Integration of priority population, health and nutrition interventions into health systems: systematic review

BMC Public Health

Research Article

Josip Car¹  Olusoji Adeyi²  Kelechi Ohiri²  Rifat Atun³  Federica V Secci³  Thyra E de Jongh³ 

[1] Department of Primary Care and Social Medicine, Imperial College Faculty of Medicine, W6 8RP, London, UK;Human Development Network, The World Bank, 1818 H St., NW, 20433, Washington, DC, USA;Imperial College Business School, South Kensington Campus, SW7 2AZ, London, UK;

关键词: Primary Health Care;    Substance Abuse Treatment;    Substance Abuse Service;    Substance Abuse Treatment Service;    Cochrane Effective Practice;   

DOI  :  10.1186/1471-2458-11-780

 received in 2011-05-08, accepted in 2011-10-10,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundObjective of the study was to assess the effects of strategies to integrate targeted priority population, health and nutrition interventions into health systems on patient health outcomes and health system effectiveness and thus to compare integrated and non-integrated health programmes.MethodsSystematic review using Cochrane methodology of analysing randomised trials, controlled before-and-after and interrupted time series studies. We defined specific strategies to search PubMed, CENTRAL and the Cochrane Effective Practice and Organisation of Care Group register, considered studies published from January 1998 until September 2008, and tracked references and citations. Two reviewers independently agreed on eligibility, with an additional arbiter as needed, and extracted information on outcomes: primary (improved health, financial protection, and user satisfaction) and secondary (improved population coverage, access to health services, efficiency, and quality) using standardised, pre-piloted forms. Two reviewers in the final stage of selection jointly assessed quality of all selected studies using the GRADE criteria.ResultsOf 8,274 citations identified 12 studies met inclusion criteria. Four studies compared the benefits of Integrated Management of Childhood Illnesses in Tanzania and Bangladesh, showing improved care management and higher utilisation of health facilities at no additional cost. Eight studies focused on integrated delivery of mental health and substance abuse services in the United Kingdom and United States of America. Integrated service delivery resulted in better clinical outcomes and greater reduction of substance abuse in specific sub-groups of patients, with no significant difference found overall. Quality of care, patient satisfaction, and treatment engagement were higher in integrated delivery models.ConclusionsTargeted priority population health interventions we identified led to improved health outcomes, quality of care, patient satisfaction and access to care. Limited evidence with inconsistent findings across varied interventions in different settings means no general conclusions can be drawn on the benefits or disadvantages of integrated service delivery.

【 授权许可】

CC BY   
© Atun et al; licensee BioMed Central Ltd. 2011