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Abstract
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).
- health policy
- international health services
- organisation of health services
- quality in health care
- primary care
- qualitative research
Data availability statement
Data are available upon reasonable request. Most of the data generated or analysed for this study are publicly available. Any additional information is available from the corresponding author upon request.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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- health policy
- international health services
- organisation of health services
- quality in health care
- primary care
- qualitative research
Data availability statement
Data are available upon reasonable request. Most of the data generated or analysed for this study are publicly available. Any additional information is available from the corresponding author upon request.
Supplementary materials
Supplementary Data
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Footnotes
Contributors AA: methods design, search strategy design, quality assessment, data acquisition, data extraction, data analysis, interpretation of data, design and writing of the manuscript. METCM: interpretation of data, regularly reviewing the work, providing feedback on manuscript, manuscript final approval. JCM: quality assessment, providing feedback on manuscript, manuscript final approval. WPW: interpretation of data, providing feedback on manuscript, manuscript final approval. HJMV: concept and design of overall study, quality assessment, data analysis, interpretation of data, regularly reviewing the work, providing feedback on manuscript, manuscript final approval.
Funding Panaxea received funding for the larger study on which this manuscript is based from the Dutch National Health Care Institute/Zorginstituut Nederland (grant number: 2018054142).
Disclaimer The funding party had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the article for publication. The views expressed are those of the authors and not necessarily those of the National Health Care Institute.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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