Approaches to developing integrated care in Europe: a systematic literature review

Abstract Purpose Many European countries have been undertaking measures to promote integration of health and social care. The purpose of this study is to identify different approaches to integrated care and retrieve a number of experiences and approaches of working in some European countries. Methods A systematic review of the integrated care literature was conducted in a 3-month period. The Pubmed, Embase, and BioMed Central databases were searched for articles from 2002 through 2008. The articles were selected according to inclusion and exclusion criteria. A standard form was used for data extraction. Findings A total of 24 studies that conformed to the criteria were found. The analysed articles describe integrated care in 16 European countries: UK, Germany, Finland, Sweden, Austria, Spain, Netherlands, Ireland, Portugal, Denmark, France, Greece, Italy, Norway, Poland, and Switzerland. The studies' setting was primary care, social care, home care, or a combination of these. In majority of the studies similar challenges to health care systems were identified: advances in health care, ageing population, multi-system nature of chronic diseases, hospital-based care system, insufficient provision of community care services, lack of cooperation among health and social care providers, fragmentation of the health and social care systems, and rurality. These challenges are seen as a stimulus to the integration of care. The articles also mentioned some integration strategies that were categorized according to: changes in organizational structure, workforce reconfiguring, and changes in the financing system. Integrated care definitions were also derived from the articles, and from the verbatim text when possible. Definitions were grouped according to their sectorial focus: community-based care, combined health and social care, combined acute and primary care, the providers, and in a more comprehensive approach the whole health system. Conclusion Despite integrated care being implemented in some European countries since the beginning of the millennium, it is a relatively new concept in health management discourse. There is room for more studies on the need for integrated care and the effectiveness of the implemented strategies. Despite integration models having a similar background there is no European consensus about the definition of integrated care. The data collected are useful for debate on the topic within the international health management and marketing community.