Literature Collection

BACKGROUND: Rapid population aging has increased the demand for integrated care for older adults, particularly in rural areas where older adults frequently experience chronic illness, frailty, and limited access to healthcare. Caregivers, both formal and informal, play a central role in supporting the wellbeing of older adults but often face substantial physical, emotional, and financial burdens. Understanding caregiver support is therefore essential to strengthening integrated care for rural older adult populations. OBJECTIVE: To identify factors influencing caregiver support within integrated care for older adults in rural areas and to highlight evidence gaps for future research. METHODS: A scoping review was conducted following the Arksey and O'Malley framework. Four databases (PubMed, Scopus, Wiley Online Library, and Taylor & Francis) were searched for English-language studies published between 2014 and 2024. Of 371 records identified, 25 studies met the inclusion criteria and were analyzed by research type, methodology, caregiver type, and caregiver support factors. RESULTS: Nineteen caregiver support factors were identified and categorized into five domains: social and community, financial, e-health, policy, and spatial. Key challenges included limited education and training opportunities, financial strain, restricted access to telehealth services, inadequate policy support, and transportation barriers. Informal caregivers, primarily family members, predominated in rural settings and experienced greater caregiving burdens due to limited institutional and service support. CONCLUSION: Caregiver support is a critical component of effective integrated care for older adults in rural areas. Strengthening social and community networks, financial assistance, e-health infrastructure, and policy frameworks is essential to reducing caregiver burden and improving outcomes for older adults. Future research should prioritize context-specific caregiver support strategies tailored to rural settings.

In Australia and internationally there is a strong policy commitment to the redesign of health services toward integrated physical and mental health care. When executed well, integrated care has been demonstrated to improve the access to, clinical outcomes from, and quality of care while reducing overtreatment and duplication. Despite the demonstrated effectiveness and promise of integrated care, exactly how integrated care is best achieved remains less clear. The aim of this review study was to identify factors that support the implementation of integrated care between physical and mental health services. An integrative review was conducted following the framework developed by Whittemore and Knafl, with quantitative and qualitative evidence systematically considered. To identify studies, Medline, PubMed, PsychINFO, CINAHL were searched for the period from 2003 to 2018, and reference lists of included studies and review articles were examined. Nineteen studies were included. Synthesis of study findings identified seven key factors supporting the implementation of integrated care between physical and mental health services: (a) adequate resourcing, (b) shared values, (c) effective communication, (d) information technology (IT) infrastructure, (e) flexible administrative organizations, (f) role clarity and accountability, and (g) staff engagement and training. There was little theoretical development in included studies, with little insight into the contextual factors or underlying mechanism required to support the implementation of integrated care initiatives. This review identified a set of inter-related barriers and facilitators which, if addressed, can improve the implementation and sustainability of truly integrated care.

BACKGROUND: Integrated care uses inter-professional and inter-organisational collaboration to ensure quality care for those with complex healthcare needs. Whilst inter-organisational collaboration is seen as a facilitator of integration, it has its own complexities and challenges. This study sought to investigate barriers to and facilitators of inter-organisational integration between the partnered organisations of an integrated care initiative in Luton, UK, as perceived by healthcare professionals. METHODS: Face to face semi – structured interviews were conducted between November 2019 and March 2020 with twenty service providers of an integrated service for physical and mental health. Thematic analysis was used to explore the experiences and perceptions of service providers on the integration of healthy lifestyle and mental health services of “Total Wellbeing Luton”. RESULTS: Five primary themes were identified: (1) Culture, (2) Communication Structures, (3) Strategic alignment, (4) Workforce dynamics, and (5) Expectation and reality of the integration. The majority of the identified themes reflect factors that facilitate or impede the integration between the participating organisations. Excellent relationships between healthcare professionals and staff’s motivation have been identified as facilitators to inter-organisational integration, while high staff turnover, lack of shared IT system and absence of co-location have been identified as barriers. Also, a theme reveals that often there was a discrepancy between the expected and the actual implementation and outcomes of integration. CONCLUSIONS: As a part of a larger evaluation programme, this study attempts a comprehensive understanding of the inter-organisational integration in the specific context of Total Wellbeing Luton. The findings and recommendations can support the inter-organisational integration of current and future integrated care initiatives in the UK and elsewhere. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-025-13051-7.

