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Introduction: The management of chronic diseases and multimorbidity is an important part of primary healthcare. Current disease management programs focus primarily on a single disease, while multimorbidity and social problems often co-occur. Person-centered integrated care delivered by interprofessional collaborative teamwork tailors care to the needs of the individual patient and empowers the patient to become an active participant in his own care. However, it is uncertain how healthcare professionals can be optimally equipped to deliver care and participate as team members in this contemporary approach. Objective: In this review, we explored what competencies primary healthcare professionals need to deliver high-quality person-centered integrated care, and how these competencies can be acquired. Methods: We performed a scoping review guided by the methodological framework proposed by Arksey and O'Malley. Guidelines and chronic disease management programs were searched in the Trip medical database with the following terms including their linguistic variations; a) primary care, b) integrated care, c) chronic illness, d) multimorbidity, e) shared decision making and f) competencies. Next, using the same keywords, we searched for peer-reviewed articles in the following scientific literature databases: Cinahl, Embase, PubMed, Medline, and Web of Science. Grey literature was hand-searched through websites of relevant national and international journals, scanning reference lists and through Google and Google Scholar. All titles and abstracts of both the guidelines and peer-reviewed articles were reviewed against inclusion and exclusion criteria and screened independently by two researchers. Then full text publications were retrieved and synthesized when they met the inclusion criteria. Results: The screening resulted in 17 guidelines and 89 articles to be obtained in full text. After reading full text papers, a total of 4 guidelines and 21 articles met the inclusion criteria and were included in the data synthesis. Next to several subthemes four main themes were identified; interprofessional communication, interprofessional collaborative teamwork, leadership and patient-centred communication. However, all included papers lacked a description of competencies' core concepts, such as knowledge, skills and attitudes necessary for the personcentered integrated care approach or how competencies can be acquired in addition to academic or bachelor professional training. Conclusion: This review provides an integrative view on professionals' competencies necessary for person-centered integrated care within the practice of primary care, though details on competencies' core concepts are lacking. More research is needed, on competencies and educational programs to ensure healthcare professionals in primary care are better equipped to deliver person-centred integrated care for chronic ill patients. [ABSTRACT FROM AUTHOR]

Introduction: LBP is a leading cause of disability and exerts a considerable burden on healthcare systems. Management is frequently inconsistent with clinical guidelines, which advocate a demedicalised approach in primary care settings for most patients, with easy access to specialised care when necessary. Integrated care pathways have potential to enhance care quality and costeffectiveness through bridging the evidence-practice gap and optimising resource use. Care integration across the primary-secondary care continuum aims to address care fragmentation, reduce duplication, improve clinical outcomes and enhance cost-effectiveness. This review aimed to synthesise the evidence for integrated care pathways for LBP from primary to specialised care. Methods: This review was reported in accordance with Preferred Reporting Information for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Electronic database searches (CINAHL, MEDLINE, Cochrane Library, EMBASE) were conducted (2006 onwards) with further manual and citation searching. Search results were exported to Covidence (systematic review software). Two independent reviewers conducted eligibility assessment and data extraction, as well as quality appraisal using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies or the Critical Appraisal Skills Programme (CASP) qualitative studies checklist. A narrative synthesis of findings is presented. Results: From 18,443 identified studies, 28 papers met inclusion criteria. LBP pathways were reported from high-income countries, primarily to address over-burdened secondary care services with long wait-times for consultant appointments. Pathways almost universally re-organised care using non-consultant interface services to manage the primary-secondary care boundary by triaging patients for surgical opinion or conservative management. Interface services aim to optimise use of the multidisciplinary workforce to ensure judicious use of surgical clinics. Accordingly, evaluation of healthcare resource use and patient flow predominated, with reports of enhanced service efficiency through decreased wait-times and appropriate use of consultant appointments. Interface services were evenly represented across community and hospital settings. Using a model that conceptualises care integration on a five-level continuum, the included pathways demonstrated the two most basic levels of integration, 'full segregation' or 'linkage'. Low quality study designs, heterogenous outcomes and insufficient comparative data precluded definitive conclusions regarding clinical and cost-effectiveness of pathways. Conclusions: Interface services, delivered by non-consultant multidisciplinary team members, to ensure appropriate referrals to specialised care dominated the LBP integrated care pathway literature with enhanced efficiency of care delivery reported. Pathways demonstrated the most basic levels of care integration, 'full segregation' and 'linkage', across traditional healthcare boundaries. Implications: Further exploration of the potential of care pathways as a model for the delivery of integrated, cost-effective, person-centred, guideline-concordant care which improves clinical outcomes for patients with LBP is required, with patient involvement in integrated care pathway development. [ABSTRACT FROM AUTHOR]

Introduction: As in many other countries, the challenges in the health status of the population and in the healthcare system persist in the Netherlands, despite longstanding reforms and integration efforts. This raises questions about the long-term sustainability of the system. As more and more studies describe the implementation of whole system transformation initiatives, approaches such as Population Health Management (PHM) gain traction. This study aims to contribute to the growing area of research by exploring the knowledge in recent literature about these kind of initiatives worldwide, focussing on the different levels of integrated care. Methods: A scoping review was performed using the six-stage methodological framework from Arksey and O'Malley. The electronic databases Embase, PubMed and Academic Search Premier were searched for papers published between January 2016 and January 2021. Structuring of the data was done from a realist analysis perspective, identifying context, mechanism and outcome (CMO) items describing what works for whom under what circumstances. Secondly, these items were then allocated to the levels of the Rainbow model of integrated care to identify the level to which the transformation item pertains. Finally, six topic clusters were formed, which constitute key elements of PHM. This resulted in a matrix of items corresponding to the levels of integrated care, the CMO structure and the six elements of PHM. Results: The literature search generated 531 articles, of which 11 were included. Structuring the data showed that most reported items were normative and functional items on the organizational level about 'accountable regional organization'. Also containing a high number of functional items are 'cross domain business model' and 'emergent implementation strategy', both on system and organizational levels. In contrast to that, items on the clinical level and normative items were overall underreported. The PHM elements 'co-designing workforce and community', 'integrated data infrastructure' and 'population health data analysis' contained overall the lowest number of items. Items that were mentioned by four or more articles were: Data availability, IT infrastructure, additional funding or monetary resources, and financial incentives aligned with system goals. Conclusions: This scoping review demonstrated that recent literature mainly reports on context, mechanisms and outcomes on system and organizational level of integrated care when it comes to PHM initiatives. And while the need for data availability and IT infrastructure are frequently specified, there is limited consideration for the normative side of integration in this regard. Implications for applicability/transferability, sustainability, and limitations: One of the limitations of this study is that many initiatives are not published in scientific literature, and therefore there may be items that are missing in the overview. However, the resultant matrix gives a first comprehensive overview of what needs to be done on what level to achieve what outcome. It also shows the lack of involvement of and attention to providers and patients within these initiatives. [ABSTRACT FROM AUTHOR]