What is primary healthcare integration?

Primary healthcare integration is a way of combining different primary healthcare services that have previously been delivered separately. The aim of this integration is usually to give people better access to healthcare and to make more efficient use of limited health resources.

Why is it important to know about healthcare workers’ views and experiences?

Primary healthcare integration has been implemented in many different countries with varying success. Healthcare workers can influence the extent to which such changes in health services are implemented successfully. Learning about healthcare workers’ views and experiences of primary healthcare integration can help us understand how healthcare workers might influence its implementation and its success or failure.

What was the purpose of this scoping review?

This scoping review searched for and mapped qualitative studies (studies with no numerical data) about healthcare workers’ views and experiences of primary healthcare integration. We wanted to describe the available research to help inform future systematic reviews and research studies in this area.

How did we identify and map the evidence?

We searched for all published qualitative studies that reported on healthcare workers’ views and experiences of primary healthcare integration up to 28 July 2020. We described the different study methods, countries, the scope and type of primary healthcare integration approaches, and the different types of healthcare workers and client groups involved. We then grouped the studies into categories.

What did we find?

We included 184 studies. The studies were from 37 countries. About half the studies took place in high-income countries and half in low- and middle-income countries.

The studies we found in our review covered a variety of settings, participants, and types of primary healthcare integration. There were different configurations for which healthcare service programmes were being combined for integrated service delivery. These were categorised into the following six configurations: mental health; HIV, tuberculosis, and sexual reproductive health; maternal, woman, and child health; non-communicable diseases (for example, heart disease, diabetes); general primary health integration, and allied and specialised services. We also explored whether integrated service delivery was fully or partially integrated, and the different integration strategies used to link and co-ordinate services.

The people participating in the implementation of integration interventions included policymakers, senior managers, middle and frontline managers, clinicians, allied healthcare professionals, lay health workers, and health system support staff. A wide range of clients were recipients of the integrated services.

Author’s conclusions

This scoping review shows the variety of primary healthcare integration approaches that have been studied. Researchers and decision-makers need to understand the relationship between different integration approaches and contexts, and the ways in which healthcare workers influence the impacts of this integration. The study categories we have developed can help researchers to understand these different types of integration approaches and to identify more focused questions for future systematic reviews.