How stakeholder participation can contribute to systematic reviews of complex interventions

Although patient and public involvement in research is a requirement for research funding in many countries, the knowledge base for how to effectively involve people —and evidence of the effectiveness of involvement—is weak. This article describes how methods used in participatory health research were used to involve patients, clients, providers and community health workers across all stages of a realist review. Sustained involvement enabled better identification of the components of the complex intervention of communitybased peer support. It also challenged assumptions of how peer support is constructed, leading the review team to question whether the process of designing and implementing interventions has more influence on effectiveness than previously recognised in empirical studies. We conclude with a discussion on when sustained involvement should be used, and the challenges of incorporating it into the traditional researcher-led approach to systematic reviews.

Integrating funds for health and social care: an evidence review

Objectives

Integrated funds for health and social care are one possible way of improving care for people with complex care requirements. If integrated funds facilitate coordinated care, this could support improvements in patient experience, and health and social care outcomes, reduce avoidable hospital admissions and delayed discharges, and so reduce costs. In this article, we examine whether this potential has been realized in practice.

Methods

We propose a framework based on agency theory for understanding the role that integrated funding can play in promoting coordinated care, and review the evidence to see whether the expected effects are realized in practice. We searched eight electronic databases and relevant websites, and checked reference lists of reviews and empirical studies. We extracted data on the types of funding integration used by schemes, their benefits and costs (including unintended effects), and the barriers to implementation. We interpreted our findings with reference to our framework ...

The degree of integration of non-dispensing pharmacists in primary care practice and the impact on health outcomes: A systematic review

A non-dispensing pharmacist conducts clinical pharmacy services aimed at optimizing patients individual pharmacotherapy. Embedding a non-dispensing pharmacist in primary care practice enables collaboration, probably enhancing patient care. The degree of integration of non-dispending pharmacists into multidisciplinary health care teams varies strongly between settings. The degree of integration may be a determinant for its success. This study investigates how the degree of integration of a non-dispensing pharmacist impacts medication related health outcomes in primary care. 

Instruments Measuring Integrated Care: A Systematic Review of Measurement Properties

Integrated care is an important strategy for increasing health system performance. Despite ots growing significance, detailed evidence on the measurement properties of integrated care instruments remains vague and limited. This systematic review aims to provide evidence on the state of the art in measuring integrated care. 

Can chronic disease be managed through integrated care cost-effectively? Evidence from a systematic review.

The increase in demand for integrated care models to manage chronic disease is a challenge for the Irish health system, which is traditionally organised around the acute hospital services. Implementing integrated care programmes requires significant investment, and thus, their economic impact requires consideration.

AIMS:This paper updates the previous evidence on the cost-effectiveness of integrated care programmes to support the development of a cost-effective integrated care programme for chronic disease management.

METHODS: A systematic review of economic evaluations of integrated care programmes for chronic diseases (respiratory, cardiovascular, diabetes and musculoskeletal diseases) was performed using methods guided by the principles of conducting systematic reviews. The evidence was combined and summarised using a narrative synthesis. A meta-analysis of the evidence was not performed due to the heterogeneity of interventions and associated outcomes.

RESULTS: Six studies met the inclusion criteria; no study considered an integrated model of care that dealt with more than ...

The impact of cash transfers on social determinants of health and health inequalities in sub-Saharan Africa: a systematic review

Cash transfers (CTs) are now high on the agenda of most governments in low-and middle- income countries. Within the field of health promotion, CTs constitute a healthy public policy initiative as they have the potential to address the social determinants of health and health inequalities. A systematic review was conducted to synthesise the evidence on CTs´impacts on social determinants of health and health inequalities in sub-Saharan Africa, and to identify the barriers and facilitators of effective CTs.

Person-Centered Integrated Care for Chronic Kidney Disease

The effectiveness of person-centered integrated care strategies for CKD is uncertain. This study conducted a systematic review and meta-analysis of randomized, controlled trials to assess the effect of person-centered integrated care for CKD.
It searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (from inception to April of 2016), and selected randomized, controlled trials of person-centered integrated care interventions with a minimum follow-up of 3 months. Random-effects meta-analysis was used to assess the effect of person-centered integrated care.

Development of the ACTIVE framework to describe stakeholder involvement in systematic reviews

Involvement of patients, health professionals, and the wider public (‘stakeholders’) is seen to be beneficial to the quality, relevance and impact of research and may enhance the usefulness and uptake of systematic reviews. However, there is a lack of evidence and resources to guide researchers in how to actively involve stakeholders in systematic reviews. In this paper, we report the development of the ACTIVE framework to describe how stakeholders are involved in systematic reviews

Implications of interprofessional primary care team characteristics for health services and patient health outcomes: A systematic review with narrative synthesis

Interprofessional primary care (IPPC) teams are promoted as an alternative to single profession physician practices in primary care with focus on preventive care and chronic disease management. Characteristics of teams can have an impact on their performance.

Literature focused on the implications of team characteristics on team processes, such as teamwork, collaboration, or satisfaction of patients or providers. Despite heterogeneity of contexts, some trends are observable: shared space, common vision and goals, clear definitions of roles, and leadership as important to good teamwork. The impacts of these on health care outputs or patient health are not clear. So, this systematic review of extant evidence on the characteristics of interprofessional primary care teams can inform policy

Implications of interprofessional primary care team characteristics for health services and patient health outcomes: A systematic review with narrative synthesis

Interprofessional primary care (IPPC) teams are promoted as an alternative to single profession physician practices in primary care with focus on preventive care and chronic disease management. Characteristics of teams can have an impact on their performance.

