Untangling the inter-relatedness within integrated care programmes for community-dwelling frail older people: a rapid realist review

Abstract

ObjectiveTo identify the relationships between the context in which integrated care programmes (ICPs) for community-dwelling frail older people are applied, the mechanisms by which the programmes do (not) work and the outcomes resulting from this interaction by establishing a programme theory.DesignRapid realist review.Inclusion criteriaReviews and meta-analyses (January 2013–January 2019) and non-peer-reviewed literature (January 2013–December 2019) reporting on integrated care for community-dwelling frail older people (≥60 years).AnalysisSelection and appraisal of documents was based on relevance and rigour according to the Realist And Meta-narrative Evidence Syntheses: Evolving Standards criteria. Data on context, mechanisms, programme activities and outcomes were extracted. Factors were categorised into the five strategies of the WHO framework of integrated people-centred health services (IPCHS).Results27 papers were included. The following programme theory was developed: it is essential to establish multidisciplinary teams of competent healthcare providers (HCPs) providing person-centred care, closely working together and communicating effectively with other stakeholders. Older people and informal caregivers should be involved in the care process. Financial support, efficient use of information technology and organisational alignment are also essential. ICPs demonstrate positive effects on the functionality of older people, satisfaction of older people, informal caregivers and HCPs, and a delayed placement in a nursing home. Heterogeneous effects were found for hospital-related outcomes, quality of life, healthcare costs and use of healthcare services. The two most prevalent WHO-IPCHS strategies as part of ICPs are ‘creating an enabling environment’, followed by ‘strengthening governance and accountability’.ConclusionCurrently, most ICPs do not address all WHO-IPCHS strategies. In order to optimise ICPs for frail older people the interaction between context items, mechanisms, programme activities and the outcomes should be taken into account from different perspectives (system, organisation, service delivery, HCP and patient).

Consensus on Integrated Care for Older People Among Dutch Experts: A Delphi Study

“…The questionnaire continued with six general questions regarding gender, age, highest level of education, current job position, number of years working within the position, and number of years of experience with integrated care for older people. The questionnaire contained another 71 questions related to ICPs [ 13 ]. Participants were asked to indicate the relevance of 15 context items, 14 mechanisms, 20 programme-activities and 22 outcomes.…”

“…This study is part of a larger study, commissioned by the National Health Care Institute. In the first part of this study, an international rapid realist review (RRR) [ 13 ] was conducted with the objective to provide insight into the relationships between the context (C) (wider external items) in which ICPs for community-dwelling older people are applied, the mechanisms (M) (enablers, underlying entities, processes, or structures) by which the ICPs (do not) work, and the outcomes (O) (intended and unintended) resulting from this interaction [ 14 15 16 ]. As a result, the RRR established an initial programme theory (PT): a hypothesised explanation of how a complex intervention or programme is expected to work [ 17 18 ].…”

Living with frailty and haemodialysis: a qualitative study

“…A focus upon guideline-driven care, which prioritises clinical targets, has been linked with discordant treatment recommendations and communication between care providers and patients [ 17 , 37 , 38 ]. Efforts to streamline and enhance the co-ordination of care across sectors has been linked to increases in function, patient, carer and HCP satisfaction and reduced institutionalisation, our findings call for work to enhance the integration between kidney services and other health and social care services [ 39 ].…”

Information and Communication Technology Based Integrated Care for Older Adults: A Scoping Review

“…Integrated care refers to the management and provision of services to provide people with continuous health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation guidance and palliative care throughout their lives and to coordinate care at different levels and locations both within and outside the health sector [ 4 ], with the aim of improving the inability of low-quality, inefficient elderly service provision to meet the increasingly complex healthcare needs of older adults. As the ‘lubricant’ and ‘glue’ of integrated care systems, the effective use of ICT can increase access to and flow of information, increase work efficiency, improve care integration and management processes, address COVID-19 concerns and social isolation [ 5 ], and has been identified as an important enabler of integrated care delivery and coordination of primary health care [ 6 7 ].…”