Health policy (Amsterdam, Netherlands) · 2026
System failures in care continuity and coordination for people with multiple long-term conditions: an umbrella review of patient, carer, and professional perspectives.
СтатьяСистематический обзорПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Richards Thomas C, Melendez-Torres G J, Dawes Helen
Аннотация
BACKGROUND: The growing number of patients with multiple long-term conditions (MLTCs) presents major challenges for continuity and coordination of care across patients, carers, professionals, and healthcare systems.
OBJECTIVES: To identify and contrast key problem areas in continuity and coordination of care from the perspectives of patients, carers, and healthcare professionals (HCPs), and define requirements for a system design toolbox to address them.
METHODS: We searched nine databases (MEDLINE, Embase, HMIC, PsycInfo, SPP, CINAHL, AgeLine, AMED, CDAS) from inception to 12 February 2024. We included English-language qualitative reviews of continuity or coordination of care for MLTCs from patient, carer, or HCP perspectives. A novel pluralistic synthesis approach was used to compare cross-stakeholder themes.
RESULTS: Forty-two reviews (1576 primary studies) were included. Seven problem domains were identified. Across stakeholder groups, there was substantial overlap in problems reported within domains, indicating shared recognition of key challenges. However, priorities differed: patients emphasised lack of consideration from HCPs, carers highlighted gaps in support and knowledge, and HCPs emphasised deficits in training and expertise. Many frustrations reported by patients and carers were also recognised by professionals, indicating systemic rather than individual failings.
CONCLUSIONS: Breakdowns in continuity and coordination arise not from lack of awareness, but from misalignment in how stakeholder needs are prioritised. Those seeking to address these challenges would benefit from a system design toolbox with capabilities to detect communication breakdowns, align care with patient priorities, and strengthen care transitions. Policy should prioritise patient-centred communication, multidisciplinary coordination, and clear accountability in care transitions.
OBJECTIVES: To identify and contrast key problem areas in continuity and coordination of care from the perspectives of patients, carers, and healthcare professionals (HCPs), and define requirements for a system design toolbox to address them.
METHODS: We searched nine databases (MEDLINE, Embase, HMIC, PsycInfo, SPP, CINAHL, AgeLine, AMED, CDAS) from inception to 12 February 2024. We included English-language qualitative reviews of continuity or coordination of care for MLTCs from patient, carer, or HCP perspectives. A novel pluralistic synthesis approach was used to compare cross-stakeholder themes.
RESULTS: Forty-two reviews (1576 primary studies) were included. Seven problem domains were identified. Across stakeholder groups, there was substantial overlap in problems reported within domains, indicating shared recognition of key challenges. However, priorities differed: patients emphasised lack of consideration from HCPs, carers highlighted gaps in support and knowledge, and HCPs emphasised deficits in training and expertise. Many frustrations reported by patients and carers were also recognised by professionals, indicating systemic rather than individual failings.
CONCLUSIONS: Breakdowns in continuity and coordination arise not from lack of awareness, but from misalignment in how stakeholder needs are prioritised. Those seeking to address these challenges would benefit from a system design toolbox with capabilities to detect communication breakdowns, align care with patient priorities, and strengthen care transitions. Policy should prioritise patient-centred communication, multidisciplinary coordination, and clear accountability in care transitions.