BACKGROUND: Cardiovascular disease (CVD) risk factors and mild-to-moderate mental health concerns (anxiety, depression) often co-occur and can worsen individual health outcomes, increase healthcare burden, and related costs relative to non-co/multi-morbidity. Existing evidence from both staff and service users suggests that integrating care for this population can be beneficial but challenging. Therefore, it is important that the key influences on integrated care are mapped to behavioural science frameworks so that intervention strategies in the system are actionable. This review aims to synthesise findings on which individual, organisational, social, and system-level factors influence integrated care for people experiencing co-occurring CVD risk factors and mild-to-moderate mental health concerns from the perspective of a range of health and social care professionals. METHODS: This systematic review will search MEDLINE, Embase, Emcare, PsycInfo, CINAHL, and grey literature in PsyArXiv and HMIC. Included studies will be qualitative primary research published in the English language reporting on the factors that influence the commissioning and implementation of integrated care for adults at risk of CVD and experiencing mild-to-moderate mental health concerns. This will be from the perspective of healthcare professionals, managers, commissioners, and policymakers. A thematic synthesis will identify relevant actions, actors, context, targets, and timeframes using the AACTT framework, and influences on actors' behaviour will be mapped to the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF). DISCUSSION: Data from this review will provide insight for a larger NHIR-funded programme of work that aims to optimise Integrated Care Services (OptICS) that will develop a whole-systems map to identify appropriate targets and intervention strategies to optimise integrated care. This review will offer a novel contribution to knowledge by synthesising qualitative evidence from a range of stakeholders on the influences on commissioning and implementation of integrated care for adults with physical and mental health comorbidities, mapped to complementary implementation frameworks. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024554221.

BACKGROUND: Implementation strategies often fail to achieve their intended outcomes, yet limited methodological guidance exists for systematically understanding why strategies fail or how to adapt them for new contexts. Causal pathway diagrams (CPDs) are tools that map the mechanisms through which implementation strategies work. This study proposes a methodologic approach to use CPDs both retrospectively to understand implementation failure in one context and prospectively to inform adaptation for a new context. METHODS: We illustrate the proposed methodology using a case study of a failed implementation strategy bundle-including an electronic best practice alert and clinical decision support, provider education, and clinical champion-designed to improve metabolic-associated steatotic liver disease (MASLD) screening in a weight management clinic. Using mixed methods data and realist evaluation principles, we constructed CPDs guided by three theoretical frameworks (i-PARIHS, Theory of Planned Behavior, and Technology Acceptance Model) and post-intervention qualitative interviews to understand failure mechanisms. We then applied insights from these CPDs alongside qualitative interviews with primary care providers to develop predictive CPDs for implementing adapted strategies in the primary care setting. RESULTS: The retrospective CPDs revealed specific failure points not apparent during initial planning. The clinical decision support strategy failed because fundamental preconditions were unmet: only 54.2% of patients had recent laboratory results needed for automated calculations, and the alert placement misaligned with provider workflows. Provider education and clinical champion strategies were undermined by moderators including lack of confidence in the FIB-4 screening tool and competing clinical priorities. The prospective primary care CPDs identified necessary adaptations including replacing best practice alerts with integrated health maintenance reminders, adding content about MASLD complications and treatments to provider education, and selecting multiple champions to ensure adequate coverage. CONCLUSIONS: CPDs provide a systematic framework for transforming implementation failures into actionable insights for future intervention design. The integration of realist evaluation principles with multi-theoretical CPD development offers a replicable methodology for retrospective mechanistic failure analysis and context-adapted prospective implementation. This approach advances implementation science by moving beyond descriptive accounts toward rigorous understanding of how and why implementation strategies work across diverse settings.

BACKGROUND: Children with medical complexity (CMC) frequently access multiple healthcare services across often fragmented systems. Paediatric integrated care models (PICMs) support health care coordination, but little is known about experiences and perceived benefits and barriers among CMC, parents or carers while accessing PICMs. This review addresses these knowledge gaps by synthesising current published evidence. METHODS: A scoping literature review based on searches of four databases: Medline, Embase, Scopus and CINAHL (2015-2024). Articles reporting on experiences of accessing PICMs by CMC aged < 19 years, their parents or carers were included. Data were extracted and thematically synthesised to describe experiences and perceived benefits and barriers. RESULTS: The seven included papers reported on the experiences of parents (mostly mothers, 89%); only one paper included the views of CMC and siblings. All seven papers described the benefits of PICMs, including greater attention to individualised needs, smoother system navigation facilitated by care coordinators and improved communication and information sharing among care teams. Four papers reported barriers including limited understanding among parents and carers of care coordinator roles and processes and pathways of PICMs. Systemic barriers limited medical records sharing across providers and settings, and in two studies, parents raised this as a risk for care quality and safety for their CMC. Other systemic barriers identified by parents included a lack of stable funding for new models of care and difficulties linking PICMs with primary care, social care and education sectors. CONCLUSIONS: The evidence on experiences, benefits and barriers of PICMs among CMC, families and carers is scarce, and the voices of CMC are largely absent. The greater involvement of CMC, their parents and carers in the design and ongoing evaluation of PICMs should be a priority to improve family-centred integrated care for CMC.