Table 1
Scoping Review Methods.
| SCOPING REVIEW STAGE | METHODS |
|---|---|
| (1) Defined the research questions and purpose |
|
| (2) Identified relevant studies |
|
| (3) Selected studies |
|
| (4) Charted the data |
|
| (5) Collated, summarised and reported the results |
[i] Notes: MeSH = Medical subject heading.
Figure 1
Literature Review Keywords and MeSH Terms.
Notes: MeSH = Medical subject heading.
Figure 2
Database Search Results.
Table 2
Characteristics of the Selected Studies (n = 62).
| CHARACTERISTIC | TOTAL N (%) | RELEVANT STUDIES |
|---|---|---|
| Type of study | ||
| Empirical | 33 (53) | |
| Non-empirical | 29 (47) | |
| Region | ||
| United States | 29 (47) | |
| Europe | 16 (25) | |
| United Kingdom | 7 (11) | |
| Canada | 5 (8) | |
| International | 3 (5) | |
| Africa | 1 (2) |
Table 3
Competencies, Themes and References.
| THEMES | SKILLS AND COMPETENCIES | REFERENCES | |
|---|---|---|---|
| 1 | Deeper understanding of our health and social care systems | Enhance workforce understanding of and exposure to alignment of activities across both the health and social care systems | [16, 33, 11] |
| 2 | Deeper understanding of our health and social care systems | Enable workforce attitudes to proactively pursue depth to understand system complexity and how to access services | [15, 33, 34, 11] |
| 3 | Deeper understanding of our patients | Skills to construct a comprehensive understanding of individual patients’ complex needs and how these can be met within their surrounding health and social care systems | [34, 3, 11, 13, 36] |
| 4 | Deeper understanding of our communities | An understanding of how social and cultural factors affect health | [4] |
| 5 | Deeper understanding of our communities | Consideration for concerns specific to vulnerable populations and their needs | [34] |
| 6 | Deeper understanding of our patients | Skills to actively pursue depth and continuously asking ‘why’ (rather than just ‘what’ or ‘how’) to construct a deep understanding of individual patients (their perceptions, beliefs and psychosocial context) and the system within which they interact | [34, 35, 11] |
| 7 | Deeper understanding of our patients | A holistic understanding of individuals’ health and wellbeing, capabilities, self-management abilities, needs, preferences and the environment in which they find themselves, including recognition that an individual’s situation is dynamic, not static and requires regular monitoring | [31, 34, 35, 36] |
| 8 | Deeper understanding of our patients | Skills to establish a longitudinal alliance with the patient and functional relationships with colleagues | [27, 28, 31, 35, 11, 36] |
| 9 | Enhanced understanding of systems and available resources | Extensive integrated knowledge of biopsychosocial aspects of disease, systems of care and social determinants of care | |
| 10 | Enhanced understanding of systems and available resources | Understanding how to apply knowledge of the major determinants of health given resources available, relevant health policies and system design within a community | |
| 11 | Caregiver involvement | Involvement of and communication with caregivers. An active approach to caregiver wellness, including understanding risk factors, recognising signs of caregiver distress, assessing caregiver needs and referring caregivers to care | [16, 34, 35, 37] |
| 12 | Caregiver involvement | Direct provision of psychosocial care to caregivers across a spectrum of needs inclusive of bereavement | [4, 34] |
| 13 | Enhanced understanding of systems and available resources | Familiarity with local and national resources to support social needs and can connect patients and caregivers to such resources, including community-based partners | [4] |
| 14 | Enhanced understanding of systems and available resources | Collaborate with community-based partners to improve patient care. Skill development to collaborate with other health providers outside specialist settings | [4, 16, 33, 34, 44, 11] |
| 15 | Illness prevention | Health promotion and disease prevention, including knowledge of and referral to preventative facilities and local programmes and support for lifestyle interventions | [15, 37, 39, 40, 11] |
| 16 | Enhanced understanding of systems and available resources | Embrace individuals, communities and services as partners in care | [5, 33] |
| 17 | A person-focused approach that considers the patient’s presenting problem and other medical issues | [5, 13, 36] | |
| 18 | Focuses on the needs of individuals, families and communities to improve their quality of care, health outcomes and wellbeing | ||
