People-centred Integrated Care Research Articles

Community-based integrated care for patients with diabetes and depression (CIC-PDD): study protocol for a cluster randomized controlled trial

BackgroundManaging the multimorbidity of diabetes and depression remains a clinical challenge for patients and healthcare professionals due to the fragmented healthcare delivery system. To effectively cope with multimorbidity, there is an urgent need for the health system to transform into people-centered integrated care (PCIC) system globally. Therefore, this paper describes the protocol of community-based integrated care for patients with diabetes and depression (CIC-PDD) project, an integrated and shared-care intervention project.Methods/designCIC-PDD project is conducted in two phases, namely “care model development” and “implementation and evaluation.” In the first phase, CIC-PDD model was designed and developed based on the four criteria of collaborative care model (CCM) and was subsequently adjusted to align with the context of China. The second phase entails a pragmatic, two-arm, cluster randomized controlled implementation trial, accompanied by parallel mixed-methods process evaluation and cost-effectiveness analysis.DiscussionWe anticipate CIC-PDD project will facilitate the development and innovation of PCIC model and related theories worldwide, particularly in low- and middle-income countries (LMICs). In addition, CIC-PDD project will contribute to the exploration of primary health care (PHC) in addressing the multimorbidity of physical and mental health issues.Trial registrationClinicalTrials.gov registration ChiCTR2200065608 (China Clinical Trials Registry https://www.chictr.org.cn). Registered on November 9, 2022.

A Realist Evaluation of Case Management Models for People with Complex Health Conditions Using Novel Methods and Tools-What Works, for Whom, and under What Circumstances?

Case management developed from a generalist model to a person-centred model aligned with the evidence-informed evolution of best practice people-centred integrated care. Case management is a multidimensional and collaborative integrated care strategy where the case manager performs a set of interventions/actions to support the person with a complex health condition to progress in their recovery pathway and participate in life roles. It is currently unknown what case management model works in real life for whom and under what circumstances. The purpose of this study was to answer these questions. The study methods used realistic evaluation framework, examined the patterns and associations between case manager actions (mechanisms), the person's characteristics and environment (context), and recovery (outcomes) over 10 years post severe injury. There was mixed methods secondary analysis of data extracted via in-depth retrospective file reviews (n = 107). We used international frameworks and a novel approach with multi-layered analysis including machine learning and expert guidance for pattern identification. The study results confirm that when provided, a person-centred case management model contributes to and enhances the person's recovery and progress towards participation in life roles and maintaining well-being after severe injury.Furthermore, the intensity of case management for people with traumatic brain injury, and the person-centred actions of advising, emotional and motivational support, and proactive coordination contribute to the person achieving their goals. The results provide learnings for case management services on the case management models, for quality appraisal, service planning, and informs further research on case management.

How does people-centered integrated care in medical alliance in China promote the continuity of healthcare for internal migrants: The moderating role of respect.

Continuity is crucial to the health care of the internal migrant population and urgently needs improvements in China. Chinese government is committed to promoting healthcare continuity by improving the people-centered integrated care (PCIC) model in medical alliances. However, little is known about the driving mechanisms for continuity. We created the questionnaire for this study by processes of a literature research, telephone interviews, two rounds of Delphi consultation. Based on the combination of quota sampling and judgment sampling, we collected 765 valid questionnaires from developed region and developing region in Zhejiang Province. Structural equation models were used to examined whether the attributes of PCIC (namely coordination, comprehensiveness, and accessibility of health care) associated with continuity, and explored the moderated mediating role of respect. The result of SEM indicated that coordination had direct effect on continuity, and also had mediating effect on continuity via comprehensiveness and accessibility. The hierarchical linear regression analysis showed that the interactive items of coordination and respect had a positive effect on the comprehensiveness (β = 0.132), indicating that respect has positive moderating effect on the relationship between coordination and comprehensiveness. The simple slope test indicated that in the developed region, coordination had a significant effect on comprehensiveness for both high respect group(β = 0.678) and low respect group (β = 0.508). The moderated mediation index was statistically significant in developed areas(β = 0.091), indicating that respect had moderated mediating effect on the relationship between coordination and continuity via comprehensiveness of healthcare in the developed region; however, the moderated mediation effect was not significant in the developing region. Such regional differences of the continuity promoting mechanism deserve the attention of policy-makers. Governments and health authorities should encourage continuity of healthcare for migrants through improving the elements of PCIC-coordination, comprehensiveness and accessibility of healthcare, shaping medical professionalism of indiscriminate respect, and empowering migrants to have more autonomy over selection of services and decisions about their health.

