Models of integrated care for multi-morbidity assessed in systematic reviews: a scoping review.

BMC Health Serv Res

Centre for Evidence-based Health Care, Division Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.

Published: August 2023

AI Article Synopsis

  • - The study aimed to evaluate integrated models of care for treating multi-morbidity, noting that while such models are gaining prevalence, their definitions and effectiveness vary widely, making it hard to draw clear conclusions about their impact on patient outcomes.
  • - A scoping review of 22 systematic reviews revealed six common components of integrated care, including the types of chronic conditions addressed and the services provided, which differed based on the income levels of the countries studied.
  • - Results were mixed; while some reviews indicated benefits of integrated care on health outcomes, others showed no significant difference when compared to traditional care models, raising questions about the universal effectiveness of these approaches.

Article Abstract

Background: The prevalence of multi-morbidity is increasing globally. Integrated models of care present a potential intervention to improve patient and health system outcomes. However, the intervention components and concepts within different models of care vary widely and their effectiveness remains unclear. We aimed to describe and map the definitions, characteristics, components, and reported effects of integrated models of care in systematic reviews (SRs).

Methods: We conducted a scoping review of SRs according to pre-specified methods (PROSPERO 2019 CRD42019119265). Eligible SRs assessed integrated models of care at primary health care level for adults and children with multi-morbidity. We searched in PubMed (MEDLINE), Embase, Cochrane Database of Systematic Reviews, Epistemonikos, and Health Systems Evidence up to 3 May 2022. Two authors independently assessed eligibility of SRs and extracted data. We identified and described common components of integrated care across SRs. We extracted findings of the SRs as presented in the conclusions and reported on these verbatim.

Results: We included 22 SRs, examining data from randomised controlled trials and observational studies conducted across the world. Definitions and descriptions of models of integrated care varied considerably. However, across SRs, we identified and described six common components of integrated care: (1) chronic conditions addressed, (2) where services were provided, (3) the type of services provided, (4) healthcare professionals involved in care, (5) coordination and organisation of care and (6) patient involvement in care. We observed differences in the components of integrated care according to the income setting of the included studies. Some SRs reported that integrated care was beneficial for health and process outcomes, while others found no difference in effect when comparing integrated care to other models of care.

Conclusions: Integrated models of care were heterogeneous within and across SRs. Information that allows the identification of effective components of integrated care was lacking. Detailed, standardised and transparent reporting of the intervention components and their effectiveness on health and process outcomes is needed.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10463690PMC
http://dx.doi.org/10.1186/s12913-023-09894-7DOI Listing

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