| 19 | Empowering patients | Support patients in their involvement in their care by empowering them with knowledge and skills per their capabilities | [5, 11, 13] |
| 20 | Patient-centred and relationship-centred care | [15, 5, 35] | |
| 21 | Interprofessional teamwork | Work effectively as a member of an interprofessional team | [15, 5, 33, 11, 41, 36] |
| 22 | Collaborate with individuals and families to develop a personalised care plan to promote health and wellbeing that incorporates integrative approaches, including lifestyle counselling and mind–body strategies | [15] | |
| 23 | Empowering patients and communities | Facilitate behaviour change in individuals, families and communities to achieve ways of living that promote health, resilience, wellbeing and disease prevention | [15] |
| 24 | Obtain an integrative health history that includes mind–body–spirit, nutrition and use of both conventional and integrative therapies | [15] | |
| 24 | Role models | Practice self-care | [15] |
| 25 | Demonstrate basic knowledge of the major health professions, both integrative and conventional | [15] | |
| 26 | Demonstrate skills to incorporate integrative healthcare into community settings and the healthcare system at large Value continuous learning, become mentors, teachers and peer learners | [15, 36] [33, 11] | |
| 27 | Patient centredness | Patient centredness; understanding and facilitating patients’ pathways through the care system | [15, 5, 36] |
| 28 | Collaborating with other providers; strong communication and collaboration skills and the ability to develop strong working relationships with team members are imperative | [24, 5, 42, 43, 44] | |
| 29 | Health promotion and disease prevention | Community-based health education, health promotion and disease prevention | [15, 40, 45] |
| 30 | Health promotion and disease prevention | Knowledge of how to teach patients self-care strategies to stay healthy and how to incorporate the patient’s strengths and resources within their care plan | [15, 37] |
| 31 | Understanding individuals’ roles in the integrated healthcare team and the ability to articulate this role to other team members | [24, 5, 36] |
Table 4
Models of Training.
| MODEL | RELEVANT STUDIES | |
|---|---|---|
| 1 | Scale up existing competencies among all practitioners to deliver more integrated care | [15, 30, 13, 36] |
| 2 | Incorporate integrated care concepts organically, so that they are fundamental to delivering care | |
| 3 | Create a working environment that values wellness and creates a climate of respect and work-life balance | [14, 36] |
| 4 | Engage faculty teaching staff who convey joy in their work and provide trainees with education around work-life balance, self-reflection and self-improvement | [14] |
| 5 | Embed structures to support collaboration and interprofessional learning among colleagues and professions across services, strengthening multisector relationships; multi-organisation training | [33, 47, 48, 11, 36] |
| 6 | Incorporate simulation-based scenarios using actors from the local community with lived experiences | [49] |
| 7 | Incorporate education and support for caregivers, including prevention of health problems and improving quality of life. For example, implement a weekly meeting for caregivers to discuss topics related to the experiences of the patients’ healthcare and their self-care needs | [37] |
| 8 | Allow more time for networking, interprofessional education and opportunities for individual service presentations and diverse attendance, including the social care and voluntary sectors | [47, 50, 36] |
| 9 | Case studies, exercises and simulations are encouraged to allow students to interact with the content in as realistic a venue as possible | [42] |
| 10 | Focus on soft skills, such as communication, teamwork and relationship building | [5, 34, 13, 41] |
| 11 | Focus on skills to build durable relationships with patients, other professionals and caregivers | [5, 34] |
| 12 | Focus on self-management promotion and skills, including the use of motivational interviewing techniques | [34] |
| 13 | Skills to navigate the health and social care systems and work on individualised care plans and assessments | [30, 34, 47, 13] |
| 14 | Ongoing mentorship | [38, 51] |
| 15 | Workplace training, including interprofessional education, strategies for new staff, such as providing an integrated care manual and shadowing opportunities for the new staff member to be placed with different professionals across sectors and services | [51, 36] |
| 16 | Workplace training, including team meetings, mutual education about workflow or processes or a review of a problematic shared case | [51, 52, 41, 36] |
