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Organisation and integrated healthcare approaches for people living with HIV, multimorbidity, or both

2023Artigo científico Acesso aberto
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dc.contributor.authorNicolau, Vanessa
dc.contributor.authorBrandão, Daniela
dc.contributor.authorRua, Tiago
dc.contributor.authorEscoval, Ana
dc.contributor.institutionCentro de Investigação em Saúde Pública (CISP/PHRC)
dc.contributor.institutionComprehensive Health Research Centre (CHRC) - Pólo ENSP
dc.contributor.institutionEscola Nacional de Saúde Pública (ENSP)
dc.contributor.pblBioMed Central (BMC)
dc.date.accessioned2023-09-08T22:14:16Z
dc.date.available2023-09-08T22:14:16Z
dc.date.issued2023
dc.descriptionFunding Information: The systematic review was conducted as part of the project “Financiamento do VIH no continuum do percurso da pessoa com doença” [HIV financing in the continuum of the care path of the person with disease”] funded by the Gilead Sciences, Inc. The present publication was funded by Fundação Ciência e Tecnologia, IP national support through CHRC (UIDP/04923/2020). Publisher Copyright: © 2023, BioMed Central Ltd., part of Springer Nature.
dc.description.abstractBackground: 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. Methods: 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. Results: 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). Conclusion: 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. Trial registration: PROSPERO number CRD42020194117.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent1425189
dc.identifier.doi10.1186/s12889-023-16485-y
dc.identifier.issn1471-2458
dc.identifier.otherPURE: 71183590
dc.identifier.otherPURE UUID: bd4d5b58-f7c5-49ec-bc05-35ec5f41708d
dc.identifier.otherScopus: 85168376076
dc.identifier.otherPubMed: 37596539
dc.identifier.otherWOS: 001050379700012
dc.identifier.otherPubMedCentral: PMC10439547
dc.identifier.otherORCID: /0000-0002-0269-4742/work/143970770
dc.identifier.urihttp://hdl.handle.net/10362/157561
dc.identifier.urlhttps://www.scopus.com/pages/publications/85168376076
dc.language.isoeng
dc.peerreviewedyes
dc.subjectCare coordination
dc.subjectChange management
dc.subjectContinuity of care
dc.subjectCoproduction
dc.subjectHIV infection
dc.subjectIntegrated care
dc.subjectLearning health systems
dc.subjectMultimorbidity
dc.subjectPeople-centred care
dc.subjectSelf-management
dc.subjectPublic Health, Environmental and Occupational Health
dc.subjectSDG 3 - Good Health and Well-being
dc.titleOrganisation and integrated healthcare approaches for people living with HIV, multimorbidity, or bothen
dc.title.subtitlea systematic reviewen
dc.typejournal article
degois.publication.issue1
degois.publication.titleBMC Public Health
degois.publication.volume23
dspace.entity.typePublication
rcaap.rightsopenAccess

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