Challenges of Universal Health Coverage in Nigeria: Urgent Action for Health System that Protects Everyone

The declaration of universal health coverage (UHC) as a sustainable development goal (SDG), in 2015 was a global resolution to building a world free of diseases and disease-related deaths. The goal is in tandem with many other work frames of the United Nations under the chaperone of the World health organization to create a healthier society. Hence, every country under the United Nations agreed to pursue this mission as part of the UN’s sustainable development goals, targeting 2030 as the project finish line. Improving health service coverage and health outcomes depends on the availability, accessibility, and capacity of the healthcare system and care providers to deliver quality and people-centred integrated care. In this regard, Nigeria has adopted several approaches to ensure the implementation of the UHC even amidst enormous challenges. This article has critically examined common but prominent factors beclouding the attainment of UHC, SDG in Nigeria. Key factors such as the primary healthcare system and health insurance schemes have been identified as major concerns while few recommendations have also been prescribed to improve the existing structures.

Building a People-Centred Integrated Care Model in Urban China: A Qualitative Study of the Health Reform in Luohu.

Introduction:China has adopted a people-centred integrated care model to reform its severely hospital-centric and fragmented delivery system. As a template of this model in urban China, the Luohu Hospital Group has generated considerable public and academic interest to scale it up.Methods:Guided by a policy triangle framework, this qualitative study explored the context, actors, content, and process of founding the Luohu Hospital Group. Three semi-structured interviews and five focus groups were conducted among 35 key informants. Content analysis was used to analyse the data.Results:The reform in Luohu took place in a competitive health care market, based on the comprehensive health reform in Shenzhen. Under the strong leadership of the district government, the reform adopted comprehensive strategies to strengthen primary care and care coordination, improve the quality and efficiency of health care delivery, and promote population health. The reform achieved a high level of organisational integration but was still in the process of fulfilling professional and clinical integration.Conclusions and discussion:The establishment of the Luohu Hospital Group transformed the originally fragmented delivery system into a tightly integrated service delivery networks. Though valuable lessons have been generated, the reform and its impacts require ongoing monitoring.

Integrated healthcare models for rheumatoid arthritis: A descriptive systematic review

IntroductionIntegrated people-centred care is a modern approach for addressing healthcare issues related to demographic changes, increasing prevalence of chronic diseases, and restricted resources. By providing an overview of integrated care models for patients with rheumatoid arthritis, we aimed to offer insight into the strategies and interventions that are being used for designing and implementing integrated models of care for this patient group, and their outcomes.MethodsWe conducted a systematic literature search of peer-reviewed literature available in English and published between 2013 and 2018, using three databases: Cochrane, PubMed and EMBASE. We analysed the publications based on the Framework on integrated people-centred health services and the Triple/Quadruple Aim framework.ResultsWe identified 1271 records. After screening, 50 articles met the criteria for inclusion in the review. Approaches for improving patient empowerment, engagement and experience of care were most prevalent in the identified care profiles. Similarly, frequently reported outcomes were related to improvements in patients’ experience of care and their health status. Most of the studies we reviewed did not demonstrate notable improvements from the perspective of cost-effectiveness or benefits for the healthcare workforce.ConclusionsOur findings suggest that for rheumatoid arthritis, integrated care is in the early stages of development. Strategies focusing on patient outcomes and patient satisfaction were found to be prioritised. Future initiatives aiming to redesign rheumatology care should adopt systems thinking perspective to better address all of the building blocks of people-centred integrated care.

Project INTEGRATE: Developing a Framework to Guide Design, Implementation and Evaluation of People-centred Integrated Care Processes.

Background:People-centred integrated care is an acknowledged approach to improve the quality and effectiveness of health systems in delivering care around people’s needs and preferences. Nevertheless, more guidance on how to effectively design, implement and evaluate the care process of people-centred integrated care services is needed. Under Project INTEGRATE, a framework was developed to guide managers in the assessment, transformation and delivery of these health service innovations.Methods:The framework is a product of the synthesis of operations, service and project management literature, relevant health care literature, and the analysis of four good practice integrated care case studies analysed under Project INTEGRATE. A first iteration of the framework was developed and then applied to one of the integrated care case studies to test its validity and utility.Results and Discussion:The tool combines a number of important considerations and criteria that have not been previously included in integrated care assessment frameworks, allowing for a pragmatic and comprehensive analysis of the care process.Conclusion:This framework can be used as a stand-alone or combined tool to guide managers to plan and evaluate the care process design of people-centred integrated care services; future work should apply this tool to other settings.

