Amaia Urionagüena, Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
Celia Piquer-Martinez, Pharmaceutical Care Research Group, University of Granada, Granada, Spain
Shalom I. Benrimoj, Pharmaceutical Care Research Group, University of Granada, Granada, Spain
Fernando Martinez-Martinez, Pharmaceutical Care Research Group, University of Granada, Granada, Spain
Victoria Garcia-Cardenas, Graduate School of Health, University of Technology Sydney, Sydney, Australia
Fernando Fernandez-Llimos, Center for Health Technology and Services Research (CINTESIS), Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
Miguel Angel Gastelurrutia, Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
ABSTRACT
Background
Traditionally, pharmacists have not been perceived as providers of health services. This is changing as in many countries the Community Pharmacy Network (CPN) is being recognised as a valuable resource for the health system due to pharmacists' accessibility, distribution and extensive knowledge of medicines. However, Community Pharmacy (CP), due to many factors remains largely not integrated in Primary Health Care (PHC) systems. Integration is a complex term with multiple interpretations with a number of policy options on the method of integration that CP could pursue.
Objective
To Identify and analyse the different types of integration used in health to assess their applicability to the integration of CPN and PHC.
Method
A narrative review was undertaken to identify the different types of integration in health. Initially, the International Journal of Integrated Care was manually reviewed from the inception of publication in November 2000 to January 2022 Additionally, a Google search was performed with the query: integration health types OR processes OR dimensions file type: pdf.
Results
The review ended with 55 articles where five integration types were identified and classified according to the hierarchical levels of the health system: clinical and service integration at micro level (CP and primary health care centres), professional and organisational integration at the meso level (provincial level), and system integration at macro level (national state level). Different attributes were identified that serve to define and consolidate the integration process. The attributes were classified into groups: breadth (horizontal, vertical); interaction (linkage, coordination, cooperation, collaboration, full integration) and enablers which assist integration (informational, normative, functional, cultural, contextual, structural and financial). The intensity of integration was related to different components such as trust, consensus, connectivity and communication.
Conclusion
The most appropriate single or combination of integration types needs to be analysed in order to approach the complex problem of integrating CPN and PHC. Without a formal integration in primary health care system the evolution of community pharmacy as a health care provider may be impaired.