Systematic review of integrated models of health care delivered at the primary–secondary interface: how effective is it and what determines effectiveness?
Geoffrey K. Mitchell A , Letitia Burridge B D , Jianzhen Zhang B , Maria Donald B , Ian A. Scott C , Jared Dart A and Claire L. Jackson B
+ Author Affiliations
- Author Affiliations
A School of Medicine, The University of Queensland, Ipswich Campus, Salisbury Road, Ipswich, Qld 4305, Australia.
B Discipline of General Practice, School of Medicine, The University of Queensland, Level 8, Health Sciences Building, Building 16/910, Royal Brisbane & Women’s Hospitals, Herston Road, Herston, Qld 4006, Australia.
C Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Qld 4102, Australia.
D Corresponding author. Email: l.burridge@uq.edu.au
Australian Journal of Primary Health 21(4) 391-408 https://doi.org/10.1071/PY14172
Submitted: 23 June 2014 Accepted: 11 April 2015 Published: 2 September 2015
Journal Compilation © La Trobe University 2015
Abstract
Integrated multidisciplinary care is difficult to achieve between specialist clinical services and primary care practitioners, but should improve outcomes for patients with chronic and/or complex chronic physical diseases. This systematic review identifies outcomes of different models that integrate specialist and primary care practitioners, and characteristics of models that delivered favourable clinical outcomes. For quality appraisal, the Cochrane Risk of Bias tool was used. Data are presented as a narrative synthesis due to marked heterogeneity in study outcomes. Ten studies were included. Publication bias cannot be ruled out. Despite few improvements in clinical outcomes, significant improvements were reported in process outcomes regarding disease control and service delivery. No study reported negative effects compared with usual care. Economic outcomes showed modest increases in costs of integrated primary–secondary care. Six elements were identified that were common to these models of integrated primary–secondary care: (1) interdisciplinary teamwork; (2) communication/information exchange; (3) shared care guidelines or pathways; (4) training and education; (5) access and acceptability for patients; and (6) a viable funding model. Compared with usual care, integrated primary–secondary care can improve elements of disease control and service delivery at a modestly increased cost, although the impact on clinical outcomes is limited. Future trials of integrated care should incorporate design elements likely to maximise effectiveness.
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