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A systematic review of facilitators and barriers for professionals in providing integrated care

Authors:

Laura Nooteboom ,

Child and Adolescent Psychiatry (Curium-LUMC), Leiden University Medical Centre, NL
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Eva Mulder,

Child and Adolescent Psychiatry (Curium-LUMC), Leiden University Medical Centre; Intermetzo, NL
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Chris Kuiper,

Leiden University of Applied Sciences; Horizon Youth Care and Special Education, NL
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Robert Vermeiren

Child and Adolescent Psychiatry (Curium-LUMC), Leiden University Medical Centre, NL
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Abstract

Introduction: Youth Care professionals support children and their families who experience a variety of problems on multiple life domains, including psychosocial impairments, problems with alcohol and drugs, parental stress, child abuse and socioeconomic disadvantages (Kolko & Perrin, 2014; Tausendfreund et al., 2016). To overcome fragmentation in, and improve the quality of Youth Care, there has been an increased focus on organizing integrated care. Although providing integrated care requires processes on different complementary levels (Valentijn, Schepman, Opheij, & Bruijnzeels, 2013), previous research has tended to focus on integrated care at organizational and clinical levels, disregarding the substantial influence of integrated care on a professional level (Sunderji, Waddell, Gutpa, Soklardis, Steinberg, 2016). The aim of the current systematic review, therefore, is to identify facilitators and barriers in providing integrated Youth Care on a professional level.

Methods: Prior to the review process, a research protocol was formulated and registered (PROSPERO, registration number CRD42018084527). A systematic literature review of studies published between 2002 and 2018 was executed (PubMed, The Cochrane Library, Web of Science, Medline and PsychINFO). Search strategy was developed in collaboration with an experienced medical research librarian, supplemented with literature obtained from the IFIC Integrated Care Search. Included studies focused on processes on a professional level regarding integrated care in YC for children (age ≤ 18 years) and their families. Two researchers independently screened potential relevant studies. After critical appraisal, qualitative synthesis was conducted to identify facilitators and barriers for professionals in providing integrated care.

Results: 55 studies were included in this review, varying in quality and design. Narrative synthesis was performed to systematically describe and compare facilitators and barriers, in order to explore patterns in the data. The coded barriers and facilitators were clustered in seven overarching themes, including interprofessional collaboration, expertise and professional identity.

Conclusion, discussion and lessons learned: Providing integrated Youth Care is a multicomponent and complex process, with several complementary barriers and facilitators that seem of substantial importance for Youth Care professionals. Although some facilitators and barriers are more frequently found in literature than others, appraising their evidence is complicated considering the wide variety of study methods and quality of studies. Results from this review offer insights and recommendations for Youth Care professionals and policy makers in providing integrated care in practice.

Limitations: Due to the heterogeneity of the terminology in the field of integrated care and Youth Care, we used a broad scope of search terms, striving for an adequate coverage of the literature available and increasing the applicability of the results. However, it is important to acknowledge that there is a possibility that some studies were overlooked. Besides, there is a wide variety in quality and robustness of the included studies, resulting in information that is extensive, but difficult to compare.

Suggestions for future research: This review is part of a comprehensive practice based action research to integrated care. Future research is needed to compare findings from this literature study to results from action based research on integrated care in practice.

How to Cite: Nooteboom L, Mulder E, Kuiper C, Vermeiren R. A systematic review of facilitators and barriers for professionals in providing integrated care. International Journal of Integrated Care. 2019;19(4):151. DOI: http://doi.org/10.5334/ijic.s3151
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Published on 08 Aug 2019.

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