Table 1
Characteristics of sample data.
| AUTHOR | YEAR | SETTING | RESEARCH DESIGN | INSTRUMENTS/TOOL | PARTICIPANTS | COUNTRY/STATE/REGION |
|---|---|---|---|---|---|---|
| 1. Souza MF et al. [28] | 2017 | Primary care National Program for Primary Care Access and Quality Improvement (PMAC-AB) Team’s work process | Cross-sectional study – use of the Item Response Theory (IRT) (Analyze the quality-External evaluation) Secondary source | Interview Samejima’s Gradual Response Model – level of coordination. PMAQ-AB Questionnaire | 17.202 primary care teams | Brazil/Minas Gerais/Southeast |
| 2. Vargas I et al. [8] | 2016 | Health Systems Focus on three level – coordination across levels | Case study – qualitative, exploratory and descriptive–interpretative study. Multicentric | Semi-structured interviews | health professional (n = 112) administrative (n = 66) professionals of different care levels (??) managers of providers (n = 42) and insurers (n = 14). | Latin America – Brazil and Colombia |
| 3. Pieri FM et al. [29] | 2014 | Primary care (Family Health Strategy) Chronic disease -leprosy | Cross-sectional study | Questionnaire (adpt) – PHC Assessment Tool (PCATool) | 165 patients (leprosy) in the end 119 patients | Brazil/Parana/ South |
| 4. Scherer MD [24] | 2013 | Training Program Family Care Program in Brazil | Cross-sectional study | Semi-structured interviews, participant observation and focus groups. | 16 health professionals | Brazil/Brasilia/Central-West |
| 5. Pinto RM et al. [30] | 2012 | Primary care (Family Health Program) | Cross-sectional study | In-depth interviews | 30 CHWs | Brazil/Rio de Janeiro/Southeast |
| 6. Santos MC, Tesser CD [31] | 2012 | Primary health and care – Brazilian Unified Health System Integrated and complementary practices – method | Research-action methodology (four stages) | The method involves four stages: 1 – definition of a nucleus responsible for implementation and consolidation thereof; 2 – situational analysis, with definition of the existing competent professionals; 3 – regulation, organization of access and legitimation; and 4 – implementation cycle: local plans, mentoring and ongoing education in health. | 112 health teams | Brazil/Santa Catarina/South /São Paulo/Southeast |
| 7. Heimann LS et al. [32] | 2011 | Primary health and care – (as strategy) stewardship capability, financing, provision, comprehensive and intersectoral | Case study (Multicentric – Argentina, Brazil, Paraguay and Uruguay) Multicentric | Literature review, document analysis and interview | Policy makers, managers, experts, users and professionals (n = 22). | Latin America – Brazil/Argentina, Paraguay/Uruguay |
| 8. Queiroz M, Delamuta L [17] | 2011 | Mental Health Programs Teams – decision process | Cross-sectional study | Interviews and participant observation | Health professionals (n = 22) Psychologist(n = 4) physician (n = 4), occupational therapists (n = 4), nurses(n = 4), nutritionists (n = 2), 1 social worker (01) nutritionist (n = 01) economist(n = 01) and administrator (n = 01) | Brazil/São Paulo/Southeast |
| 9. Villa et al. [33] | 2011 | Primary Health Care Health service performance in TB control in Brazil | Cross-sectional study Multicentric | Interviews – Primary Care Assessment Tool adapted for TB | 514 patients (TB) | Brazil/São Paulo/Bahia/Paraiba – Southeast and Northeast |
| 10. Costa MC et al. [18] | 2010 | Network Care – National Program of Integrated and Referential Actions (PAIR) child and adolescent’s sexual violence | Cross-sectional study – Descriptive study | Interviews | Professionals from the Institutions of care (n = 38), Municipal Committee of PAIR (n = 11) and key community informants (n = 78) | Brazil/Bahia/Northeast |
| 11. Kell MC, Shimizu H [27] | 2010 | Primary care (Family Health Strategy) FH Teams | Qualitative research | Observations, interviews and focus groups | Four complete FH teams (physician, nurse, community health workers, nursing assistants) 32 professionals from the Family Health Strategy | Brazil/Goiás/Central-West |
| 12. Mello AS, Moysés SJ [21] | 2010 | Pre-hospital assistance (mobile and fixed emergency services) attending accidents and violence against elderly. | Situational analysis (General conditions of infrastructure, planning and support at the pre-hospitalar assistance level elderly – quantitative and qualitative approaches | Interview | 4 health managers; 14 health professionals | Brazil/Paraná/ South |
| 13. Moretti AC et al. [34] | 2010 | Primary Care – (Family Health Strategy) oral health teams Intersectoral actions | Cross-sectional study with quantitative and qualitative methodology | Self-response questionnaire and focus group | 94 Family Health Units (oral health team) | Brazil/Paraná/South |
| 14. Araújo MB, Rocha PM [35] | 2009 | Primary Care (Family Health Strategy) FH Team | Qualitative case study | Semi-structured interviews | Family health units- 06; 25 health professionals 5 physicians; 5 nurses; 2 dentists; 6 community health workers; 6 nursing assistants and 1 dental assistant | Brazil/Rio Grande do Norte/ Northeast |
| 15. Consoli GL et al. [22] | 2009 | Public health network Mental health and care | Not stated | Structured questionnaires | professional public health care 31 municipalities | Brazil/Rio Grande do Sul/South |
| 16. Giovanella L [36] | 2009 | Primary Care (Family Health Strategy) FH Team | Four case studies Multicentric | Semi- structured interviews with managers and surveys with health care professionals and registered families. | municipal managers (n =77) professionals from the FH teams with self-administered questionnaires (n = 1,336); registered families with structured questionnaires at home (3,312 families | Brazil/Sergipe/Northeast/Minas Gerais and Espírito Santo/ Southeast//Santa Catarina/ South |