| 17 | Short courses, such as motivational interviewing | |
| 18 | Understanding of primary care providers, including how to interface and refer clients | [14] |
| 19 | Interprofessional skill development and education for faculty and a willingness and ability for faculty to evaluate and update curriculum in line with changes within the healthcare environment | [16, 53, 13, 36] |
| 20 | Blended learning approaches that use discussions among participants, role play, problem-based learning and case application | [15] |
| 21 | Provide opportunities for students and healthcare workers to develop interpersonal and interprofessional strategies to consult, coordinate and collaborate routinely in practice | [5, 28, 41] |
| 22 | Create opportunities and a focus on building relationships and care pathways with organisations in the community | [44, 11] |
| 23 | Include opportunities for critical thinking and reflective practice and the use of case presentations and role-plays | [16] |
| 24 | Create opportunities for all disciplines to train, think, create and seek solutions as a unit | [16, 28, 36] |
| 25 | Create an environment where there is a willingness to think differently about how services are delivered to meet the changing needs and expectations of people using health and social care services | [54] |
| 26 | Opportunities for broader and more meaningful engagement across health and social care | [54, 57] |
| 27 | Incorporate and encourage innovative training and development that spans across health and social care | [54, 36] |
| 28 | Design clinical practice environments to support and enable continuous learning that benefits not just learners, but also patients, communities and providers | [9] |
| 29 | Provide opportunities for participants to gain placement experience engaging in team-based assessments and intervention strategies | [24] |
Table 5
Barriers/Challenges.
| BARRIER/CHALLENGE | RELEVANT STUDIES | |
|---|---|---|
| 1 | Siloed competency domains and traditionally siloed health systems | [18, 50, 43] |
| 2 | Current curricula do not promote the acquisition of experience and skills in the community and integrated care settings | [7] |
| 3 | Fragmented, outdated and static curricula | |
| 4 | Systems that allow only limited and narrow functional relationships with colleagues | [50] |
| 5 | Professional training programmes do not adequately prepare clinicians to work in a collaborative and integrative setting | |
| 6 | A small number of professionals may receive training within a short course or generalist training programme, but this represents a limited number of professions who are field-ready after their studies | |
| 7 | The general nature of integrated care and learning about other services may not align with the expectations of specialty training | [7, 50] |
| 8 | A lack of consultant-led integrated services, restricting consultant supervision and workforce development in such services | [7] |
| 9 | In many training programmes, students learn the principles of primary care but are then placed in clinical environments where it is challenging to implement and practice those principles | [8] |
| 10 | Current curricula for higher medical trainees do not promote the acquisition of experience and skills working across services and within integrated care settings | [7] |
| 11 | Emphasis on using standardised clinical pathways and specialists who do not fully understand and are unable to facilitate patients’ pathways through the care system | [29, 41, 51] |
| 12 | Time, budget, organisational and logistic constraints and a lack of access to experts to provide training | [9, 10] |
| 13 | Training still relies on models that emphasise diagnosis and treatment of acute diseases | |
| 14 | Hospital specialists seem unaware of general practice conditions, focusing on disease treatment without considering the daily life of the patient and the existence of comorbidities | [52] |
| 15 | A lack of a shared system to facilitate transfer of information across settings and time constraints are major barriers to effective care transitions | [52] |
| 16 | Observing patients at different disease stages indirectly affected goal setting | [52] |
| 17 | The rigid separation of disciplines at the educational level results in a process that can lead to discontent, animosity, fragmented learning, fragmented practice and, subsequently, fragmented care | [24] |
| 18 | Although health and social care staff may value joint working to improve quality of care, interprofessional collaboration did not occur routinely due to organisational limitations | [26] |
| 19 | Employees and organisations had limited understanding of integrated care practices | [48] |