Tseng Olivia L, Kim Grace, Ho Wan Yu, Lee Esther J, Chang Howard, Lacaille Diane, Newton Christie, Vasarhelyi Krisztina, Poureslami Iraj, Liow Eric, Mitton Craig
Department of Family Practice, University of British Columbia, Vancouver, BC Canada
Centre for Clinical Epidemiology & Evaluation, Vancouver, BC Canada.
Ann Fam Med. 2025 Jul 28;23(4):350-362. doi: 10.1370/afm.240118.
Strengthening primary care's integration function is a systematic approach to promote integrated care. Understanding the factors influencing the process of integrating care for every patient is crucial for effective intervention planning. The objective of this study was to generate an analytic framework and evidence map of the barriers and facilitators perceived by family physicians (FPs) in clinical integration, a process to coordinate health care services across time, place, discipline, diseases, and patient demographics.
Using the Joanna Briggs Institute umbrella review methodology, we searched the MEDLINE, Embase, and CINAHL databases, identifying 90 reviews (2010-2022) on primary care FPs and clinical integration. We adopted a best-fit framework approach to group the factors into a customized clinical integration framework, reflecting how a health care system functions. Two evidence maps were created to visualize the reviews' distribution. We validated the framework with another 21 reviews (2022-2024).
The analytic framework consisted of 9 themes and 21 subthemes based on 2,891 factors derived from external and internal sources within primary care practices. Several subthemes were common across themes related to individuals (FPs, physicians other than family physicians and allied health providers, patients) and operating units (systems, organizations, practices), highlighting shared elements. The professional theme was the most significant, appearing in 86% of the reviews and including subthemes related to diseases, clinical guidelines, and teamwork. In contrast, themes related to systems, organizations, and practices were reported less frequently (48%, 22%, and 23%).
The complex interactions among factors, subthemes, and themes elucidate challenges in finding a universal strategy or implementing initiatives. The generated evidence maps indicated knowledge gaps to guide future research work.
加强初级保健的整合功能是促进综合医疗服务的系统方法。了解影响每位患者医疗服务整合过程的因素对于制定有效的干预计划至关重要。本研究的目的是生成一个分析框架和证据图谱，以展示家庭医生在临床整合（这是一个跨时间、地点、学科、疾病和患者人口统计学协调医疗服务的过程）中所感知到的障碍和促进因素。
我们采用乔安娜·布里格斯研究所的系统评价方法，检索了MEDLINE、Embase和CINAHL数据库，共识别出90篇关于初级保健家庭医生和临床整合的综述（2010年至2022年）。我们采用最佳拟合框架方法将这些因素分组到一个定制的临床整合框架中，以反映医疗系统的运作方式。创建了两个证据图谱来直观展示综述的分布情况。我们用另外21篇综述（2022年至2024年）对该框架进行了验证。
分析框架由9个主题和21个子主题组成，这些主题基于从初级保健实践的外部和内部来源得出的2891个因素。在与个体（家庭医生、非家庭医生的内科医生和专职医疗人员、患者）和运营单位（系统、组织、机构）相关的主题中，有几个子主题是共有的，突出了共享元素。专业主题最为显著，出现在86%的综述中，包括与疾病、临床指南和团队合作相关的子主题。相比之下，与系统、组织和机构相关的主题出现频率较低（分别为48%、22%和23%）。
因素、子主题和主题之间的复杂相互作用揭示了在寻找通用策略或实施举措方面的挑战。生成的证据图谱指出了知识空白，以指导未来的研究工作。
