Barriers and facilitators to integrated primary care from the perspective of people with chronic conditions and multiple care needs: A scoping review.

Abstract

Background: Integrated care attempts to address multiple care needs, but barriers to implementation remain. The service user perspective can guide policy and practice to advance implementation.

Objective: To map barriers and facilitators to integrated primary care from the perspective of people with chronic conditions and multiple care needs.

Methods: A scoping review was conducted by searching PubMed, Embase, Web of Science, CINAHL, and grey literature. Eligible studies were analysed by categorising barriers and facilitators at the micro, meso, and macro levels of the healthcare system. They were further mapped by the components retrieved from the SELFIE framework for integrated care for multimorbidity.

Results: Across the 34 included studies, people with multiple care needs identified more barriers and facilitators at the micro level than at the meso and macro levels. Mapped under 'the individual and their environment', social and personal barriers (e.g. socioeconomic disadvantages, lack of social support) hindered integrated care. Mapped under 'service delivery' and 'workforce', a trusting relationship with a key care provider as part of a multidisciplinary care team was identified to facilitate integrated care.

Conclusions: Our findings show that 'soft' relational and social factors are critical to integrated care. These 'soft' factors are primarily created at the micro level, but seem actionable at meso and macro levels. The unique perspective of people with multiple care needs suggests that more rigorous involvement of service users at higher levels is needed to inform policymakers and care providers on how to shape enabling conditions for the implementation of integrated care.