Literature Collection

Cardiovascular disease (CVD) commonly coexists with multiple long-term conditions (MLTC), including diabetes, chronic kidney disease, obesity, and mental health disorders. This clustering creates a syndemic burden associated with poorer outcomes, polypharmacy, high treatment burden, and rising healthcare costs. Fragmented, single-disease care models are ill-suited to address this complexity. The WHF roadmap for integrated care in people living with - or at risk of - CVD and MLTC provides a structured framework to support the design, implementation, and scale-up of person-centred, coordinated care models globally. Drawing on current evidence, expert consensus, case studies, and stakeholder surveys, the Roadmap outlines the epidemiological and systemic challenges of MLTC and identifies practical strategies adaptable across high-, middle-, and low-income settings. This Roadmap emphasises multidisciplinary teamwork, aligned financing, digital health infrastructure, workforce development, patient partnership, and robust monitoring and evaluation. By shifting from siloed care to integrated, capacity-sensitive approaches, health systems can improve clinical outcomes, enhance quality of life, reduce avoidable hospitalisations, and build resilience in the face of growing multimorbidity.

INTRODUCTION: Why do integrated care programmes succeed in some settings but not others, even when national leadership and funding are aligned? This persistent question shaped our examination of the New Zealand Falls and Fracture Prevention Programme (FFPP), a complex, cross-sector initiative targeting older adults. We applied and extended the Context and Capabilities for Integrating Care (CCIC) framework to explore how organisational and inter-organisational factors contributed to variation in implementation and outcomes. METHOD: We conducted a qualitative comparative case study of four large districts with differences in FFPP implementation including 28 semi-structured interviews. Thematic analysis was primarily deductive, using the CCIC framework, but remained open to emergent, context-specific themes. RESULTS: We identified 43 organisational and implementation factors, of which five had a particularly important effect on FFPP implementation and outcomes: a well-structured governance team, collaborative leadership, engagement with primary care and private organisations, positive prior collaboration experience, and applying a population-based approach. We modified the CCIC framework to more fully reflect our observations by adding prior collaboration experience and a life-cycle approach (from pre-engagement to establishment). CONCLUSION: The CCIC framework captured most key organisational dynamics but was enhanced by incorporating temporal and historical dimensions of collaboration.

BACKGROUND: Optimizing antibiotic use is a UK Government priority. This study aimed to identify which combinations of interventions are associated with meeting primary care antibiotic prescribing targets in England's National Health Service, going beyond typical evaluations of individual interventions. METHODS: Data on interventions implemented by Integrated Care Boards (ICBs) in England were collected via an online survey (October 2023 to January 2024). The survey gathered information about 61 interventions covering data monitoring, incentives, governance, staff training, guidance, diagnostics, decision support tools and public awareness-raising activities.The survey data were linked to ICB-level antibiotic prescribing data, analysed descriptively and through a set-theoretic approach (fuzzy-set Qualitative Comparative Analysis, fsQCA). Clusters of ICBs that used a common set of interventions and met prescribing targets were identified. The average prescribing rates were calculated for each cluster and compared with ICBs that did not implement those interventions. RESULTS: Fifty-four responses were received from staff at 29 out of 42 ICBs (69%). Locally adapted prescribing guidance was used by all ICBs meeting targets. ICBs that monitored data and used incentives, guidance and/or challenged prescribers on their behaviour had the lowest prescribing. Implementing diagnostics, staff training or public awareness-raising interventions was not associated with lower prescribing. CONCLUSIONS: In a country that has been reducing antibiotic prescribing and implementing numerous antimicrobial stewardship interventions over the last decade, commissioning organizations that met policy targets were using combinations of a limited number of interventions by 2024. National and local efforts could therefore start prioritizing fewer interventions to further reduce prescribing.