Occupational Therapy Within Integrated Community Care Systems: A Systematic Review and Narrative Synthesis of Policy and System-Level Evidence.

BACKGROUND/

OBJECTIVES

Population aging and rising long-term-care demand require community-based systems that support function and participation. Occupational therapy (OT) is provided across community-care settings, yet its policy- and system-level position remains inconsistently defined. This review examined how OT is positioned, financed, accessed, coordinated, staffed, and implemented within integrated community care.

METHODS

PubMed, CINAHL, Scopus, ProQuest Central, and APA PsycINFO were searched for English-language peer-reviewed literature published from 1 January 2010 to 29 July 2026. Two reviewers independently conducted study selection, data extraction, and design-matched critical appraisal. GRADE-CERQual and GRADE were applied to eligible qualitative and quantitative findings, respectively. The review synthesized peer-reviewed evidence describing policy- and system-level arrangements rather than systematically reviewing primary policy documents themselves.

RESULTS

Of 15,402 records, 5131 duplicates were removed, 10,271 screened, and 38 reports assessed in full text; 21 reports representing 20 unique studies/datasets were included. Framework synthesis refined the initial deductive categories into five higher-order domains: institutional positioning; financing/coverage; referral/coordination; service-delivery roles/infrastructure; and workforce/implementation support, with accessibility, equity, and user participation as cross-cutting themes. CERQual confidence was moderate for role clarity/team understanding, organizational integration supports, and service context/workforce capacity, and low for reimbursement/billing constraints, referral-prioritization/fairness judgments, and service-redesign tensions. Waiting-time change, waiting-list association, and OT integration feasibility had very low GRADE certainty.

CONCLUSIONS

OT integration reflected interrelated policy-system arrangements rather than a validated model. Downstream system effects remain insufficiently established.