Department of Biosciences and Arts & Sciences, University College London, London, United Kingdom.
Front Public Health. 2024 Jan 4;11:1286479. doi: 10.3389/fpubh.2023.1286479. eCollection 2023.
Integrated care refers to person-centered and coordinated, health and social care, and community services. Integrated care systems are partnerships of organizations that deliver health and care services which were placed on a statutory footing in England, April 2022. Due to the need for fast, accessible, and relevant evidence, a rapid review was conducted according to World Health Organization methods to determine barriers and enablers of integrated care across the United Kingdom, 2018-2022. Nine databases were searched for review articles reporting evaluation of integrated care interventions involving medical (clinical and diagnostic) and nonmedical (public health services and community-based or social care/person-centred care) approaches, quality checked with the Critical Appraisal Skills Program qualitative checklist. OpenGrey and hand searches were used to identify grey literature, quality checked with the Authority, Accuracy, Coverage, Objectivity, Date, and Significance checklist. Thirty-four reviews and 21 grey literature reports fitted inclusion criteria of adult physical/mental health outcomes/multiple morbidities. Thematic analysis revealed six themes (collaborative approach; costs; evidence and evaluation; integration of care; professional roles; service user factors) with 20 subthemes including key barriers (cost effectiveness; effectiveness of integrated care; evaluation methods; focus of evidence; future research; impact of integration) and enablers (accessing care; collaboration and partnership; concept of integration; inter-professional relationships; person-centered ethos). Findings indicated a paucity of robust research to evaluate such interventions and lack of standardized methodology to assess cost effectiveness, although there is growing interest in co-production that has engendered information sharing and reduced duplication, and inter-professional collaborations that have bridged task-related gaps and overlaps. The importance of identifying elements of integrated care associated with successful outcomes and determining sustainability of interventions meeting joined-up care and preventive population health objectives was highlighted.
整合照护是指以患者为中心、协调一致的医疗和社会照护以及社区服务。整合照护系统是提供医疗和照护服务的组织之间的合作伙伴关系，2022 年 4 月在英格兰将这些服务置于法定基础之上。由于需要快速、可及且相关的证据，根据世界卫生组织的方法，对 2018 年至 2022 年期间联合王国的整合照护障碍和促进因素进行了快速审查。对 9 个数据库进行了检索，以查找报告评估涉及医疗（临床和诊断）和非医疗（公共卫生服务以及基于社区或社会护理/以患者为中心的护理）方法的整合照护干预措施的评价文章，使用批判性评估技能计划定性清单进行质量检查。使用 OpenGrey 和手工搜索来确定灰色文献，使用权威、准确性、涵盖范围、客观性、日期和意义清单进行质量检查。34 篇综述和 21 篇灰色文献报告符合纳入成人身体/心理健康结果/多种合并症的标准。主题分析揭示了六个主题（协作方法；成本；证据和评估；照护整合；专业角色；服务使用者因素），有 20 个子主题，包括主要障碍（成本效益；整合照护的效果；评估方法；证据重点；未来研究；整合的影响）和促进因素（获得照护；合作和伙伴关系；整合概念；跨专业关系；以患者为中心的精神）。研究结果表明，缺乏评估此类干预措施的稳健研究，也缺乏评估成本效益的标准化方法，尽管人们越来越关注共同创作，这促进了信息共享和减少重复，并促进了跨专业合作，弥合了相关任务之间的差距和重叠。强调了确定与成功结果相关的整合照护要素以及确定符合联合照护和预防人群健康目标的干预措施可持续性的重要性。
