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Integrated Primary Care and Social Services for Older Adults With Multimorbidity in England: A Scoping Review

Integrated Primary Care and Social Services for Older Adults With Multimorbidity in England: A Scoping Review
Integrated Primary Care and Social Services for Older Adults With Multimorbidity in England: A Scoping Review
Background: As the prevalence of older adults with multimorbidity increases, greater integration of services is necessary to manage the physical and psycho-social needs of this cohort. This study describes and summarises current evidence, clinical provision and progress towards integrated primary care and social services for older adults with multimorbidity in England.

Methods: A scoping review was conducted involving systematic searches of a range of electronic academic and policy databases. Articles were screened and extracted in duplicate by two independent reviewers. Data were extracted onto a charting sheet and thematic synthesis was used to summarise findings. Articles were included if published in English and related to primary care, social care and multimorbidity in older adults in England. Conceptually, the review was framed using the Rainbow Model of Integrated Care.

Results: The search yielded 7656 articles of which 84 were included. Three themes were identified: (1) a focus on individual level services rather than multi-level or multi-sector integration, with an increasing emphasis on the need to consider broader determinants of population health as critical to integrated care for older adults with multimorbidity; (2) the need for policymakers to allow time for integration to embed, to enable new structures and relationships to develop and mature; and (3) the inherent tension between top-down and bottom-up driven approaches to integrated care requires a whole-systems structure, while allowing for local flexibilities.

Conclusions: There is limited evidence of multi-level and multi-sector integration of services for older adults with multimorbidity in England. The literature increasingly acknowledges wider determinants of population health that are likely to require integration beyond primary care and social services. Improving clinical care in one or two sectors may not be as effective as simultaneously improving the organisation or design across services as one single system of provision. This may take time to establish and will require local input.

Keywords: England; Integrated care; Multimorbidity; Older adults.
England, Integrated care, Multimorbidity, Older adults
1471-2318
Dambha-Miller, Hajira
58961db5-31aa-460e-9394-08590c4b7ba1
Simpson, Glenn
802b50d9-aa00-4cca-9eaf-238385f8481c
Hobson, Lucy
7343b281-6e17-4f8a-a465-6bc88d0728a7
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Everitt, Hazel
80b9452f-9632-45a8-b017-ceeeee6971ef
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
Dambha-Miller, Hajira
58961db5-31aa-460e-9394-08590c4b7ba1
Simpson, Glenn
802b50d9-aa00-4cca-9eaf-238385f8481c
Hobson, Lucy
7343b281-6e17-4f8a-a465-6bc88d0728a7
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Everitt, Hazel
80b9452f-9632-45a8-b017-ceeeee6971ef
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc

Dambha-Miller, Hajira, Simpson, Glenn, Hobson, Lucy, Roderick, Paul, Little, Paul, Everitt, Hazel and Santer, Miriam (2021) Integrated Primary Care and Social Services for Older Adults With Multimorbidity in England: A Scoping Review. BMC Geriatrics, 21 (1), [674]. (doi:10.1186/s12877-021-02618-8).

Record type: Article

Abstract

Background: As the prevalence of older adults with multimorbidity increases, greater integration of services is necessary to manage the physical and psycho-social needs of this cohort. This study describes and summarises current evidence, clinical provision and progress towards integrated primary care and social services for older adults with multimorbidity in England.

Methods: A scoping review was conducted involving systematic searches of a range of electronic academic and policy databases. Articles were screened and extracted in duplicate by two independent reviewers. Data were extracted onto a charting sheet and thematic synthesis was used to summarise findings. Articles were included if published in English and related to primary care, social care and multimorbidity in older adults in England. Conceptually, the review was framed using the Rainbow Model of Integrated Care.

Results: The search yielded 7656 articles of which 84 were included. Three themes were identified: (1) a focus on individual level services rather than multi-level or multi-sector integration, with an increasing emphasis on the need to consider broader determinants of population health as critical to integrated care for older adults with multimorbidity; (2) the need for policymakers to allow time for integration to embed, to enable new structures and relationships to develop and mature; and (3) the inherent tension between top-down and bottom-up driven approaches to integrated care requires a whole-systems structure, while allowing for local flexibilities.

Conclusions: There is limited evidence of multi-level and multi-sector integration of services for older adults with multimorbidity in England. The literature increasingly acknowledges wider determinants of population health that are likely to require integration beyond primary care and social services. Improving clinical care in one or two sectors may not be as effective as simultaneously improving the organisation or design across services as one single system of provision. This may take time to establish and will require local input.

Keywords: England; Integrated care; Multimorbidity; Older adults.

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Accepted/In Press date: 9 November 2021
Published date: 3 December 2021
Keywords: England, Integrated care, Multimorbidity, Older adults

Identifiers

Local EPrints ID: 454116
URI: http://eprints.soton.ac.uk/id/eprint/454116
ISSN: 1471-2318
PURE UUID: 5a3174d1-8f50-4671-be56-0cacb51f9f4f
ORCID for Hajira Dambha-Miller: ORCID iD orcid.org/0000-0003-0175-443X
ORCID for Glenn Simpson: ORCID iD orcid.org/0000-0002-1753-942X
ORCID for Paul Roderick: ORCID iD orcid.org/0000-0001-9475-6850
ORCID for Paul Little: ORCID iD orcid.org/0000-0003-3664-1873
ORCID for Hazel Everitt: ORCID iD orcid.org/0000-0001-7362-8403
ORCID for Miriam Santer: ORCID iD orcid.org/0000-0001-7264-5260

Catalogue record

Date deposited: 31 Jan 2022 17:49
Last modified: 12 Jul 2024 02:06

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Contributors

Author: Glenn Simpson ORCID iD
Author: Lucy Hobson
Author: Paul Roderick ORCID iD
Author: Paul Little ORCID iD
Author: Hazel Everitt ORCID iD
Author: Miriam Santer ORCID iD

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