TY - JOUR
AU - O. L. Tseng
AU - G. Kim
AU - W . Y. Ho
AU - E. J. Lee
AU - H. Chang
AU - D. Lacaille
AU - C. Newton
AU - K. Vasarhelyi
AU - I. Poureslami
AU - E. Liow
AU - C. Mitton
A1 - 
AB - PURPOSE: Strengthening primary care's integration function is a systematic approach to promote integrated care. Understanding the factors influencing the process of integrating care for every patient is crucial for effective intervention planning. The objective of this study was to generate an analytic framework and evidence map of the barriers and facilitators perceived by family physicians (FPs) in clinical integration, a process to coordinate health care services across time, place, discipline, diseases, and patient demographics. METHODS: Using the Joanna Briggs Institute umbrella review methodology, we searched the MEDLINE, Embase, and CINAHL databases, identifying 90 reviews (2010-2022) on primary care FPs and clinical integration. We adopted a best-fit framework approach to group the factors into a customized clinical integration framework, reflecting how a health care system functions. Two evidence maps were created to visualize the reviews' distribution. We validated the framework with another 21 reviews (2022-2024). RESULTS: The analytic framework consisted of 9 themes and 21 subthemes based on 2,891 factors derived from external and internal sources within primary care practices. Several subthemes were common across themes related to individuals (FPs, physicians other than family physicians and allied health providers, patients) and operating units (systems, organizations, practices), highlighting shared elements. The professional theme was the most significant, appearing in 86% of the reviews and including subthemes related to diseases, clinical guidelines, and teamwork. In contrast, themes related to systems, organizations, and practices were reported less frequently (48%, 22%, and 23%). CONCLUSION: The complex interactions among factors, subthemes, and themes elucidate challenges in finding a universal strategy or implementing initiatives. The generated evidence maps indicated knowledge gaps to guide future research work.
AD - Department of Family Practice, University of British Columbia, Vancouver, BC Canada otseng@alumni.ubc.ca.; Centre for Clinical Epidemiology & Evaluation, Vancouver, BC Canada.; Vancouver Coastal Health Research Institute, Vancouver, BC Canada.; Doctors of Medicine Program, University of British Columbia, Vancouver, BC Canada.; Whitehorse General Hospital, Whitehorse, YT Canada.; Complex Care Program, British Columbia Children's Hospital, Vancouver, BC Canada.; Pediatric Palliative Medicine Program, Canuck Place Children's Hospice, Vancouver, BC Canada.; Department of Pediatrics, Division of Pediatric Hospital Medicine, Division of Palliative Medicine, University of British Columbia, Vancouver, BC Canada.; Department of Family Practice, University of British Columbia, Vancouver, BC Canada.; Arthritis Research Canada, Vancouver, BC Canada.; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, BC Canada.; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.; Division of Respiratory Medicine, University of British Columbia, Vancouver, BC Canada.; School of Population and Public Health, University of British Columbia, Vancouver, BC Canada.
AN - 40721330
BT - Ann Fam Med
C5 - Education & Workforce
CP - 4
DA - Jul 28
DO - 10.1370/afm.240118
DP - NLM
ET - 20250728
IS - 4
JF - Ann Fam Med
LA - eng
N2 - PURPOSE: Strengthening primary care's integration function is a systematic approach to promote integrated care. Understanding the factors influencing the process of integrating care for every patient is crucial for effective intervention planning. The objective of this study was to generate an analytic framework and evidence map of the barriers and facilitators perceived by family physicians (FPs) in clinical integration, a process to coordinate health care services across time, place, discipline, diseases, and patient demographics. METHODS: Using the Joanna Briggs Institute umbrella review methodology, we searched the MEDLINE, Embase, and CINAHL databases, identifying 90 reviews (2010-2022) on primary care FPs and clinical integration. We adopted a best-fit framework approach to group the factors into a customized clinical integration framework, reflecting how a health care system functions. Two evidence maps were created to visualize the reviews' distribution. We validated the framework with another 21 reviews (2022-2024). RESULTS: The analytic framework consisted of 9 themes and 21 subthemes based on 2,891 factors derived from external and internal sources within primary care practices. Several subthemes were common across themes related to individuals (FPs, physicians other than family physicians and allied health providers, patients) and operating units (systems, organizations, practices), highlighting shared elements. The professional theme was the most significant, appearing in 86% of the reviews and including subthemes related to diseases, clinical guidelines, and teamwork. In contrast, themes related to systems, organizations, and practices were reported less frequently (48%, 22%, and 23%). CONCLUSION: The complex interactions among factors, subthemes, and themes elucidate challenges in finding a universal strategy or implementing initiatives. The generated evidence maps indicated knowledge gaps to guide future research work.
PY - 2025
SN - 1544-1709 (Print); 1544-1709
SP - 350
EP - 362+
ST - Mapping Evidence and Constructing an Analytic Framework: An Umbrella Review Summarizing Primary Care Family Physicians' Experiences With Clinical Integration
T1 - Mapping Evidence and Constructing an Analytic Framework: An Umbrella Review Summarizing Primary Care Family Physicians' Experiences With Clinical Integration
T2 - Ann Fam Med
TI - Mapping Evidence and Constructing an Analytic Framework: An Umbrella Review Summarizing Primary Care Family Physicians' Experiences With Clinical Integration
U1 - Education & Workforce
U3 - 10.1370/afm.240118
VL - 23
VO - 1544-1709 (Print); 1544-1709
Y1 - 2025
ER -