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Search terms and search string

Search terms and search string

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Article
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Background: Integrated care interventions for chronic conditions can lead to improved outcomes, but it is not clear when and why this is the case. This study aims to answer the following two research questions: First, what are the context, mechanisms and outcomes of integrated care for people with type 2 diabetes? Second, what are the relationship...

Contexts in source publication

Context 1
... Cochrane and PubMed databases were searched for the period 2003-2013 using the following four groups of search terms: 1. health condition; 2. intervention type; 3. CCM components; and 4. implementation. Table 2 shows the complete search terms and search string. ...
Context 2
... studies took place elsewhere (Canada and Israel). Additional file 2: Table S2 shows the intervention types of the included studies. Nineteen studies included all CCM components [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43], ten studies concerned three compo- nents [44][45][46][47][48][49][50][51][52][53] and two studies targeted two components [54,55]. ...
Context 3
... studies included all CCM components [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43], ten studies concerned three compo- nents [44][45][46][47][48][49][50][51][52][53] and two studies targeted two components [54,55]. One study used practice implementation of the CCM as the dependent variable without reporting specific sub-components (indicated as empty cells in Additional file 2: Table S2) [56]. ...

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... The process by which models of integrated care are implemented is not well understood [27][28][29][30][31]; specifically, why these models work in some circumstances and not others [10,32,33]. There is growing emphasis on theory-based evaluations which are better equipped to deal with the complexity of introducing such multi-component interventions, like integrated care for chronic conditions such as diabetes, into complex and dynamic health systems [34]. ...
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... Self-management interventions, such as those in the American Diabetes Prevention Program [16] and Finnish Diabetes Prevention Study [17], are also recommended because they demonstrate that lifestyle changes are effective and have sustainable benefits [18][19][20][21][22][23]. These interventions appear to target constructs of the social cognitive theory that support behaviour change, such as observational learning, reinforcement and expectations within a social context, and self-efficacy [24,25]. ...
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... Two reviews [12,13] included low-income countries, namely Tanzania, Nigeria, India, Ethiopia, Ghana, Kenya, Uganda, Pakistan, Kosovo and Malawi. Seven reviews involved primary care [14][15][16][17][18][19][20], two systematic reviews covered primary, secondary and tertiary care [12,17], and 15 did not specify the level of care. A total of 87.5% of reviews used quality assessment tools for the included studies, and within these, the Critical Appraisal Skills Programme was used in 38%. ...
... Frequently mentioned barriers were the absence of a leader that establishes priorities and manages the implementation process [20,23,26,27,29]; difficulties with teamwork, lack of coordination and disagreement with colleagues [6,17,[26][27][28][29]; the absence of recognising the role of the professional and a lack of clarity of responsibilities [23,[26][27][28], and financial constrains for the adoption of new interventions [6,13,26,35]. ...
... [19] "The nurses did not complete the risk assessment because they thought it was the doctor's responsibility." [26] The facilitators were consistent leadership, which creates enthusiasm and provides clear objectives of care [16,19,20,22]; commitment of the multidisciplinary team members and the support of administrators [14,16,23]; the exchange of experiences among staff [23]; the superiors' support for the implementation of the guide [16,23], and confidence in other experienced colleagues [14,23]. ...
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Introduction: Clinical practice guidelines (CPGs) are designed to improve the quality of care and reduce unjustified individual variation in clinical practice. Knowledge of the barriers and facilitators that influence the implementation of the CPG recommendations is the first step in creating strategies to improve health outcomes. The present systematic meta-review sought to explore the barriers and facilitators for the implementation of CPGs. Methods: A search was conducted in the PubMed, Embase, Cochrane, Health System Evidence and International Guideline Library (G-I-N) databases. Systematic reviews of qualitative, quantitative or mixed-methods studies that identified barriers or facilitators for the implementation of CPGs were included. The selection of the title and abstract, the evaluation of the full text, extraction of the data and the quality assessment were carried out by two independent reviewers. To summarise the evidence, we grouped the barriers and facilitators according to the following contexts: political and social, health organisational system, guidelines, health professionals and patients. Results: Overall, 25 systematic reviews were selected. The relevant barriers in the social-political context were the absence of a leader, difficulties with teamwork and a lack of agreement with colleagues. Relevant barriers in the health system were a lack of time, financial problems and a lack of specialised personnel. Barriers of the CPGs included a lack of clarity and a lack of credibility in the evidence. Regarding the health professional, a lack of knowledge about the CPG and confidence in oneself were relevant. Regarding patients, a negative attitude towards implementation, a lack of knowledge about the CPG and sociocultural beliefs played a role. Some of the most frequent facilitators were consistent leadership, commitment of the members of the team, administrative support of the institution, existence of multidisciplinary teams, application of technology to improve the practice and education regarding the guidelines. Conclusions: The barriers and facilitators described in this review are factors that influence the implementation of evidence in clinical practice. Knowledge of these factors should contribute to the development of a theoretical basis for the creation of CPG implementation strategies to improve professional practice and health outcomes for patients.
