Integrated care for chronic respiratory disease: a narrative review

Integration of healthcare services for people with chronic respiratory disease (CRD) is proposed as a means to improve the delivery of evidence-based therapies, thereby improving outcomes, experience of care and reducing health inequalities. In this narrative review we define categories of integration interventions, present a structured assessment of the evidence supporting both horizontal and vertical integrated care models and case-finding in CRD, and describe the implications for the implementation and scaling of integrated care programmes in clinical practice. Our findings suggest better coordination of the provision of evidence-based interventions through horizontal integration can improve clinical outcomes in CRDs, including reducing episodes of unscheduled care. Vertical integration provided by different organisational units in healthcare systems can enhance delivery of evidence-based interventions but impact on longer-term outcomes is less clear. The available evidence, whilst providing support for integration, does not conclusively support a specific model of care or organisational structure. Careful attention is required to define components of integrated care interventions. Study duration and choice of outcomes are key to evaluating clinical and cost effectiveness in future trials.