Mapping Evidence and Constructing an Analytic Framework: An Umbrella Review Summarizing Primary Care Family...

Area of Science:

• Health Services Research
• Primary Care Medicine
• Integrated Care Systems

Background:

• Strengthening primary care's integration function is vital for promoting coordinated healthcare.
• Understanding barriers and facilitators to clinical integration is crucial for effective intervention planning.
• Clinical integration involves coordinating health services across various dimensions.

Purpose of the Study:

• To generate an analytic framework and evidence map of barriers and facilitators perceived by family physicians (FPs) in clinical integration.
• To identify factors influencing the coordination of healthcare services.
• To inform intervention strategies for improving integrated care in primary care settings.

Main Methods:

• Umbrella review methodology using Joanna Briggs Institute guidelines.
• Searched MEDLINE, Embase, and CINAHL databases for reviews on primary care FPs and clinical integration (2010-2022).
• Developed a customized clinical integration framework and validated it with additional reviews (2022-2024).

Main Results:

• An analytic framework with 9 themes and 21 subthemes was developed from 2,891 factors.
• The 'professional' theme (diseases, guidelines, teamwork) was most significant (86% of reviews).
• System, organization, and practice themes were less frequently reported (48%, 22%, 23% respectively).

Conclusions:

• Complex interactions among factors highlight challenges in developing universal integration strategies.
• Evidence maps reveal knowledge gaps, guiding future research in primary care integration.
• Further research is needed to address system-level factors influencing clinical integration.