People-centred integrated care in urban China.

In most countries, the demand for integrated care for people with chronic diseases is increasing as the population ages. This demand requires a fundamental shift of health-care systems towards more integrated service delivery models. To achieve this shift in China, the World Health Organization, the World Bank and the Chinese government proposed a tiered health-care delivery system in accordance with a people-centred integrated care model. The approach was pioneered in Luohu district of Shenzhen city from 2015 to 2017 as a template for practice. In September 2017, China’s health ministry introduced this approach to people-centred integrated care to the entire country. We describe the features of the Luohu model in relation to the core action areas and implementation strategies proposed and we summarize data from an evaluation of the first two years of the programme. We discuss the challenges faced during implementation and the lessons learnt from it for other health-care systems. We consider how to improve collaboration between institutions, how to change the population’s behaviour about using community health services as the first point of contact and how to manage resources effectively to avoid budget deficits. Finally, we outline next steps of the Luohu model and its potential application to strengthen health care in other urban health-care systems.

Legal reflections on the evolving role of general practitioners in China's primary care: an assessment of regulatory strategies.

AimTo assess the regulation of the Chinese healthcare system in assisting a nationwide implementation of general practitioner (GP) services. BACKGROUND: Along with the perennial problems of unaffordable and inequitable healthcare, a rapidly ageing population and the increasing burden of non-communicable diseases pose challenges to the Chinese healthcare system. Recognising these challenges and to satisfy people's demands for more and better healthcare, China has initiated a plan, named 'Healthy China 2030', based on the findings from a two-year joint study by the World Health Organization (WHO) and the World Bank Group (WBG) in collaboration with Chinese agencies. The Chinese healthcare plan, officially approved in 2016, is an attempt to use the people-centred, integrated care (PCIC) model recommended by the WHO and WBG to shape the Chinese healthcare system. In accordance with PCIC, China began the implementation of gatekeeping primary care by introducing GP services to local communities. METHODS: A comparative analysis was employed to point out the importance of introducing GP services. A systematic assessment was carried out to evaluate the regulatory sector of the Chinese healthcare system, including a critical review of related legal norms and a theoretical exploration of external impediments (eg, cultural attitudes, government capacity and interest groups).FindingsResults demonstrate that the current regulatory sector of the Chinese healthcare system needs to be improved in order to assist the nationwide implementation of GP services and to strengthen its gatekeeping role. Major deficiencies include the problematic relationship between legal norms and health policies, the lack of effective and consistent new legislation, the low rate of social acceptance, and lack of support from agencies. To address those challenges, this paper recommends that preliminary efforts be devoted, in part, to two changes in the legal structure: enacting a specific law, and creating an independent regulatory oversight body.

Patient Engagement at the Household Level: A Feasible Way to Improve the Chinese Healthcare Delivery System Toward People-Centred Integrated Care.

Influenced by the people-centered integrated care (PCIC) model, Healthy China 2030 was drafted recently with a special concern given to patient engagement. Although there are three levels of engagement (i.e., individual, household, community), patients are more likely to be empowered and activated through an individualistic approach. Thus, engaging patients at the household level appear to have been overlooked so far. Supported by ethical values and practical evidence, this article attempts to address the importance of engaging patients at the household level in shaping the Chinese healthcare system with the PCIC model orientation, and thus recommends four strategies for empowering and activating patients at the household level in the Chinese context.

A participatory evaluation of the validity and feasibility of the Meta-framework of Person and People-centred Integrated Health Care (PPCIHC)

Background: We developed the Meta-framework of Person and People-centred Integrated Health Care (PPCIHC) using mixed qualitative research methods including expert critical review. Our aim was to explain the concepts and phenomenon of person-centred integrated health care. The meta-framework provides a conceptualisation combining two segments. The nano to macro level and six dimensions of integrated health systems are fused with the key factors of person and population health determinants, experience and status, and the dimensions of negative or positive personal states with the care cycle. Further assessment of its validity and feasibility as a tool for policy makers, planners and practice is needed. The workshop will involve a participatory evaluation of the Meta-framework PPCIHC using a nominal group technique. This type of evaluation is, in a sense a ‘diagnostic analysis’ on the feasibility of the Meta-framework of PPCIHC as a tool. The workshop will provide valuable information from potential international users and interested people to inform and refine the Meta-framework and resources. The Meta-framework, the development method and the definitions of concepts will be presented to the group. Questions and ideas on the Meta-framework as a tool will be discussed and clarified. All group members will be encouraged to contribute to the discussions using knowledge from their own experiences and the research. Following discussions, specific questions on the feasibility of the meta-frameworks will be posed to the individuals in the group. The questions will focus on the applicability and relevance, acceptability and practicality on the potential use of the framework as a tool for policy, practice and research. Target participants: The workshop is open to anyone interested in discussing the Meta-framework and the complex issues of person and people-centred integrated care. Participants may be from a policy, management, practice, research background or a consumer representative. Due to the nature of the workshop, there will be a maximum of 25 people attending.

