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Service user, carer and provider perspectives on integrated care for older people with frailty, and factors perceived to facilitate and hinder implementation: a systematic review and narrative synthesis: a systematic review and narrative synthesis

Service user, carer and provider perspectives on integrated care for older people with frailty, and factors perceived to facilitate and hinder implementation: a systematic review and narrative synthesis: a systematic review and narrative synthesis
Service user, carer and provider perspectives on integrated care for older people with frailty, and factors perceived to facilitate and hinder implementation: a systematic review and narrative synthesis: a systematic review and narrative synthesis

Introduction Older people with frailty (OPF) can experience reduced quality of care and adverse outcomes due to poorly coordinated and fragmented care, making this patient population a key target group for integrated care. This systematic review explores service user, carer and provider perspectives on integrated care for OPF, and factors perceived to facilitate and hinder implementation, to draw out implications for policy, practice and research. Methods Systematic review and narrative synthesis of qualitative studies identified from MEDLINE, CINAHL, PsycINFO and Social Sciences Citation Index, hand-searching of reference lists and citation tracking of included studies, and review of experts’ online profiles. Quality of included studies was appraised with The Critical Appraisal Skills Programme tool for qualitative research. Results Eighteen studies were included in the synthesis. We identified four themes related to stakeholder perspectives on integrated care for OPF: different preferences for integrated care among service users, system and service organisation components, relational aspects of care and support, and stakeholder perceptions of outcomes. Service users and carers highlighted continuity of care with a professional they could trust, whereas providers emphasised improved coordination of care between providers in different care sectors as key strategies for integrated care. We identified three themes related to factors facilitating and hindering implementation: perceptions of the integrated care intervention and target population, service organisational factors and system level factors influencing implementation. Different stakeholder groups perceived the complexity of care needs of this patient population, difficulties with system navigation and access, and limited service user and carer involvement in care decisions as key factors hindering implementation. Providers mainly also highlighted other organisational and system factors perceived to facilitate and hinder implementation of integrated care for OPF.

1932-6203
1-25
Sadler, Euan
e5891abe-c97b-4e74-b9b3-6d7c43435360
Potterton, Victoria
716e821b-a5ff-4937-93c7-0674cbdedbc0
Anderson, Ruth
d6052fa0-74a1-42dc-84ca-1ae4621b84e0
Khadjesari, Zarnie
f381df38-624a-4d29-88d0-68344fa2975b
Sheehan, Katie
399341f6-4c3b-4fa7-8847-a3235aeb2dcd
Butt, Farida
4a8907bc-af2b-457b-a0a3-2ee5dd6f97eb
Sevdalis, Nick
0910262b-1085-41fa-931c-40b643912854
Sandall, Jane
12cd61c5-5f93-47df-82df-d383bcbf31a0
Sadler, Euan
e5891abe-c97b-4e74-b9b3-6d7c43435360
Potterton, Victoria
716e821b-a5ff-4937-93c7-0674cbdedbc0
Anderson, Ruth
d6052fa0-74a1-42dc-84ca-1ae4621b84e0
Khadjesari, Zarnie
f381df38-624a-4d29-88d0-68344fa2975b
Sheehan, Katie
399341f6-4c3b-4fa7-8847-a3235aeb2dcd
Butt, Farida
4a8907bc-af2b-457b-a0a3-2ee5dd6f97eb
Sevdalis, Nick
0910262b-1085-41fa-931c-40b643912854
Sandall, Jane
12cd61c5-5f93-47df-82df-d383bcbf31a0

Sadler, Euan, Potterton, Victoria, Anderson, Ruth, Khadjesari, Zarnie, Sheehan, Katie, Butt, Farida, Sevdalis, Nick and Sandall, Jane (2019) Service user, carer and provider perspectives on integrated care for older people with frailty, and factors perceived to facilitate and hinder implementation: a systematic review and narrative synthesis: a systematic review and narrative synthesis. PLoS ONE, 14 (5), 1-25, [e0216488]. (doi:10.1371/journal.pone.0216488).

Record type: Article

Abstract

Introduction Older people with frailty (OPF) can experience reduced quality of care and adverse outcomes due to poorly coordinated and fragmented care, making this patient population a key target group for integrated care. This systematic review explores service user, carer and provider perspectives on integrated care for OPF, and factors perceived to facilitate and hinder implementation, to draw out implications for policy, practice and research. Methods Systematic review and narrative synthesis of qualitative studies identified from MEDLINE, CINAHL, PsycINFO and Social Sciences Citation Index, hand-searching of reference lists and citation tracking of included studies, and review of experts’ online profiles. Quality of included studies was appraised with The Critical Appraisal Skills Programme tool for qualitative research. Results Eighteen studies were included in the synthesis. We identified four themes related to stakeholder perspectives on integrated care for OPF: different preferences for integrated care among service users, system and service organisation components, relational aspects of care and support, and stakeholder perceptions of outcomes. Service users and carers highlighted continuity of care with a professional they could trust, whereas providers emphasised improved coordination of care between providers in different care sectors as key strategies for integrated care. We identified three themes related to factors facilitating and hindering implementation: perceptions of the integrated care intervention and target population, service organisational factors and system level factors influencing implementation. Different stakeholder groups perceived the complexity of care needs of this patient population, difficulties with system navigation and access, and limited service user and carer involvement in care decisions as key factors hindering implementation. Providers mainly also highlighted other organisational and system factors perceived to facilitate and hinder implementation of integrated care for OPF.

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Submitted date: 2017
Accepted/In Press date: 22 April 2019
Published date: 13 May 2019

Identifiers

Local EPrints ID: 431361
URI: http://eprints.soton.ac.uk/id/eprint/431361
ISSN: 1932-6203
PURE UUID: 78804ebf-07b0-4bcf-9844-f2e0a5e4b62b

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Date deposited: 29 May 2019 16:30
Last modified: 07 Oct 2020 00:15

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