Abstract
BackgroundAs the prevalence of older adults with multimorbidity increases, greater integration of services is necessary to manage the physical and psycho-social needs of this cohort. This study describes and summarises current evidence, clinical provision and progress towards integrated primary care and social services for older adults with multimorbidity in England.MethodsA scoping review was conducted involving systematic searches of a range of electronic academic and policy databases. Articles were screened and extracted in duplicate by two independent reviewers. Data were extracted onto a charting sheet and thematic synthesis was used to summarise findings. Articles were included if published in English and related to primary care, social care and multimorbidity in older adults in England. Conceptually, the review was framed using the Rainbow Model of Integrated Care.ResultsThe search yielded 7656 articles of which 84 were included. Three themes were identified: (1) a focus on individual level services rather than multi-level or multi-sector integration, with an increasing emphasis on the need to consider broader determinants of population health as critical to integrated care for older adults with multimorbidity; (2) the need for policymakers to allow time for integration to embed, to enable new structures and relationships to develop and mature; and (3) the inherent tension between top-down and bottom-up driven approaches to integrated care requires a whole-systems structure, while allowing for local flexibilities.ConclusionsThere is limited evidence of multi-level and multi-sector integration of services for older adults with multimorbidity in England. The literature increasingly acknowledges wider determinants of population health that are likely to require integration beyond primary care and social services. Improving clinical care in one or two sectors may not be as effective as simultaneously improving the organisation or design across services as one single system of provision. This may take time to establish and will require local input.
Highlights
Closer health and social care integration has been a key policy goal of successive UK governments for 40 years but the advancement of this agenda has not been achieved at the pace required to meet the demands of an increasingly ageing population with higher levels of multimorbidity [1, 2]
Dambha‐Miller et al BMC Geriatrics (2021) 21:674 profiles suggests that 80% of the ageing population, that is people aged 65 years or older according to the UK National Health Service, will require medium or high dependency care due to multimorbidity [3]
This study examined variation in timing In the short term, pooling health and 2 of uptake to examine the short- (1 year) social care budgets alone does not and intermediate-term appear to reduce hospital use nor costs effects of the Better Care Fund on 7 but does appear to stimu‐
Summary
Closer health and social care integration has been a key policy goal of successive UK governments for 40 years but the advancement of this agenda has not been achieved at the pace required to meet the demands of an increasingly ageing population with higher levels of multimorbidity [1, 2]. Dambha‐Miller et al BMC Geriatrics (2021) 21:674 profiles suggests that 80% of the ageing population, that is people aged 65 years or older according to the UK National Health Service, will require medium or high dependency care due to multimorbidity [3] In this context, it is essential that primary care is capable of working closely with social services and wider community care providers to harness collective capacity, which can address the range of behavioural, social, and physical health care needs of the population. It is essential that primary care is capable of working closely with social services and wider community care providers to harness collective capacity, which can address the range of behavioural, social, and physical health care needs of the population This requires more careful consideration of the organisation, structures, systems and funding across providers to identify specific opportunities for successful integration. This study describes and summarises cur‐ rent evidence, clinical provision and progress towards integrated primary care and social services for older adults with multimorbidity in England
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