People-centred integrated care: Advancing an expansive, contested paradigm and setting an agenda for the public university

People-centred integrated care (PCIC) offers an important paradigm in the contemporary re-modelling of service design and delivery (Ferrer & Goodwin, 2014; WHO, 2015). Placing the needs, desires and humanity of the person at the centre of a seamless, accessible and layered suite of responses does challenge accustomed ways of thinking and acting. Furthermore, and by its very nature, the paradigm is an expansive one. To be people-centred requires a continuous re-evaluation of the core concepts of integration and care. The first and major part of the paper examines these features of the paradigm. The latter part of the paper considers what an expansive paradigm means for the role of the public university, focussing on the initiatives being adopted by one specific higher education provider in Australia.Understandings from public health, wellness perspectives, social models of health and health promotion, for example, can all be deployed to good effect to bring meaning to the PCIC paradigm. Yet they may be insufficient in themselves to realise the potential of the paradigm (Gawanda, 2014; Nies, 2014). Moreover, the paradigm has to engage with the material realities of health and social care –the political economies and public policies that allocate resources and differentiate responsibilities, and the social and cultural orders that privilege or marginalise (Ashton, 2015). Translating a PCIC paradigm from idea to reality becomes imbued with ethical and political significance.The paper proposes that the paradigm achieves added value when accepted as a proposition to be continuously contested and expanded. Specifically, the paper argues that the PCIC paradigm needs to transcend a predominantly health and welfare orientation if it is to realise its potential. The paper suggests that for PCIC to be better attuned to emergent and changing contexts there are three contemporary theoretical strands of particular value: eco-systemic perspectives (Kalache, 2013; Nies, 2014); critical social innovation (Bovaird, 2007; Dodgson et al, 2011); and the political ethic of care (Held, 2004; Lynch, Baker & Lyons, 2009; Sennett, 2003).Through these theoretical strands, attention is drawn to the multiple environments within which care is shaped and experienced; to issues of power and diversity in processes of coproduction and innovation through collaboration; and to the social determinants of dignity, respect and compassion in relationships of care. It is explained how contributions from these areas can usefully augment the meanings of the paradigm in ways more suited to global trends, societal requirements and ethical imperatives.In the latter part of the paper, attention turns the role of the public university within an expansive, contested paradigm. Advancing integrated care is considered here in relation to the new knowledge economies of developed countries and the very different ways in which a public university may engage with the transitions and challenges associated with people-centred care (Anderson et al, 2013; Carayannis & Campbell, 2012; Universities Australia, 2014). It does this by examining how the expanded paradigm has resulted in a fresh agenda for one specific university in metropolitan Australia.The paper describes and analyses the emergence of a series of new initiatives being undertaken within that university. Informed by the theoretical strands outlined above, the initiatives seek to create new cross-disciplinary integration that reflects the intersections of multiple care environments, including the built and natural environments, socio-technical environments, aesthetic and cultural environments, the environments of paid and unpaid care work, place-based environments of local communities, and the intimate environments of personal care.The programs of knowledge creation (research) and learning (education and training) for these cross-disciplinary assemblies are formed within deep and productive strategic integration between the university and key parties from the aligned sector organisations and end-user groups. The initiatives are strongly driven by collaborative models through which members from formal and informal systems of care identify the knowledge and learning requirements required to generate dignified, respectful and compassionate relationships of care that make for ‘a good life’.Knowledge requirements to date have been both ‘conceptual’ and ‘solutions’ focussed. This requires research capabilities in both theory building and design thinking, and openness to the creative collisions of cross-disciplinary innovation. Learning requirements are spread across the tertiary spectrum, from certificates through to doctorates. Major policy reforms in Australia, in aged care and disability especially, are leading to fundamental workforce (paid and unpaid) re-structuring within uncertain territory. This necessitates sitting alongside the impacted systems to assist identify emerging workforce development needs and generating education and training programs accordingly.In conclusion, the paper addresses the timely opportunity opened up by a PCIC paradigm to re-imagine the scope of integration and the complexities of care. It shows how a public university, conceived as part of an expanded paradigm, can assist build capacity within multiple environments of care to promote ‘a good life’ for people whose lives might otherwise be defined by frailty and vulnerability.

