O'Donnell Deirdre, Davies Carmel, Devaney Catherine, Radomska Apolonia, O'Shea Marie, O'Donoghue Gráinne, De Brún Aoife, Donnelly Sarah, Whitty Helen, Harnett P J, Lang Deirdre, Ahern Emer, Hammoud Sahar, Shé Éidín Ní
UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS Centre), University College Dublin, Belfield, Dublin 4, Ireland.
Syst Rev. 2025 May 27;14(1):117. doi: 10.1186/s13643-025-02862-8.
Community-centred care integration for older adults is a cornerstone of the WHO's Integrated Care for Older People (ICOPE) implementation framework. Realising the potential of care integration for older people requires cohesive coordination of services and interprofessional collaboration (IPC) within and across teams. There is a gap in research evidence to understand how IPC can be fostered and sustained within team-based community care integration for older people. We report on a realist evidence synthesis to identify the contextual influences and mechanisms that support IPC in interprofessional community care teams for older people.
The three phases of the realist synthesis included an exploratory scoping of research evidence and consultation with four local stakeholder groups to produce initial programme theories. The second phase involved systematic retrieval and synthesis of evidence, including peer-reviewed published empirical studies and grey literature recommended by an expert panel. The third phase involved the development of refined programme theory with stakeholder validation. The stakeholder cohorts included representatives of older people and caregivers, healthcare professionals and operational managers of community specialist older person teams, national policymakers, and programme managers.
The resource and reasoning mechanisms that enable contexts for IPC and their associated outcomes are identified within seven programme theory areas: (1) professional identity and growth, (2) information sharing and care coordination across boundaries, (3) effective operational and clinical governance, (4) developing a team learning culture, (5) meaningful inclusion of older people and caregivers, (6) quality improvement and programme development, (7) workforce planning and retention.
The results provide policymakers and clinicians with evidence-based programme theory that will catalyse critical dialogue on IPC implementation. This programme theory informs the prioritisation of resources to enable favourable contexts for successful IPC intervention development and implementation. This research complements and expands the work presented in the WHO ICOPE implementation framework. We encourage local realist application and evaluation of the programme theory within varying health system contexts.
以社区为中心的老年人综合护理是世界卫生组织老年人综合护理（ICOPE）实施框架的基石。要实现老年人护理整合的潜力，需要团队内部及跨团队的服务紧密协调和跨专业协作（IPC）。在基于团队的老年人社区护理整合中，关于如何促进和维持IPC的研究证据存在空白。我们报告了一项现实主义证据综合分析，以确定支持老年人跨专业社区护理团队中IPC的背景影响因素和机制。
现实主义综合分析的三个阶段包括对研究证据进行探索性范围界定，并与四个当地利益相关者群体进行磋商，以形成初步的项目理论。第二阶段涉及对证据进行系统检索和综合分析，包括同行评审的已发表实证研究以及专家小组推荐的灰色文献。第三阶段涉及在利益相关者验证的基础上完善项目理论。利益相关者群体包括老年人及其照顾者的代表、医疗保健专业人员以及社区老年专科团队的运营经理、国家政策制定者和项目经理。
在七个项目理论领域中确定了促成IPC环境及其相关结果的资源和推理机制：（1）专业身份与成长；（2）跨边界的信息共享与护理协调；（3）有效的运营和临床治理；（4）营造团队学习文化；（5）有意义地纳入老年人及其照顾者；（6）质量改进与项目开发；（7）劳动力规划与留用。
研究结果为政策制定者和临床医生提供了基于证据的项目理论，这将促进关于IPC实施的关键对话。该项目理论为资源优先配置提供了依据，以便为成功开展和实施IPC干预创造有利环境。本研究补充并扩展了世界卫生组织ICOPE实施框架中提出的工作。我们鼓励在不同的卫生系统背景下对该项目理论进行本土化的现实主义应用和评估。
