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

• Published in: PloS one Vol. 14; no. 5; p. e0216488
• Main Authors: Sadler, Euan, Potterton, Victoria, Anderson, Ruth, Khadjesari, Zarnie, Sheehan, Katie, Butt, Farida, Sevdalis, Nick, Sandall, Jane
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13-05-2019; Public Library of Science (PLoS)
• Subjects: Aged; Aged, 80 and over; Beliefs, opinions and attitudes; Caregivers; Citation analysis; Co-design; Collaboration; Community health care; Continuity of care; Decision Making; Delivery of Health Care; Delivery of Health Care, Integrated; Elderly; Environmental science; Female; Frail elderly; Frailty; Health aspects; Health care; Health sciences; Health services; Health Services Needs and Demand; Humans; Identification methods; Life sciences; Male; Medical care quality; Medicine and Health Sciences; Narration; Navigation systems; Neurosciences; Older people; Patient care; People and Places; Physicians; Practice; Psychiatry; Qualitative research; Research and Analysis Methods; Social sciences; Synthesis; Systematic review; United Kingdom; United Kingdom > UK; England
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0216488

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.
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.
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.
Similarities and differences in lay and professional stakeholder perspectives on integrated care for OPF and factors perceived to facilitate and hinder implementation were evident. Findings highlight the importance of addressing organisational and system level components of integrated care and factors influencing implementation for OPF. Greater attention needs to be placed on collaboratively involving service users, carers and providers to improve the co-design and implementation of integrated care programmes for this patient population.