Abstract
BackgroundIntegrated care is a people-centered health delivery approach that ensures the comprehensiveness, quality, and continuity of service across the settings and levels of health systems. The World Health Organization (WHO) recommends integration across levels and building-blocks of health systems as a prerequisite of Universal Health Coverage (UHC). While health systems of low- and middle-income countries (LMICs) are often fragmented and led by siloed service delivery structure, several LMICs—including India—have attempted health system integration. Several systematic reviews of evidence on healthcare integration from developed countries exist, but no synthesis from LMICs was reported to date. This review will overview the existing evidence of primary-secondary care integration (PSI) in the context of LMICs, aiming to support policy decisions for the effective integration of health delivery systems in India.MethodsThe review will be conducted following the six steps recommend by Arksey and O'Malley. Scientific and grey literature will be systematically selected from PubMed, Embase, Scopus, Web of Science, Global Index Medicus, and electronic repositories (such as WHO, World Bank, Health Policy Plus, and OpenGrey). Using a comprehensive search strategy, literature written in English and published between 2000 and 2020 will be selected, and two independent authors will screen their titles and abstracts. The result will be charted using a data extraction form and reported using tables, figures, and narrative forms.DiscussionNo ethical approval is necessary for the review. The final report will be developed with the consultation of other stakeholders and disseminated through workshops, conference papers, and peer review articles. The review will serve as a guiding tool to approach, implement, and test the PSI models in India and other LMICs.Scoping review registrationhttps://osf.io/kjhzt.
Highlights
Integrated care is a people-centered health delivery approach that ensures the comprehensiveness, quality, and continuity of service across the settings and levels of health systems
To be included in the review, the document or article will need to include evidence on the primary-secondary integrated health care model in low- and middle-income countries, which we have considered as: Stage 1: identifying the research questions Collaborating with researchers from Johns Hopkins Bloomberg School of Public Health (JHSPH) and Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), India, three research questions are proposed with a broader scope while having a precise aim, listed in the previous section
Ethical approval will not be necessary for the scoping review
Summary
Integrated care is a people-centered health delivery approach that ensures the comprehensiveness, quality, and continuity of service across the settings and levels of health systems. An approach to strengthen people-centered health systems through the promotion of the comprehensive delivery of quality services across the life-course, designed according to the multidimensional needs of the population and the individual and delivered by a coordinated multidisciplinary team of providers working across settings and levels of care... Within the hierarchical structure of the health system, PSI can bring “closer-to-community services” within broader management (organizational integration) or provide the opportunity for functional, clinical, or service level integration [4] It opens the prospect for organized service delivery between primary care provider and specialist, leading to early detection of disease, improved quality of care, better follow-up, and patient outcome [6,7,8,9,10]——effectiveness of the integration can vary by context and interventions [11]
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