Theories, Models and Frameworks: How to achieve the integration of community pharmacy in primary health care? 

Celia Piquer-Martinez, Pharmaceutical Care Research Group, University of Granada, Granada, Spain

Amaia Urionagüena, Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Spain

Shalom I. Benrimoj, Pharmaceutical Care Research Group, University of Granada, Granada, Spain

ABSTRACT

Health policies focus on achieving integrated health systems to improve their efficiency and sustainability. System integration result in improved health and patient satisfaction. It is a means of unifying visons and missions, and attempts to optimize the use of the available resources, whether professional, financial or setting. However, in spite of being a major gateway to primary healthcare, due to the reach and accessibility of community pharmacy (CP), it often remains overlooked by governments in integration policies and processes. Critically there is limited literature on theoretical concepts that could be applied to the possible integration of CP and primary health care (PHC).

Purpose

To identify and classify the theories, models and frameworks of health system integration.

Method

A systematic review was undertaken in PubMed, Scopus, Web of science, Psycinfo and Cochrane library using the terms: “integrated/organized delivery system, health care/services/systems integration, and integrated health care / services / system / delivery” from 2013 to 2022. The guidelines for the classifications were; Theory was “a set of analytical principles or statements designed to structure our observation, understanding and explanation of the world”. Theories are explanatory as well as descriptive.; Models typically “involves a deliberate simplification of a phenomenon or a specific aspect of a phenomenon”.; Framework usually “denotes a structure, overview, outline, system or plan consisting of various descriptive categories, e.g., concepts, constructs or variables”. Frameworks do not provide an explanation however they only describe empirical phenomena by fitting them into a set of categories. 

Results

From 4323 articles, 30 papers were retrieved according to inclusion and exclusion criteria, identifying 12 models, 10 frameworks and 2 theories, categorized; Theories: Integration degree; Complex Adaptive Systems or Complexity theory. Models: Model for an integrated health system; Model INSIDE; Network Integration; LOPSI Conceptual Model; SNEI; The McKinsey 7S model; Conceptual model of integration types (Singer); Integrated Primary Care (IPC) Model; Shared Mental Models; Provider-based Conceptual Model; Funnel Model; Co-location Model.; Frameworks: Conceptual Framework: Five health care activities that facilitates Integration (5As); The Four Domain Integrated Health (4DIH) framework; Atun el at. Framework; Clinical integration Conceptual Framework based on Mauer (2006); Integrated Performance and Incentive Framework; System level measures framework; Theoretical framework: Conceptual scheme of different forms of integration; Monitoring and Evaluation (M&E) framework; Framework SAAS.

Conclusion

It’s interesting to know that there were many interpretations to the differentiation between a theory, a model and a framework but the literature review did not produce any CP and PHC specific model, framework or theory. However, there were suggestions on positioning CP in integrated care, rather than integrating into PHC. In order to find and choose the most suitable model, framework or theory to guide the integration of CP into PHC, rigorous criteria need to be set according to national health needs, culture and local context for PHC and CP. 

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