背景:抗逆转录病毒药物及其有效性的普遍建议提出了确保对PLHIV(HIV感染者)采取长期和持续的护理方法的挑战,受老化和多发病的压力。正在出现更适应这一现实的综合办法。研究这些方法,以及它们与交付安排的内容和实施过程的关系,可能支持未来的战略,以获得更有效的组织响应。
方法:我们回顾了关于HIV,多浊度,或者两者兼而有之。这些研究发表在2011年至2020年之间,描述了综合方法,他们的设计,实施,和评估策略。定量,定性,或混合方法被包括在内。电子数据库审查涵盖PubMed,Scopus,和WebofScience。对每项研究进行了叙事分析,数据提取是根据卫生系统干预措施的有效实践和护理分类组织完成的。
结果:共30项研究,报告22种不同的干预措施,进行了分析。总的来说,干预措施以模型和框架为基础和指导,专注于特定的亚群,或预后较差风险增加的优先群体。干预措施混合了多个集成组件。以更频繁的临床整合为目标的交付安排(n=13),和近距离护理,基于社区或在线电话(n=15)。干预报告了对用户角色的投资,通过自我管理支持(n=16),在协调中,通过多学科团队(n=9)和连续性护理(n=8)。实施战略有针对性的教育和培训活动(n=12),而且很少,迭代改进机制(n=3)。在组织设计和治理层面,干预通过代表动员用户和社区,在董事会和委员会,通过咨询,沿着设计过程的不同阶段(n=11)。
结论:这些数据提供了重要的经验教训和考虑因素,可以在两个关键层面上从以疾病为中心的护理向综合护理迈进:设计和实施。多学科工作,护理的连续性,用户的有意义的参与似乎对于获得全面和更近端的护理至关重要,在组织内部或跨组织,或部门。有希望的实践在设计层面是先进的,实施,和评估,这将集成设置为一个持续的改进过程,并将专业人员和用户的知识作为这些阶段的资产加以重视。
背景:PROSPERO编号CRD42020194117。
Universal recommendation for antiretroviral drugs and their effectiveness has put forward the challenge of assuring a chronic and continued care approach to PLHIV (People Living with HIV), pressured by aging and multimorbidity. Integrated approaches are emerging which are more responsive to that reality. Studying those approaches, and their relation to the what of delivery arrangements and the how of implementation processes, may support future strategies to attain more effective organizational responses.
We reviewed empirical studies on either HIV, multimorbidity, or both. The studies were published between 2011 and 2020, describing integrated approaches, their design, implementation, and evaluation strategy. Quantitative, qualitative, or mixed methods were included. Electronic databases reviewed cover PubMed, SCOPUS, and Web of Science. A narrative analysis was conducted on each study, and data extraction was accomplished according to the Effective Practice and Organisation of Care taxonomy of health systems interventions.
A total of 30 studies, reporting 22 different interventions, were analysed. In general, interventions were grounded and guided by models and frameworks, and focused on specific subpopulations, or priority groups at increased risk of poorer outcomes. Interventions mixed multiple integrated components. Delivery arrangements targeted more frequently clinical integration (n = 13), and care in proximity, community or online-telephone based (n = 15). Interventions reported investments in the role of users, through self-management support (n = 16), and in coordination, through multidisciplinary teams (n = 9) and continuity of care (n = 8). Implementation strategies targeted educational and training activities (n = 12), and less often, mechanisms of iterative improvement (n = 3). At the level of organizational design and governance, interventions mobilised users and communities through representation, at boards and committees, and through consultancy, along different phases of the design process (n = 11).
The data advance important lessons and considerations to take steps forward from disease-focused care to integrated care at two critical levels: design and implementation. Multidisciplinary work, continuity of care, and meaningful engagement of users seem crucial to attain care that is comprehensive and more proximal, within or cross organizations, or sectors. Promising practices are advanced at the level of design, implementation, and evaluation, that set integration as a continued process of improvement and value professionals and users\' knowledge as assets along those phases.
PROSPERO number CRD42020194117.