Approaches to reducing fragmented care in systemic lupus erythematosus (SLE) and other multimorbid conditions: A realist review

Abstract

Introduction Fragmented care overwhelmingly affects populations with multimorbid chronic conditions, like systemic lupus erythematosus (SLE). However, strategies to mitigate care fragmentation typically focus on singular disease frameworks with insufficient evidence regarding approaches for individuals with two or more concurrent chronic conditions (multimorbidity). This review explores the literature to identify the (C)ontextual influences, underlying (M)echanisms, and associated (O)utcomes of fragmented care prevention in SLE and other multimorbid conditions. Methods A realist review was applied to systematically examine literature, including the search of >1300 published articles focused on SLE and multimorbidity, continuity of care, and approaches to mitigate fragmented care. The analysis was guided by care continuity elements and organized by fragmented care concepts explicated by the MacColl Institute for Healthcare Innovations Care Coordination Model and further grouped for context–mechanism–outcome (CMO) configurations. Results Fourteen articles met inclusion/exclusion criteria and were included in the sample to illustrate the relationship between C-M-O for approaches focused on fragmented care prevention. Favorable outcomes in mechanisms that produced positive responses to resources relevant to fragmented care prevention included 1) opportunities for exposure and negotiation within professional teams, 2) structured health education, role clarity, and access to adherence services for patients, and 3) awareness of workflow waste and use of clinical algorithms. Discussion Review findings suggest using a multidimensional approach to mitigate fragmented care in SLE and other multimorbid conditions. Multidimensional approaches should focus on shared decision-making, social support, social–cultural–economic factors, patient engagement, and technological infrastructure to support the complex care needs of the multimorbid patient.

Healthy ageing and longevity

“…The building blocks of such an approach are described in more detail by the authors in their paper. 2 To evaluate the caregiving burden and social support in family caregivers of patients with cancer and their influencing factors, Karimollahi et al 3 conducted a cross-sectional study among 190 family members in a local area in Iran. This study highlights that family caregivers of patients with cancer in Iran are in need of support.…”

“…In the current issue of the International Journal of Care Coordination , Sumpter et al 2 explored the literature to identify the contextual influences, underlying mechanisms, and associated outcomes of fragmented care prevention in Systemic Lupus Erythematosus (SLE) and other multimorbid conditions. Fourteen studies were included in this realist review.…”

“…The building blocks of such an approach are described in more detail by the authors in their paper. 2…”