NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal.
King's College London, London, UK.
BMC Public Health. 2023 Aug 18;23(1):1579. doi: 10.1186/s12889-023-16485-y.
Universal recommendation for antiretroviral drugs and their effectiveness has put forward the challenge of assuring a chronic and continued care approach to PLHIV (People Living with HIV), pressured by aging and multimorbidity. Integrated approaches are emerging which are more responsive to that reality. Studying those approaches, and their relation to the what of delivery arrangements and the how of implementation processes, may support future strategies to attain more effective organizational responses.
We reviewed empirical studies on either HIV, multimorbidity, or both. The studies were published between 2011 and 2020, describing integrated approaches, their design, implementation, and evaluation strategy. Quantitative, qualitative, or mixed methods were included. Electronic databases reviewed cover PubMed, SCOPUS, and Web of Science. A narrative analysis was conducted on each study, and data extraction was accomplished according to the Effective Practice and Organisation of Care taxonomy of health systems interventions.
A total of 30 studies, reporting 22 different interventions, were analysed. In general, interventions were grounded and guided by models and frameworks, and focused on specific subpopulations, or priority groups at increased risk of poorer outcomes. Interventions mixed multiple integrated components. Delivery arrangements targeted more frequently clinical integration (n = 13), and care in proximity, community or online-telephone based (n = 15). Interventions reported investments in the role of users, through self-management support (n = 16), and in coordination, through multidisciplinary teams (n = 9) and continuity of care (n = 8). Implementation strategies targeted educational and training activities (n = 12), and less often, mechanisms of iterative improvement (n = 3). At the level of organizational design and governance, interventions mobilised users and communities through representation, at boards and committees, and through consultancy, along different phases of the design process (n = 11).
The data advance important lessons and considerations to take steps forward from disease-focused care to integrated care at two critical levels: design and implementation. Multidisciplinary work, continuity of care, and meaningful engagement of users seem crucial to attain care that is comprehensive and more proximal, within or cross organizations, or sectors. Promising practices are advanced at the level of design, implementation, and evaluation, that set integration as a continued process of improvement and value professionals and users' knowledge as assets along those phases.
PROSPERO number CRD42020194117.
普遍推荐抗逆转录病毒药物及其有效性，给 PLHIV（艾滋病毒感染者）带来了挑战，需要确保他们能够获得慢性和持续的护理，因为他们正在逐渐衰老，并且还患有多种疾病。为了应对这一现实，出现了一些综合方法。研究这些方法及其与提供安排的“什么”和实施过程的“如何”之间的关系，可能有助于为未来制定更有效的组织应对策略提供支持。
我们回顾了 2011 年至 2020 年间发表的关于 HIV、多种疾病或两者的实证研究。这些研究描述了综合方法、它们的设计、实施和评估策略。纳入了定量、定性或混合方法。审查的电子数据库包括 PubMed、SCOPUS 和 Web of Science。对每一项研究进行叙述性分析，并根据健康系统干预的有效实践和组织护理分类法进行数据提取。
共分析了 30 项研究，报告了 22 项不同的干预措施。一般来说，干预措施基于模型和框架，并针对特定的亚人群或处于较差结果风险增加的优先群体。干预措施混合了多种综合组成部分。提供安排更频繁地针对临床整合（n=13）和靠近（n=15）、社区或在线电话为基础的护理。干预措施报告了对用户角色的投资，通过自我管理支持（n=16）和通过多学科团队（n=9）和连续护理（n=8）进行协调。实施策略针对教育和培训活动（n=12），迭代改进机制则较少（n=3）。在组织设计和治理层面，干预措施通过代表、董事会和委员会，以及通过咨询，在设计过程的不同阶段，动员用户和社区参与（n=11）。
数据提供了重要的经验教训和考虑因素，以便从以疾病为重点的护理向前迈进，在两个关键层面实现综合护理：设计和实施。多学科工作、连续性护理和用户的有意义参与，对于在组织内或跨组织或部门提供更全面和更接近的护理至关重要。在设计、实施和评估层面上，有一些有希望的实践方法，将整合作为一个持续改进的过程，并将专业人员和用户的知识作为这些阶段的资产。
PROSPERO 编号 CRD42020194117。
