Integrated community care: who are we addressing?

Background: Despite the efforts that have been made to ensure greater efficiency and quality in the healthcare provision of industrialized countries, the success achieved to date is still very limited, which may be the result of inconsistency between the various strategies and instruments adopted. Therefore, new unifying models of primary-care provision are emerging, namely “person-centred care” (i.e., involvement of the patients in all aspects of the healthcare system, in which their individual preferences, needs and values are considered and guide clinical decisions (Zejnilović, L., Oliveira, P., & Canhão, H., 2016)) or “community-based integrated care” that unifies “community-based care”, which is characterised as based on and guided by the health needs of the community, and “integrated care” that is conceptualised to reduce fragmentation in the healthcare provision by increasing coordination and improving continuity of care (Plochg & Klazinga, 2002). This work arose from an interest to systematise ongoing initiatives exploring these models and, particularly, the type of patients been targeted. Methods: The purpose of this scoping review was to identify and map evidence on the topic of new primary care models, with a focus on the target group(s) that have been addressed so far. For this purpose, an electronic search was performed, using the keywords referred above, and 202 articles were retrieved. Their abstracts were assessed independently by two reviewers and 71 articles were excluded. Results: 41 references were classified as reviews or overviews and 90 references were classified as primary studies. The 41 reviews or overviews give significant context and focused the following aspects related to the span of community care, ordered by decreasing importance (i.e., number of references): older adults; human resources; collaboration; pharmacies; assessment models; child/maternal healthcare; context/conceptual; correctional healthcare; ICT; infectious diseases; mental health; palliative care; payment models and podiatry. Among the primary studies, 31 experiences were focused on elder adults, 14 were dedicated to mental health, nine were directed to infectious diseases and eight targeted to maternal and child health. The remainder 28 articles reported on initiatives distributed among different target groups, individually underrepresented in this sample. These were: cancer; COPD; community care training; chronic heart failure; COVID; diabetes; eye care; multimorbidity; nutrition; palliative/supportive care; Parkinson disease; sanitation; and substance abuse. Conclusion: Although the most addressed group in the initiatives identified in this review was, as expected, older adults, experiences focused on other target groups have also been found, which in some way reveals the scope and potential of new primary-care approaches, to be successfully replicated. The next step in the research will be a question-orientated systematic review, delving deeper into this topic of research. References: Plochg, T., & Klazinga, N. S. (2002). Community-based integrated care: myth or must?. International Journal for Quality in Health Care, 14(2), 91-101. Zejnilović, L., Oliveira, P., & Canhão, H. (2016). Innovations by and for patients, and their place in the future health care system. Boundaryless Hospital: Rethink and Redefine Health Care Management, 341-357.