Figure 1
The points in a health system at which barriers to care continuity and its coordination can exert an influence – adapted from WHO’s Integrated People-Centred Health Services- [4].
Figure 2
The range of approaches and interventions for achieving continuity of care (adapted from WHO’s Integrated People-Centred Health Services) [4].
Figure 3
Adapted PRISMA flowchart [15] of the study inclusion process.
Figure 4
Characteristics of the included studies: country, number of publications and years.
Figure 5
Included publications on chronic conditions by countries.
Figure 6
Summarised results from quality appraisal tools, where: yes, no, partially and unclear, refer to the studies meeting each tool’ summarised quality requirements or item responses.
Figure 7
Main points across the health system at which continuity and care coordination barriers emerged for First Nations Peoples [17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31]: At the micro level and clinical integration points, [4] individuals face constraints such as limited access to coaching and peer support [28, 32, 33] and deficiencies in case management and holistic care planning [34, 35, 36, 37, 38, 39]. The meso level presents challenges in terms of professional integration points [4], characterised by siloed team approaches [40, 41], inadequate clinical pathways [42, 43], and gaps in transitional care services [25, 44]. Organisational integration points [4] reveal barriers related to the absence of community initiatives [21, 45, 46], challenges in service collocation [47, 48, 49], and issues surrounding points of access [38, 50]. Functional integration points [4] present obstacles primarily in continuity of information [32, 39, 41], decision support [51, 52], and the utilisation of technology for care enablement [53, 54]. The macro level, focusing on system integration points [4], highlights significant limitations, including deficient health and social care networks [24, 55, 56], constrained health and social care pathways [57, 58, 59], and challenges related to care management [60, 61, 62]. For a more detailed analysis and synthesis of the studies underpinning Figure 7, please refer to Figure 8 and subsequent narrative explanations.
Figure 8
The points in a health system where barriers to continuity and coordination of care emerged for First Nations Peoples – The figure was created based on WHO’s IPSCH and is citing examples from reviewed literature; the numbers in columns represent the frequency of each WHO’s IPSCH theme as per reviewers’ cataloguing using Figure 1 as a guide [4]. The cells highlighted in orange represent the most frequent themes. In the columns, FNP refers to First Nations Peoples, AU to Australia, CA to Canada and AO to Aotearoa.
Figure 9
Decision-making matrix to co-design evidence-based care solutions with First Nations Peoples [16]: This matrix includes the most important enablers and strategies for achieving continuity of care and its integration for First Nations Peoples living with chronic conditions, as per the synthesis of 103 publications. It situates the reader on the order of importance of needed strategies (nature, levels, and types) around enabling care for First Nations Peoples [23, 40, 65, 67, 68, 69, 70, 71]. These enablers are ranked in order of importance with numbers from 1–18, considering the frequency of WHO’s IPSCH [4] theme identification within the qualitative review process.
Figure 10
Enablers for achieving continuity of care for and with First Nations Peoples – The figure was created based on WHO’s IPSCH by citing examples from reviewed literature; the numbers in columns represent the frequency of each WHO’s IPSCH theme as per reviewers’ cataloguing using Figure 2 as a guide [4]. The cells highlighted in orange represent the most frequent themes. In the columns, FNP refers to First Nations Peoples, AU to Australia, CA to Canada and AO to Aotearoa.