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Untangling the interrelatedness within integrated care programmes for community-dwelling frail older people: a rapid realist review


Anam Ahmed

Panaxea, Amsterdam, Radboudumc, Nijmegen, NL
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Introduction: Integrated care programmes (ICPs) for community-dwelling frail older people work for some, but not for others. Why and how ICPs work, is rather unknown because the ‘mechanisms’ and the ‘context’ often remain underexposed. The study objectives are 1) to identify the relationships between the context in which ICPs are applied, the mechanisms by which ICPs do (not) work, and the outcomes resulting from this interaction, and 2) to analyse to what extent the World Health Organization (WHO) framework on integrated people-centred health services (IPCHS) is applied in ICPs.

Methods: A rapid realist review was conducted to identify the mechanisms of ICPs that operate in particular contexts to generate outcomes. Peer-reviewed (reviews and meta-analyses) and non-peer-reviewed literature reporting on integrated care for community-dwelling frail older people (≥ 60 years) was included. Selection and appraisal of documents was based on relevance and rigour according to the Realist And Meta-Narrative Evidence Syntheses: Evolving Standards (RAMESES) criteria. Data on context, mechanisms, and outcomes were extracted. Per source publication, context-mechanism-outcome configuration(s) (CMOc(s)) were aimed to be identified. Factors were categorized into the five strategies of the WHO-IPCHS framework.

Results: 27 papers were included. The most prevalent WHO-IPCHS strategies as part of ICPs are “creating an enabling environment”, followed by “strengthening governance and accountability“. For ICPs to demonstrate positive effects on the functionality of older people, satisfaction of older people, informal caregivers and healthcare providers (HCPs), and a delayed placement in a nursing home, it is essential to establish multidisciplinary teams of competent HCPs (by means of education and training) providing person-centred care, closely working together and communicating effectively with other stakeholders. Heterogenous effects were however found for hospital-related outcomes, quality of life, healthcare costs, and use of healthcare services. Older people and informal caregivers should be involved in the care process in order to get a better picture of the patient’s wishes and needs, and shared decision-making should be established. Financial support, efficient use of information technology, and organisational alignment were found essential.

Conclusion and discussion: ICPs for older people are still in development, as most ICPs do not address all WHO-IPCHS strategies. To optimize ICPs for frail older people the comprehensiveness of the WHO-IPCHS framework and the interaction between items should be taken into account from different perspectives (system, organisation, service delivery, HCP, and patient). Within this study, data on context, mechanisms, and outcomes may show overlap, which is often considered an interpretative challenge within realist research. Additional realist research is needed to establish more comprehensive and detailed relationships of items related to ICPs for frail older people.


How to Cite: Ahmed A. Untangling the interrelatedness within integrated care programmes for community-dwelling frail older people: a rapid realist review. International Journal of Integrated Care. 2022;22(S3):23. DOI:
Published on 04 Nov 2022.


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