Introduction
Models of care are needed for improving access to holistic and coordinated care for people with chronic disease. Evidence supports integration of primary and hospital care, but the effects on outcomes are unclear, as are the elements of complex interventions that are most effective.
Method
Recent international literature was systematically reviewed to identify common elements in care models for managing chronic diseases across the primary/secondary interface, and their impact on consumers, providers and health systems. Studies of interest included primary and secondary care medical practitioners, reported outcomes, and were published in English in peer-reviewed journals. Study quality was assessed using a standard appraisal tool.
Results
Fourteen studies provided evidence of benefits from integrated models including: improved clinical outcomes; enhanced teamwork and intersectoral communication; greater patient satisfaction with consultations; improved access to care; shorter waiting times to appointments; and reduction in travel-related costs or cost-containment. Six elements were identified as important for achieving integrated primary-secondary care: multidisciplinary teamwork, communication/information exchange, training/education, access and acceptability, a viable funding model, and shared care guidelines/pathways. All models used more than one of these elements. The implications for health care policy makers, managers and clinicians will be discussed.
Conclusion
Surprisingly few high quality studies detailed successful models of integrated care. Effective models are needed for the increasing numbers of people living with chronic disease. While some models appear to be better than others, further collaboration and rigorous research is needed to evaluate the impact and implementation of different models.