Effectiveness of comprehensive care programs for patients with multiple chronic conditions or frailty: A systematic literature review

Hopman, Petra; Bruin, Simone de; Forjaz, Maria João; Rodríguez‐Blázquez, Carmen; Tonnara, Giuseppe; Lemmens, Lidwien C.; Onder, Graziano; Baan, Caroline A.; Rijken, Mieke

doi:10.1016/j.healthpol.2016.04.002

Cited by 164 publications

(163 citation statements)

References 57 publications

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“…However, the development of new and more effective collaborative working arrangements is deemed necessary to serve imminent epidemiological and demographical demands [2]. It is envisioned that multi-professional team-based care approaches, in which professionals from different disciplines benefit from each other’s complementary skills and work towards common goals, will improve patient and provider satisfaction and the standards of care for persons with complex medical needs, such as mental illness, disabilities, multimorbidity or addictions [3456]. Likewise, interdisciplinary teamwork is regarded as a core skill for future healthcare professionals (HCPs) beyond the command of knowledge and facts [7].…”

Section: Introductionmentioning

confidence: 99%

A Scoping Review of Facilitators of Multi-Professional Collaboration in Primary Care

Sørensen¹,

Stenberg²,

Garnweidner-Holme

2018

Int J Integr Care

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Introduction:Multi-professional collaboration (MPC) is essential for the delivery of effective and comprehensive care services. As in other European countries, primary care in Norway is challenged by altered patient values and the increased expectations of health administrations to participate in team-based care. This scoping review reports on the organisational, processual, relational and contextual facilitators of collaboration between general practitioners (GP) and other healthcare professionals (HCPs) in primary care.Methods:A systematic search in specialist and Scandinavian databases retrieved 707 citations. Following the inclusion criteria, nineteen studies were considered eligible and examined according to Arksey and O’Malley’s methodological framework for scoping reviews. The retrieved literature was analysed employing a content analysis approach. A group of stakeholders commented on study findings to enhance study validity.Results:Primary care research into MPC is immature and emerging in Norway. Our analysis showed that introducing common procedures for documentation and handling of patient data, knowledge sharing, and establishing local specialised multi-professional teams, facilitates MPC. The results indicate that advancements in work practices benefit from an initial system-level foundation with focus on local management and MPC leadership. Further, our results show that it is preferable to enhance collaborative skills before introducing new professional teams, roles and responsibilities. Investing in professional relations could build trust, respect and continuity. In this respect, sufficient time must be allocated during the working day for professionals to share reflections and engage in mutual learning.Conclusion:There is a paucity of research concerning the application and management of MPC in Norwegian primary care. The work practices and relations between professionals, primary care institutions and stakeholders on a macro level is inadequate. Health care is a complex system in which HCPs need managerial support to harvest the untapped benefits of MPC in primary care. As international research demonstrates, local managers must be supported with infrastructure on a macro level to understand the embedding of practice and look at what professionals actually do and how they work.

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Section: Introductionmentioning

confidence: 99%

A Scoping Review of Facilitators of Multi-Professional Collaboration in Primary Care

Sørensen¹,

Stenberg²,

Garnweidner-Holme

2018

Int J Integr Care

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“…In this study, three key components were selected, which were considered to represent the main principles of integrated care (De Bruin et al, ; Hopman et al, ; Kodner & Spreeuwenberg, ): (a) comprehensiveness: focus on problems and (care) needs in different domains of life (e.g. physical, cognitive, psychological, social and environmental), (b) multidisciplinarity: involvement of health and social care professionals from multiple disciplines and sectors and (c) person‐centredness: active involvement of older people and their informal carers in decision‐making and planning their care process, and putting their capacities, needs and preferences at the centre.…”

Section: Methodsmentioning

confidence: 99%

Comprehensive geriatric assessments in integrated care programs for older people living at home: A scoping review

Stoop

Lette

Gils

et al. 2019

Health Soc Care Community

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In many integrated care programs, a comprehensive geriatric assessment (CGA) is conducted to identify older people's problems and care needs. Different ways for conducting a CGA are in place. However, it is still unclear which CGA instruments and procedures for conducting them are used in integrated care programs, and what distinguishes them from each other. Furthermore, it is yet unknown how and to what extent CGAs, as a component of integrated care programs, actually reflect the main principles of integrated care, being comprehensiveness, multidisciplinarity and person‐centredness. Therefore, the objectives of this study were to: (a) describe and compare different CGA instruments and procedures conducted within integrated care programs for older people living at home, and (b) describe how the principles of integrated care were applied in these CGAs. A scoping review of the scientific literature on CGAs in the context of integrated care was conducted for the period 2006–2018. Data were extracted on main characteristics of the identified CGA instruments and procedures, and on how principles of integrated care were applied in these CGAs. Twenty‐seven integrated care programs were included in this study, of which most were implemented in the Netherlands and the United States. Twenty‐one different CGAs were identified, of which the EASYcare instrument, RAI‐HC/RAI‐CHA and GRACE tool were used in multiple programs. The majority of CGAs seemed to reflect comprehensiveness, multidisciplinarity and person‐centredness, although the way and extent to which principles of integrated care were incorporated differed between the CGAs. This study highlights the high variability of CGA instruments and procedures used in integrated care programs. This overview of available CGAs and their characteristics may promote (inter‐)national exchange of CGAs, which could enable researchers and professionals in choosing from the wide range of existing CGAs, thereby preventing them from unnecessarily reinventing the wheel.

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“…A synthesis of 18 comprehensive programmes encompassing various components of the Chronic Care Model for people with multimorbidity or frailty reported some evidence of improved health-related quality of life, function, and satisfaction with care but no reduction in health services utilisation or costs [10]. These programmes included standard chronic care interventions such as case managers, multi-professional teams, and individualised care plans delivered at specific touchpoints in the care pathway.…”

Section: European Joint Actionmentioning

confidence: 99%

Integrated Care: A Collaborative ADVANTAGE for Frailty

Hendry¹,

Cariazo²,

Vanhecke³

et al. 2018

International Journal of Integrated Care

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Frailty is increasingly recognised as a public health priority due to the associated demand for acute and longer term health and social care support, and the impact on the lives of individuals, caregivers and families. Integrated care is widely considered to be most effective when applied to an older population, but there is limited data on outcomes and costs from studies of integrated care to prevent and manage frailty. This paper describes work by the ADVANTAGE Joint Action (JA), co-funded by the European Union and 22 Member States, to develop a common European approach to the prevention and management of frailty. The authors reflect on the emerging evidence and experience of implementing integrated care for frailty, and invite readers to participate in ongoing dialogue on this topic through the ADVANTAGE JA website and IFIC Academy activities.

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Effectiveness of comprehensive care programs for patients with multiple chronic conditions or frailty: A systematic literature review

Cited by 164 publications

References 57 publications

A Scoping Review of Facilitators of Multi-Professional Collaboration in Primary Care

A Scoping Review of Facilitators of Multi-Professional Collaboration in Primary Care

Comprehensive geriatric assessments in integrated care programs for older people living at home: A scoping review

Integrated Care: A Collaborative ADVANTAGE for Frailty

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