providers, an executive summary for clinical leaders and policy-makers, and social media for the public.
临床（服务）整合是指家庭医生（FPs）在一段时间内通过跨越医疗保健环境的协调，提供综合护理以满足患者的护理需求。为了改善医疗服务整合和规划，了解其众多影响因素的系统方法至关重要。本研究的目的是生成一张全面的图表，展示影响跨疾病和患者人群的临床整合的 FP 感知因素。
我们在 Joanna Briggs 研究所系统评价方法框架的指导下制定了方案。一名信息专家使用多学科团队迭代收集的关键词和 MeSH 术语为 MEDLINE、EMBASE 和 CINAHL 数据库构建了搜索策略。两名评审员将在整个研究过程中独立工作，从文章选择到数据分析。将通过标题和摘要筛选确定的记录，并根据以下标准在全文中进行审查：初级保健中的 FP（人群）、临床整合（概念）以及 2011-2021 年发表的定性和混合评论（背景）。我们将首先描述综述研究的特征。然后，我们将提取定性的、FP 感知的因素，并根据内容相似性（例如患者因素）对其进行分组。最后，我们将使用自定义框架描述提取因素的类型。
系统评价不需要伦理批准。确定的因素将有助于为第二阶段研究开发的调查生成一个项目库，以确定干预的高影响因素，以及指导未来研究的证据差距。我们将通过多种渠道与各种知识用户分享研究结果，以提高对临床整合问题的认识：为研究人员和护理提供者发布出版物和会议，为临床领导和决策者编写执行摘要，以及为公众发布社交媒体。
