Organisation and integrated healthcare approaches for people living with HIV, multimorbidity, or both: a systematic review

BMC Public Health

Research

Tiago Rua¹  Ana Escoval²  Vanessa Nicolau²  Daniela Brandão² 

[1]King’s College London, London, UK

[2]NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal

关键词: Integrated care;    People-centred care;    HIV infection;    Multimorbidity;    Continuity of care;    Self-management;    Care coordination;    Change management;    Coproduction;    Learning health systems;   

DOI  :  10.1186/s12889-023-16485-y

 received in 2022-12-12, accepted in 2023-08-09,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundUniversal recommendation for antiretroviral drugs and their effectiveness has put forward the challenge of assuring a chronic and continued care approach to PLHIV (People Living with HIV), pressured by aging and multimorbidity. Integrated approaches are emerging which are more responsive to that reality. Studying those approaches, and their relation to the what of delivery arrangements and the how of implementation processes, may support future strategies to attain more effective organizational responses.MethodsWe reviewed empirical studies on either HIV, multimorbidity, or both. The studies were published between 2011 and 2020, describing integrated approaches, their design, implementation, and evaluation strategy. Quantitative, qualitative, or mixed methods were included. Electronic databases reviewed cover PubMed, SCOPUS, and Web of Science. A narrative analysis was conducted on each study, and data extraction was accomplished according to the Effective Practice and Organisation of Care taxonomy of health systems interventions.ResultsA total of 30 studies, reporting 22 different interventions, were analysed. In general, interventions were grounded and guided by models and frameworks, and focused on specific subpopulations, or priority groups at increased risk of poorer outcomes. Interventions mixed multiple integrated components. Delivery arrangements targeted more frequently clinical integration (n = 13), and care in proximity, community or online-telephone based (n = 15). Interventions reported investments in the role of users, through self-management support (n = 16), and in coordination, through multidisciplinary teams (n = 9) and continuity of care (n = 8). Implementation strategies targeted educational and training activities (n = 12), and less often, mechanisms of iterative improvement (n = 3). At the level of organizational design and governance, interventions mobilised users and communities through representation, at boards and committees, and through consultancy, along different phases of the design process (n = 11).ConclusionThe data advance important lessons and considerations to take steps forward from disease-focused care to integrated care at two critical levels: design and implementation. Multidisciplinary work, continuity of care, and meaningful engagement of users seem crucial to attain care that is comprehensive and more proximal, within or cross organizations, or sectors. Promising practices are advanced at the level of design, implementation, and evaluation, that set integration as a continued process of improvement and value professionals and users’ knowledge as assets along those phases.Trial registrationPROSPERO number CRD42020194117.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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