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Background: Most current care models are disease- or symptom-focused and mostly do not account for the individual needs of patients with chronic diseases. The aim of this study was to develop an innovative, evidence-based and expert-based practice model for the management of patients with type 2 diabetes mellitus. Method: An iterative approach was used combining systematic literature search with qualitative methods, including a standardised survey of experts in chronic care (n = 92), an expert workshop of professionals (n = 22) and a multilingual online survey (n = 659). Using three consensus meetings involving researchers, policy makers and experts in chronic care, a limited number of core components and care recommendations was set up to develop a new chronic care model. Results: The developed 'MANAGE CARE MODEL' includes aspects of the health and social care system, resources derived from the living environment, aspects of health promotion and prevention, as well as an expanded understanding of improved outcomes as an integral part of chronic care. Conclusion: The MANAGE CARE MODEL provides guidance for the development and implementation of chronic care programs, regional networks and national strategies. Future research is needed to validate the model as an instrument of regional chronic care management.
... González-Ortiz, Calciolari, Goodwin, & Stein, 2018). Although studies investigating the effect of integrated care models on outcomes are scarce, integrated care is considered promising in health care for people with complex needs and/or chronic disease(Busetto, Luijkx, Elissen, & Vrijhoef, 2016; Van Duijn, Zonneveld, Montero, Minkman, & Nies, 2018;González-Ortiz et al., 2018). In integrated care, coordination of (medical and social) care, around people's needs (person-centred), is crucial(González-Ortiz et al., 2018). ...
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... These elements determine the outcomes of the intervention and thus the effectiveness and/or satisfaction with a certain care intervention. The mechanisms and context of the COMIC model are based on two existing theoretical models, namely the Chronic Care Model and the Implementation Model [28][29][30][31]. The use of both models is widespread [32][33][34]. ...
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Background: Geriatric rehabilitation care (GRC) is short-term and multidisciplinary rehabilitation care for older vulnerable clients. Studies were conducted about its effects. However, elements that influence the quality of GRC have not been studied previously. Methods: In this study realist evaluation is used to find out which are the mechanisms and outcomes and which (groups of) persons are the context for GRC, according to GRC professionals. The mechanisms, outcomes and context of GRC were explored in three consecutive phases of qualitative data gathering, i.e. individual interviews, expert meeting, and focus groups. Results: Eight mechanisms - client centeredness, client satisfaction during rehabilitation, therapeutic climate, information provision to client and informal care givers, consultation about the rehabilitation (process), cooperation within the MultiDisciplinary Team (MDT), professionalism of GRC professionals, and organizational aspects - were found. Four context groups-the client, his family and/or informal care giver(s), the individual GRC professional, and the MDT-were mentioned by the respondents. Last, two outcome factors were determined, i.e. client satisfaction at discharge and rehabilitation goals accomplished. Conclusions: In order to translate these insights into a practical tool that can be used by MDTs in the practice of GRC, identified mechanisms, contexts, and outcomes were visualized in a GRC evaluation tool. A graphic designer developed an interactive PDF which is the GRC evaluation tool. This tool may enable MDTs to discuss, prioritize, evaluate, and improve the quality of their GRC practice.
... This also resulted in a number of systematic literature reviews aimed at identifying the best models or profiles of integrated care for certain types of patients. [20][21][22] However, no such overview exists on integrated (people-centred) care for people with RA. Mapping the current status of integrated care for these patients could contribute to the understanding of how integrated care is defined and designed in the context of RA, and how it is performing. ...
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Introduction Integrated people-centred care is a modern approach for addressing healthcare issues related to demographic changes, increasing prevalence of chronic diseases, and restricted resources. By providing an overview of integrated care models for patients with rheumatoid arthritis, we aimed to offer insight into the strategies and interventions that are being used for designing and implementing integrated models of care for this patient group, and their outcomes. Methods We conducted a systematic literature search of peer-reviewed literature available in English and published between 2013 and 2018, using three databases: Cochrane, PubMed and EMBASE. We analysed the publications based on the Framework on integrated people-centred health services and the Triple/Quadruple Aim framework. Results We identified 1271 records. After screening, 50 articles met the criteria for inclusion in the review. Approaches for improving patient empowerment, engagement and experience of care were most prevalent in the identified care profiles. Similarly, frequently reported outcomes were related to improvements in patients’ experience of care and their health status. Most of the studies we reviewed did not demonstrate notable improvements from the perspective of cost-effectiveness or benefits for the healthcare workforce. Conclusions Our findings suggest that for rheumatoid arthritis, integrated care is in the early stages of development. Strategies focusing on patient outcomes and patient satisfaction were found to be prioritised. Future initiatives aiming to redesign rheumatology care should adopt systems thinking perspective to better address all of the building blocks of people-centred integrated care.