Abstract
Background: Clinical (service) integration in primary care settings describes how comprehensive care is coordinated by family physicians (FPs) over time across healthcare contexts to meet patient care needs. Promoting integrated care with interventions that lack systematic approaches can unintentionally increase the complexity and fragmentation of the healthcare system. To improve care integration and healthcare service planning, a systematic approach to understanding its many influencing factors is paramount. Phase I of this study aims to generate a comprehensive map of FP perceived factors across diseases and patient demographics.
Methods: The protocol development is guided by Arksey and O’Malley’s scoping review methodology framework. Keywords and Medical Subject Headings (MeSH) terms were contributed by a multidisciplinary team of healthcare professionals, researchers and patient representatives through an iterative discussion and were tested to build a search strategy using the MEDLINE database by an Information Specialist. The resulting strategy was then adjusted for the EMBASE and CINAHL databases. The identified records were screened and selected for data extraction by two independent reviewers. FP perceived factors, based on source and nature, will be extracted and mapped into themes of the Clinical Integration Framework, such as FP and patient factors. The framework is a merging of two existing models that were identified from literature and modified to capture factors originating from within a healthcare system and within practices respectively. The distributions of studies and factors across the framework themes will be presented descriptively.
Discussion: The identified factors will be used to help develop a survey for Phase II of the study to ascertain high impact factors for intervention(s), as well as thematic and evidence gaps to guide future research. The study findings will be shared with stakeholders to promote awareness of clinical integration issues through multiple channels: publications and conferences for researchers and care providers, an executive summary for clinical leaders and policy makers, and social media for the public.