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Research Article
Integrated Primary Care and Social Services for Older Adults With Multimorbidity in England: A Scoping Review
Hajira Dambha-Miller
University of Southampton
Corresponding Author
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This work is licensed under a CC BY 4.0 License. Read Full License
Background: As the prevalence of older adults with multimorbidity increases, greater integration of services is necessary to manage the range of physical and social needs of the population. The aim of this study is to describe and summarise current evidence, clinical provision and progress towards integrated primary care and social services for older adults with multimorbidity in an English context.
Methods: A scoping review was conducted which included a systematic electronic search of Medline, EMBASE, The Cochrane Library, Web of Science, the Cumulative Index to Nursing and Allied Health Literature, Science and Social Science Citation Indices and Opengrey from data inception until the 16th June 2020. Articles were screened and extracted in duplicate by two independent reviewers. Data were extracted onto a charting sheet and thematic synthesis used to summarise findings.
Results: Our search yielded 7656 papers of which 84 papers were included. Three themes were identified: (1) diverse 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 in multimorbidity; (2) time was needed for integration to embed to allow new structures and relationships to develop and mature; and (3) we identified inherent tension between top-down and bottom-up driven approaches to integrated care that 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 an English context. 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
Integrated care, older adults, multimorbidity, England
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CURRENT STATUS: Under Review
Version 1
Posted 13 Jan, 2021
No community comments so far
Reviewers invited
Invitations sent on 15 Jan, 2021
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On 15 Jan, 2021
Editor invited
On 08 Jan, 2021
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On 08 Jan, 2021
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On 04 Jan, 2021
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Subject Areas
Geriatrics & Gerontology
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This preprint is under consideration at BMC Geriatrics. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Integrated Primary Care and Social Services for Older Adults With Multimorbidity in England: A Scoping Review
Hajira Dambha-Miller
University of Southampton
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 13 Jan, 2021
No community comments so far
Reviewers invited
Invitations sent on 15 Jan, 2021
Editor assigned
On 15 Jan, 2021
Editor invited
On 08 Jan, 2021
Submission checks complete
On 08 Jan, 2021
First submitted
On 04 Jan, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Geriatrics & Gerontology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: As the prevalence of older adults with multimorbidity increases, greater integration of services is necessary to manage the range of physical and social needs of the population. The aim of this study is to describe and summarise current evidence, clinical provision and progress towards integrated primary care and social services for older adults with multimorbidity in an English context.
Methods: A scoping review was conducted which included a systematic electronic search of Medline, EMBASE, The Cochrane Library, Web of Science, the Cumulative Index to Nursing and Allied Health Literature, Science and Social Science Citation Indices and Opengrey from data inception until the 16th June 2020. Articles were screened and extracted in duplicate by two independent reviewers. Data were extracted onto a charting sheet and thematic synthesis used to summarise findings.
Results: Our search yielded 7656 papers of which 84 papers were included. Three themes were identified: (1) diverse 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 in multimorbidity; (2) time was needed for integration to embed to allow new structures and relationships to develop and mature; and (3) we identified inherent tension between top-down and bottom-up driven approaches to integrated care that 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 an English context. 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.
Figure 1
Figure 2
Due to technical limitations, figure 3 is only available as a download in the Supplemental Files section.