Integrated care at the end –of-life: experiences, models, trends

Summary: Palliative care has traditionally been at the forefront in coordinating specialised services with primary care and home care. Health care staff work in interdisciplinary teams, using empathy as the basis for analyzing the needs of patients and their families, from a holistic and integrated perspective.In the context of the new paradigm of people-centred integrated care models, true integrated care in palliative care is linked to two key elements: the coordination of health and social services in end of life care and the involvement of society through awareness and training of community networks. The first requires a change in the organizational model and the second needs a basic refocusing on training of professionals.A number of international experiences are showing the way, proving compassionate social care models which empower families and carers and align professionals and resources to provide high-quality integrated care to end-of-life patients. Which are these? What can we learn from them? What trends can be identified in palliative integrated care?

Nursing Perspectives on Person- and People-Centered Integrated Care for All

Person-centeredness resides at the heart of nursing and nurses also place people at the centre of their activities to achieve a healthier society. The commitment of the International Council of Nurses (ICN) to deliver person- and people-centered care is evident in the ICN Code of Ethics for Nurses [1], ICN policy papers and is translated into various guidelines, programmes and research. Person- and people-centered healthcare requires not only commitment of individual nurses and other healthcare workers but also changes in healthcare systems including service delivery systems and other structures. It is necessary to take a whole government approach where person- and people-centered healthcare is considered by all ministries including non-health sectors. Active involvement of care recipients, nurses and other healthcare professionals in healthcare design and decision making is essential to achieve person- and people-centered healthcare.

2014 Geneva Declaration on Person- and People-centered Integrated Health Care for All

We, participants in the 7th Geneva Conference on Person-centered Medicine, call on everyone to join together to promote person-centered and people-centered health care in order to improve health for all in ways that are equitable, sustainable, and cost-effective. Equity and integration in person-centered health care are crucial foundations for targeting opportunities for effective action. The International College of Person-Centered Medicine (ICPCM) adheres to the new perspectives on universal health care endorsed by the World Health Assembly since 2009 and reads with interest the 2013 Lancet Commission Report on “Global Health 2035: World converging within a generation”, both of which outline objectives, research, and strategies for developing Person- and People-centered Integrated Care (PPCIC) for all people

New Frontiers of People-Centered Integrated Care for Complex Chronic Disease

Objective: Heart failure is a chronic, progressive clinical syndrome with an unpredictable trajectory and difficult prognosis. In 2012, the Italian region of Friuli-Venezia Giulia was appointed pilot leader of a European-funded project for ICT-supported integrated care addressed to European frail citizens, to test the viability and evaluate the impact of health and social care integrated services through an extensive deployment program involving 23 European regions. Methods: Cohort, prospective, randomized study with 1:1 intervention vs. usual care ratio (200 total users) Medical sensor devices and environmental sensors all contribute to keeping end-users safely at home. Integrated, real-time access to the platform allows for integration of clinical and social data. Help-desk and Contact Centre staff, provide 24/7 monitoring of alarms, as well as support to adherence and social inclusion. Results: The European project is planned to end as of December 31st, 2015. While final results are pending, focus groups, case studies and qualitative interviews show that Smart Care integrated platform is being perceived as possibly facilitating person-centred supportive care by streamlining services, allowing for updated information sharing, and providing empowerment to patients, families and professionals alike. Comments and conclusion: Integrated ICT-supported care may successfully complement chronic care pathways for complex cardiac patients. However, in-depth quanti/qualitative data analysis will have to be carried out to understand whether the benefits in terms of work overload and economic costs are such as to allow for costly technical and organizational choices. Supportive pathways need to build on actual integrated team work experience and leadership. GPs’ roles, responsibilities and economic incentives need to be clearly defined in order to make integration viable and sustainable in the long run. Nurses may play an important role in the coordination and monitoring of services but workloads and responsibilities require clear definition and assessment. Training and education need to be carefully planned and steadily monitored to maintain retention and support stakeholders’ empowerment. Integrated ICT-supported care should always be utilized within a beehive-integrated person-centred model to enhance the quality of IT-supported health and social care interventions which cannot and should not replace personal and social interactions.

