Integrated healthcare models for rheumatoid arthritis: A descriptive systematic review

Abstract

Introduction: Integrated people-centred care is a modern approach for addressing healthcare issues related to demographic changes, increasing prevalence of chronic diseases, and restricted resources. By providing an overview of integrated care models for patients with rheumatoid arthritis, we aimed to offer insight into the strategies and interventions that are being used for designing and implementing integrated models of care for this patient group, and their outcomes. Methods: We conducted a systematic literature search of peer-reviewed literature available in English and published between 2013 and 2018, using three databases: Cochrane, PubMed and EMBASE. We analysed the publications based on the Framework on integrated people-centred health services and the Triple/Quadruple Aim framework. Results: We identified 1271 records. After screening, 50 articles met the criteria for inclusion in the review. Approaches for improving patient empowerment, engagement and experience of care were most prevalent in the identified care profiles. Similarly, frequently reported outcomes were related to improvements in patients' experience of care and their health status. Most of the studies we reviewed did not demonstrate notable improvements from the perspective of cost-effectiveness or benefits for the healthcare workforce. Conclusions: Our findings suggest that for rheumatoid arthritis, integrated care is in the early stages of development. Strategies focusing on patient outcomes and patient satisfaction were found to be prioritised. Future initiatives aiming to redesign rheumatology care should adopt systems thinking perspective to better address all of the building blocks of people-centred integrated care.

Exploration of understanding of integrated care from a public health perspective: A scoping review

“…Both models originate in WHO. 33 , 34 These frameworks include a population health approach and focus on prevention among its guiding principles. The frameworks are aimed at all phases in the prevention and management of chronic conditions and combine the principles of “integrated” and “people centered” care, its vision is to encourage and guide the paradigm shift of healthcare provision toward, amongst other aims, a system that better corresponds to the needs of people with chronic disease.…”

Care coordination: Complicated or complex?

“…Much work needs to be done for patients with rheumatoid arthritis to experience and benefit from integrated care delivery. 6 Where patient centeredness has become an increasingly important feature for many health care organisations and systems, Kamimura et al examined it from the perspective of underserved primary care patients visiting a free clinic in Utah, United States of America. Most interestingly, their study shows that while better physical health is associated with higher levels of perceived empathy in consultation, high levels of emotional health and depression are not.…”