Untangling the inter-relatedness within integrated care programmes for community-dwelling frail older people: a rapid realist review
Objective To 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.Desig...
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| Format: | Article |
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BMJ Publishing Group
2021-04-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/4/e043280.full |
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| author | Walter P Wodchis Hubertus J M Vrijhoef Anam Ahmed Maria E T C van den Muijsenbergh Janne C Mewes |
| author_facet | Walter P Wodchis Hubertus J M Vrijhoef Anam Ahmed Maria E T C van den Muijsenbergh Janne C Mewes |
| author_sort | Walter P Wodchis |
| collection | DOAJ |
| description | Objective To 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.Design Rapid realist review.Inclusion criteria Reviews 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).Analysis Selection 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).Results 27 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’.Conclusion Currently, 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). |
| format | Article |
| id | doaj-art-a5c76a8b5ffb489198ec606a5adf2e5e |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-a5c76a8b5ffb489198ec606a5adf2e5e2024-11-21T09:40:08ZengBMJ Publishing GroupBMJ Open2044-60552021-04-0111410.1136/bmjopen-2020-043280Untangling the inter-relatedness within integrated care programmes for community-dwelling frail older people: a rapid realist reviewWalter P Wodchis0Hubertus J M Vrijhoef1Anam Ahmed2Maria E T C van den Muijsenbergh3Janne C Mewes4Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, CanadaPanaxea B.V, Amsterdam, the NetherlandsPanaxea, Amsterdam, NetherlandsPrimary and Community Care, Radboudumc, Nijmegen, Gelderland, NetherlandsPanaxea, Amsterdam, NetherlandsObjective To 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.Design Rapid realist review.Inclusion criteria Reviews 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).Analysis Selection 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).Results 27 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’.Conclusion Currently, 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).https://bmjopen.bmj.com/content/11/4/e043280.full |
| spellingShingle | Walter P Wodchis Hubertus J M Vrijhoef Anam Ahmed Maria E T C van den Muijsenbergh Janne C Mewes Untangling the inter-relatedness within integrated care programmes for community-dwelling frail older people: a rapid realist review BMJ Open |
| title | Untangling the inter-relatedness within integrated care programmes for community-dwelling frail older people: a rapid realist review |
| title_full | Untangling the inter-relatedness within integrated care programmes for community-dwelling frail older people: a rapid realist review |
| title_fullStr | Untangling the inter-relatedness within integrated care programmes for community-dwelling frail older people: a rapid realist review |
| title_full_unstemmed | Untangling the inter-relatedness within integrated care programmes for community-dwelling frail older people: a rapid realist review |
| title_short | Untangling the inter-relatedness within integrated care programmes for community-dwelling frail older people: a rapid realist review |
| title_sort | untangling the inter relatedness within integrated care programmes for community dwelling frail older people a rapid realist review |
| url | https://bmjopen.bmj.com/content/11/4/e043280.full |
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