However, the empirical evidence of the implications of IPPC team design on various aspects of care processes or health outcomes is specific to particular contexts, but a general understanding of optimal team design is not available.

Clinical leadership and integrated primary care: A systematic literature review

As numbers of chronically ill patients with complex healthcare needs are increasing, primary care professionals will be challenged to deliver integrated care. Integrated care is about ‘delivering seamless care for patients with complex long-term problems cutting across multiple services, providers and settings.
Leaders are needed to address healthcare changes essential for implementation of integrated primary care. What kind of leadership this needs, which professionals should fulfil this role and how these leaders can be supported remains unclear.

What do the healthcare experiences of people with long-term conditions tell us about person-centred care? A systematic review.

Growing numbers of people now live with long term conditions. For each person, the challenges are multiple and unique to that individual. In recognition of this, health policy places greater emphasis on the delivery of person-centred care (PCC). However, patients report declining levels of such care. One reason for this may be a mismatch between patient and professional/policy understanding of PCC. PCC does not depend on the efforts of the clinician alone, but results from a collaboration with the patient and needs to be enabled by the wider organisational and educational systems.

Integrated older people care and advanced practice nursing: an evidence-based review.

The world's population is aging rapidly. This is a fact, and the demand for services adapted to this new reality is increasingly necessary. The World Health Organization has proposed an integrative strategy centered on people. Here present a systematic review of strategies that address the care of older adults with the integrated care-centered approach to people.

Effective implementation approaches for healthy ageing interventions for older people: A rapid review

Given the advanced demographic transition in the world, seeking healthy aging is an imperative task. In this review, strategies that favor a better quality of life for the elderly are shown, including the interaction of different levels of care (intra and extra system). All of this results in better global health indicators for the elderly population, which in turn translates into less need for care by the system.

mHealth for Integrated People-Centred Health Services in the Western Pacific: A Systematic Review

The global move towards achieving Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs) requires a fundamental shift towards integrated healthcare systems. This vision of ‘Integrated care’ has been defined as a “coherent set of methods and models on the funding, administrative, organisational, service delivery and clinical levels designed to create connectivity, alignment and collaboration within and between the cure and care sectors.”

Digital Health includes the use of mobile health (mHealth) applications, social media and health information systems and data. With the Internet of Things (IoT), it improves the data flow and interface between self-care, home-based services, primary care, ambulatory care, outreach services, and hospital-based curative and palliative services

This review analized how mobile health (mHealth) to support integrated people-centred health services has been implemented and evaluated in the World Health Organization (WHO) Western Pacific Region (WPR).

Physician Assistants and Nurse Practitioners in Primary Care Plus: A Systematic Review

Shifting specialist care from the hospital to primary care/community care (also called primary care plus) is proposed as one option to reduce the increasing healthcare costs, improve quality of care and accessibility.

The aim of this systematic review was to get insight in primary care plus provided by physician assistants or nurse practitioners.

The Effect of Integration of Family Planning Into HIV Services on Contraceptive Use Among Women Accessing HIV Services in Low and Middle-Income Countries: A Systematic Review

There is substantial unmet need for family planning (FP) among women living with HIV (WLHIV), leading to unintended pregnancies and may contribute indirectly to increasing the risk of transmission of HIV. This review aims to determine whether integration of FP into HIV testing and care results in increased use of contraception, a reduction in unmet need for FP, improved use of safer conception methods and a reduction in unintended pregnancies in low and middle-income countries. The primary outcome of the review was contraceptive uptake and secondary outcomes included unmet need for FP, safer conception and unintended pregnancy.

The effect of integrated health care in patients with hypertension and diabetes: a systematic review and meta-analysis

A growing number of studies show that integrated health care provides comprehensive and continuous care to patients with hypertension or diabetes. However, there is still no consensus about the effect of integrated health care on patients with hypertension or diabetes. The objective of this study was to verify the effectiveness of integrated health care for patients with hypertension or diabetes by using a systematic review and meta-analysis.

Integrated Care Components in Transitional Care Models from Hospital to Home for Frail Older Adults: A Systematic Review

Frail older adults frequently experience transitions from hospital to home due to their complex care needs. Transitional care models (TCMs) are recommended to tackle adverse outcomes in frail patients. This review summarizes the use of integrated care components in addressing transitional care from hospital to home, provides an overview on reported outcomes and describes the impact of identified components on the outcomes hospital readmission and emergency department visit.

How can Big Data Analytics Support People-Centred and Integrated Health Services: A Scoping Review

Frail older adults frequently experience transitions from hospital to home due to their complex care needs. Transitional care models (TCMs) are recommended to tackle adverse outcomes in frail patients. This review summarizes the use of integrated care components in addressing transitional care from hospital to home, provides an overview on reported outcomes and describes the impact of identified components on the outcomes hospital readmission and emergency department visit.

Analysis of Variation in Organizational Definitions of Primary Care Panels: A Systematic Review

Primary care panel size plays an increasing role in measuring primary care providers (ie, physicians and advanced practice providers, which include nurse practitioners and physician assistants) workload, setting practice capacity, and determining pay and can influence the quality of care, access, and burnout. However, reported panel sizes vary widely.

This systematic review aims to identify how panels are defined, the degree of variation in these definitions, the consequences of different definitions of panel size, and research on the strengths of different approaches.

Patient-centered care in the Middle East and North African region: a systematic literature review

The need for patient centered care (PCC) and its subsequent implementation has gained policy maker attention worldwide. Despite the evidence showing the benefits and the challenges associated with practicing PCC in western countries there has been no comprehensive review of the literature on PCC practice in the Middle East and North African (MENA) region, yet there is good reason to think that the practices of PCC in these regions would be different.