Integrating primary and secondary care to enhance chronic disease management: A scoping review.

Sara Murtagh, John Broughan, Geoff Mccombe, Áine Carroll, Mary Casey, Áine Harrold, Thomas Dennehy, Ronan Fawsitt, Walter Cullen

Keywords: chronic disease; integrated care; primary care; secondary care; scoping review;

In Ireland, as in many healthcare systems, health policy has committed to delivering an integrated model of care to address the increasing burden of chronic disease. But implementing this model is difficult as integrating primary and secondary care is a considerable challenge.

Research questions:
What does the literature tell us about ensuring optimal integration between primary and secondary care in chronic disease management?

A scoping review framework comprising an iterative six-stage process (Arksey & O’Malley, 2005; Levac et al., 2010) was used to conduct the study. A search was conducted of ‘PubMed’, ‘Cochrane Library’ and ‘Google Scholar’ for papers that (a) were published between 2009-2019, (b) were written in English, and (c) documented integration in countries with similar (i.e., two-tiered) healthcare systems to Ireland (e.g., EU countries, Canada, Australia).

Twenty-two studies were included. These (a) reported research from various countries (most commonly UK, Australia, the Netherlands), (b) adopted a range of methodologies (most commonly randomised / non-randomised controlled trials, case studies, qualitative studies) and (c) studied patients with numerous chronic conditions (most commonly diabetes, COPD, Parkinson’s disease). No studies reported on interventions addressing the needs of whole populations. Interventions to enhance integration included multidisciplinary teams, education of healthcare professionals, and e-health interventions. Reported intervention benefits included swifter transitions between primary and secondary care, the maintenance of patient-centred integration philosophies, improved patient quality of life/self-care ability, and positive relationships between healthcare professionals. Mixed findings were reported regarding interventions’ impact on patients’ clinical outcomes and cost-effectiveness.

Interventions to enhance integration between primary and secondary care in chronic disease management are promising. Future research is needed to examine how such approaches may improve outcomes for wider populations rather than patients with specific chronic disease conditions only.

Points for discussion:
Ireland’s integrated care strategy for chronic disease management.

The study findings’ implications for chronic disease management programmes.

Directions for future research.