| 17. Franco TB, Merhy EE [37] | 2008 | Primary care (Home health care) Work process and network | qualitative study | Semi-structured interviews, observation, technical visit and documental analysis | Coordinator of the home care operator, manager of the home care service provider, the coordinator of the teams in the Home Care Program, the workers who make up the teams, beneficiaries or caregivers included in the program. | Brazil/Rio de Janeiro/Southeast |
| 18. Costa-e-Silva V et al. [15] | 2007 | Primary Care (Family Health Unit) Maternal and child health | Case study used Qualitative approach | Interview semi-structured (regional and central level); Self-completed questionnaire. Workshop | 35 health professionals: 23 health family unity – and 6 (specialized centers) | Brazil/Espírito Santo/Southeast |
| 19. Macinko J et al. [25] | 2007 | Primary care –(Family Health Strategy) Infants mortality rates, Neonatal mortality, Post-neonatal mortality | Pooled cross-sectional ecological analysis Secondary source (follows a quasi-experimental design) | Panel data from Brazilian microregions | 557 Brazilian microregions. 3342 observations (6 years 1999-2004) | Brazil (Throughout the country – 27 Brazilian states – regions North, Northeast, Southeast, South and Central-west) |
| 20. de Oliveira EM, Spiri WC [26] | 2006 | Primary care – (Family Health Strategy) Multiprofessional teamwork | Qualitative approach -phenomenology, | Interviews | Two physicians, two nurses, two nursing assistants, and two community health workers | Brazil/Rio Grande do Sul/ South |
| 21. Baxter YC et al. [16] | 2005 | Hospital – Integrated home-hospital Model of Integrating Hospital and Home vs Conventional Hospital Model Dehospitalization – nutritional therapy | A retrospective controlled study, paired (age, sex, disease, and surgical procedure) Secondary data | Various sources – Medical record, nutritional attendance form, Finances, Pharmacy Division for Esophageal Surgery | 56 documents of patients from Digestive surgery | Brazil/São Paulo/Southeast |
| 22. Gupta N et al. [38] | 2005 | Primary care – (Home care) Support Domiciliary Therapeutic Assistance program | Quasi experimental design with subjects divided into three groups: | Interview, | 56 subjects divided into three groups (G1/DTA = 15 subjects; G2/Previous DTA = 21 and G3/Non DTA = 20) | Brazil/Espírito Santo/Southeast |
| 23. Magnani RJ et al. [20] | 2001 | Schools and Clinics training courses Adolescent Reproductive Health Program in Bahia – HIV infection | Quasi-experimental control-group panel design | Self-administered surveys, Observation | Students, 300 providers (physicians, nurses, social workers) attended) | Brazil/Bahia/Northeast |
| 24. Pinotti JA et al. [11] | 2000 | Hospital and Primary Health care (PHC) Women’s health project integration of diagnostic and therapeutic services | Information about the patients obtained in a computerized system | Questionnaire-self organization of an experimental model of primary health and care (Project) | Patients, Nurse assistant, Physician | Brazil/São Paulo/Southeast |
[i] Articles summarised based on their key characteristics, e.g. by setting (how many in primary care, acute care, etc.), research design (e.g. how many used case study, cross-sectional, qualitative interviews, etc.), participants (e.g. professionals, patients), country (Brazil, other LMIC), etc.
Table 2
Summary of main results.
| TOPIC | MAIN RESULTS |
|---|---|
| Concept of Integration | Studies referred to integration as a phenomenon between individuals, professionals or activities within work groups. Some definitions are tautological as they reinforce that integration is composed of mechanisms of integration and coordination between members of a multiprofessional family health team. There is also a shared comprehension between integration and integrated service to the patient. Many studies assumed that both phenomena are inextricably linked, with one necessarily leading to the other. Almost all articles investigated mechanisms of clinical integration between health professionals from the same team. Most studies analyzed coordination processes between groups and units of the same organization. Few studies investigated the integration between institutions/organizations in the provision of care to patients, family members, caregivers, and the community |
| Measures or indicators | The participation of users and professionals in the coordination of different care interventions was seen as one indicator to infer integration. Measures to assess the outcomes and benefits of care processes on the reactions of patients, family members and/or caregivers, professionals, or manager. Measures of care impacts on patients’ behavior were discussed by some authors [23] Some indicators as the existence of a communication channel (telephone/internet), number of institutional communication flows (case discussion, technical meetings with specialist), telehealth usage and participation, electronic medical record, reference/counter-reference file and electronic communication). |
| Factors that influence integrated health care | The barriers brought up by the articles can be grouped as follows: lack of integration, for example, in primary and secondary care; lack of protocols with preventive approach; need for a continuous medical supervision; need of constant team conduct negotiation; lack of a consensual definition; lack of clarity about the forms of intervention and measurement of care coordination; hegemonic place conferred to physicians in the professional hierarchy, deficiencies in case records; unsatisfactory adhesion and poor support institutional framework; impact of regional disparities and social inequality of Brazil on care delivery, unprepared health professional to deal with the complexity of health and care problems; deficiencies on health professional courses; insufficient training and low professional experience; low repertoire in interdisciplinary health and care work; incoherence between the theoretical work model and daily work services. |