E-Gears as new tools for enhancing eMental Health interventions in people centered integrated care

Internet and mobile phone technologies are used by most citizens, and are a powerful way for delivering accessible and affordable interventions to the population level. In fact, during the last years, it has been an explosion on the development of evidence-based e-resources (e.g. apps for monitor mental health, ehubs for Mental Wellbeing, internet forums for people with mental health problems, webs with basic education about mental health...). However, people may feel lost with such amount of information, not knowing which one to use, or just using the first they find, which may not be the best. To overcome this problem we propose to develop an “e-Gear tool”. e-Gear can be defined as an etool for connecting e-resources. Following the gear or cogwheel metaphor, it will help the user to connect, select and integrate the available e-resources that are more adjusted to their mental health profile. The level of complexity may vary from a very basic e-Gear, just connecting the eresources, or a more sophisticated one that will allow users to manage all the resources (e.g. which ones have been used, what are the favorites, to monitor their mental health status, etc.). In addition, users can use this web to communicate with their health and social providers, sharing their data and promoting integrated care. The main component of the e-gear would be a profiling algorithm. This will help us to know the specific profile of each one of the users, matching them with specific e-resources. In this communication, we will discuss the utility of an e-gear for the prevention of mental disorders in the context of personalized integrated care, based on our previous experience in developing risk algorithms and eTools.

Systematic review on policies, programmes and interventions on high quality people-centred integrated care

High quality people-centred integrated care conducive to universal health coverage (UHC) is a construct for which there is no universally agreed conceptual framework available. This systematic literature review provides a comprehensive overview of policies, programmes and strategies that are of relevance in relation to this construct, either directly of indirectly. The review was done as part of work commissioned by the World Health Organization (WHO) to inform the development of WHO’s People-centred and Integrated Health Services Strategy. A parallel search strategy was performed via Medline, EMBASE, The Cochrane Library of Systematic Reviews, CINAHL, and PRE CINAHL, complemented with a reference review of key articles that resulted in a total of 442 articles. The search strategy included a combination of Medical Subject Headings (MeSH) terms with regard to patient-centered and integrated care. English articles as from January 1, 2007 until August 31, 2013 were selected that examined the effects of patient-centered and/or integrated care policies/programmes/interventions with regard to different services, in different settings, for different patients’ needs, for different life stages, countries, and goals set. We appraised policies/programmes/interventions on high-quality patient-centered and integrated care, using a pre-defined set of attributes of high quality patient-centered and integrated care. The review revealed a set of 12 distinct categories of policies that deal with 1. the integration of people-centred, integrated care as a strategic direction for health system reform, 2. the development of inter-sectoral action programmes, 3. the integration of the financial allocation system with a performance evaluation system, 4. investments in public private partnerships, and, 5. academic and healthcare partnerships, 6. the integration of service levels and providers, 7. the integration of different professional disciplines into professional (post-graduate) education, 8. the World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-11690– http://www.ijic.org/ integration of information technology, 9. empowerment of patients and citizens at the population level, and 10. empowerment of patients and citizens at the individual level, 11. policies to address patients’ needs (individual level), and, 12. policies on education of patients and families. A gap-analysis of the available evidence revealed the majority of the evidence relates to advanced economies, with a particular paucity of evidence on people-centred and integrated care in postconflict and fragile states. People-centred and integrated health services described in literature predominantly focus on treatment and diagnosis with less attention to health protection, health promotion, diseases prevention, long-term care, rehabilitation and palliative care. Integrated care within or including community, public health (individual level), and specialist care is less well developed compared to integrated care initiatives between and within primary and secondary care. There is a dominant focus on physical needs in integrated care initiatives, with psychological, social spiritual and existential needs in patients receiving little attention. People-centred and integrated care models primarily focus on adult health and elderly health with maternal & perinatal health, newborn health, child health and adolescent health to receive far less attention. (Cost)effectiveness is considered the most important goal in people-centred and integrated care initiatives, with less emphasis on patient-reported and population-based outcome measures. Any strategy towards high quality people-centred integrated care conducive to UHC must acknowledge the complexity and interrelatedness of the different elements of this construct and monitor if all policies are implemented in a sustainable way, taking into account the context in which the national, regional or local strategies on high quality people-centred and integrated care are developed. A life course and inter-sectoral approach to high quality people-centred and integrated care seems essential if policy makers aim to respond to the many challenges that result from the mutual interrelatedness of the different life stages, the ageing population, the rapid rise in the number of people affected by non-communicable diseases, increasing financial expenditures and the pressing demand from the public for universal access to high quality care.