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Elements of integrated care approaches for older people: a review of reviews
  1. Andrew M Briggs1,2,
  2. Pim P Valentijn3,4,5,
  3. Jotheeswaran A Thiyagarajan1,
  4. Islene Araujo de Carvalho1
  1. 1 Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland
  2. 2 School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
  3. 3 Department of Patient and Care, Maastricht University Medical Center, Maastricht, The Netherlands
  4. 4 Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
  5. 5 Integrated Care Evaluation, Essenburgh Research & Consultancy, Hierden, The Netherlands
  1. Correspondence to Professor Andrew M Briggs; A.Briggs{at}curtin.edu.au and Dr Islene Araujo de Carvalho; araujodecarvalho{at}who.int

Abstract

Objective The World Health Organization (WHO) recently proposed an Integrated Care for Older People approach to guide health systems and services in better supporting functional ability of older people. A knowledge gap remains in the key elements of integrated care approaches used in health and social care delivery systems for older populations. The objective of this review was to identify and describe the key elements of integrated care models for elderly people reported in the literature.

Design Review of reviews using a systematic search method.

Methods A systematic search was performed in MEDLINE and the Cochrane database in June 2017. Reviews of interventions aimed at care integration at the clinical (micro), organisational/service (meso) or health system (macro) levels for people aged ≥60 years were included. Non-Cochrane reviews published before 2015 were excluded. Reviews were assessed for quality using the Assessment of Multiple Systematic Reviews (AMSTAR) 1 tool.

Results Fifteen reviews (11 systematic reviews, of which six were Cochrane reviews) were included, representing 219 primary studies. Three reviews (20%) included only randomised controlled trials (RCT), while 10 reviews (65%) included both RCTs and non-RCTs. The region where the largest number of primary studies originated was North America (n=89, 47.6%), followed by Europe (n=60, 32.1%) and Oceania (n=31, 16.6%). Eleven (73%) reviews focused on clinical ‘micro’ and organisational ‘meso’ care integration strategies. The most commonly reported elements of integrated care models were multidisciplinary teams, comprehensive assessment and case management. Nurses, physiotherapists, general practitioners and social workers were the most commonly reported service providers. Methodological quality was variable (AMSTAR scores: 1–11). Seven (47%) reviews were scored as high quality (AMSTAR score ≥8).

Conclusion Evidence of elements of integrated care for older people focuses particularly on micro clinical care integration processes, while there is a relative lack of information regarding the meso organisational and macro system-level care integration strategies.

  • geriatric medicine
  • rehabilitation medicine

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 and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors JAT, PPV and IAC conceived the study. PPV designed the methods and undertook the search, appraisal, extraction and reporting of the data, with a subset performed by AMB. AMB and PPV drafted the manuscript, and all the authors revised it for intellectual content. All authors read and approved the final manuscript.

  • Funding The authors gratefully acknowledge the financial support for the broader programme of work provided by the Japanese Ministry of Health, Labour and Welfare. AMB is supported by a fellowship awarded by the Australian National Health and Medical Research Council (No 1132548) and the Global Alliance for Musculoskeletal Health with funding from the International League of Associations for Rheumatology (ILAR) and Curtin University (Australia).

  • Disclaimer The views expressed in this paper are those of the authors and do not necessarily reflect the views of WHO.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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