Abstract Background: Despite Australia's universal health insurance scheme, Medicare, out-of-pocket costs (OOPC) for health care comprises 14 % of total health expenditure. People with chronic conditions spend a greater proportion of their incomes on health care than people without a chronic condition. Objective: To review the qualitative literature examining experiences of OOPC of out-of-hospital care by people with chronic conditions and to discuss this in relation to current Australian health policy. Methods: Systematic review and narrative synthesis of the qualitative literature examining OOPC for people with chronic conditions in Australia. Search: Pubmed, CINAHL Complete, Cochrane Library, PsycINFO and EconLit databases from 1999 to 10th April 2025. Results: 37 studies met the inclusion criteria. Reduced or lost employment due to ill-health led to income loss, aggravating the financial burden of health management. While many people were able to access bulk-billing general practitioners, challenges in affording upfront and copayments for medical and allied health consultations, and medication costs were reported. Cost was the greatest barrier to accessing dental care. Trade-offs were described between health management and meeting basic living needs, particularly for people who earned too much to qualify for government welfare payments. Conclusion: While Australian health policies effectively reduce the financial burden of health care for many people, distinct challenges exist for groups ineligible for concessional thresholds. Future research to identify the priorities and preferences of people with chronic conditions can further inform policy to improve the equity of health financing in Australia.

This systematic review examined trends in the prevalence of type 2 diabetes mellitus (T2DM) and identified its risk factors among adults in Vietnam. PubMed, Web of Science, Wiley Online Library, and Scopus databases were searched to identify relevant literature. The search yielded 10 studies, including 2 national surveys and 8 regional investigations. National prevalence estimates of T2DM were 2.7% in 2002 and 5.4% in 2012. The estimates for the northern region were 1.4% in 1994 and 3.7% in 2012 and those for the southern region were 3.8% in 2004, 7.0% in 2008, and 12.4% in 2010. The major determinants of T2DM included older age, urban residence, high levels of body and abdominal fat, physical inactivity, sedentary lifestyle, genetic factors, and hypertension. The prevalence rate by gender was variable in both national and regional studies. There was insufficient information available on some potentially important risk factors such as smoking, dietary intake, income, and educational level. Our review signifies a rapidly growing prevalence of T2DM in Vietnam and suggests that extra effort is required to prevent and control this disease

Background: Tension-type headache (TTH) is a prevalent primary headache disorder significantly impacting quality of life and healthcare resource utilization, with females typically bearing a higher disease burden. However, comprehensive analyses and predictive studies on the global TTH burden stratified by gender are currently lacking. Aim: This study utilized data from the Global Burden of Disease (GBD) Study to analyze the global burden of tension - type headache by sex from 1990 to 2021 and conducted a 15 - year projection (up to 2036). Methods: We conducted a systematic review of GBD 2021 data, employing Joinpoint regression analysis and decomposition analysis to assess TTH incidence, prevalence, YLDs, and DALYs. Additionally, we used the ARIMA model for a 15-year predictive analysis of TTH burden trends. Results: From 1990 to 2021, global female TTH cases rose from 669.54 million (95% UI: 586.2-751.8 million) to 1.04 billion (95% UI: 923.0-1.1 billion), with incidence increasing from 242.9 million (95% UI: 218.8-267.0 million) to 369.86 million (95% UI: 332.5-407.2 million). Male cases grew from 616.82 million (95% UI: 537.2-696.4 million) to 970 million (95% UI: 851.0-1.0 billion). Decomposition analysis indicated population growth was the primary driver of the increase in female TTH prevalence. Projections suggest that by 2036, the incidence will reach 9,174.84 per 100,000 females (95% UI: 8,854.8-9,494.9), prevalence will be 25,135.1 per 100,000 females (95% UI: 23,977.2-26,283.0), YLD rate will be 62.76 per 100,000 females (95% UI: 58.8-66.7), and DALY rate will be 60.97 per 100,000 females (95% UI: 56.7-65.2). Conclusion: This study highlights the significance of gender in TTH burden, particularly the heightened risk for females. Through temporal trend analysis and predictive modeling, we provide insights into future TTH disease trajectories, aiding global public health policy formulation and healthcare resource allocation.

Gastrointestinal (GI) cancers are among the leading causes of cancer-related morbidity and mortality worldwide, presenting a significant public health challenge. Even with medical research advancements, their incidence remains rising due to modifiable and non-modifiable risk factors across lifestyle, environmental, genetic, and socioeconomic factors. This narrative review identifies and synthesizes key risk factors contributing to GI cancers, including unhealthy diets (high consumption of processed foods, red meat, and added sugars), physical inactivity, obesity, smoking, alcohol use, infections (e.g., Helicobacter pylori), environmental pollution, chronic stress, and socioeconomic disparities. The review emphasizes the interaction among these factors and how this interplay is responsible for the development and progression of GI cancer. It emphasizes the importance of early detection, lifestyle modifications, and public health interventions tailored to specific populations. Understanding these interconnected risk factors provides critical insights for guiding prevention strategies, policymaking, and health education. Addressing modifiable risk factors through a comprehensive, multi-sectoral approach may significantly reduce the global burden of GI cancers and improve long-term health outcomes.

Background: Cancer is a growing public health concern in Africa and Asia, where access to effective healthcare and resources is often limited. There is an urgent need for evidence-based cancer control policies in Africa and Asia, along with systems for prevention, early detection, diagnosis and treatment, and palliative care. This emerging issue has garnered growing interest from international institutions but there has been little visible action, and the existing knowledge remains scattered and fragmented. This scoping review aims to explore the breadth and scope of evidence regarding knowledge transfer interventions to enhance cancer care in Africa and Asia. Methods: We conducted a systematic search of Embase, Emcare, ERIC, APA PsycInfo, Medline, and Google Scholar, supplemented by expert bibliographies and references. Peer-reviewed empirical studies in English or French from January 1978 to September 2024 were included. Data were organised using the AIMD (Aims, Ingredients, Mechanism & Delivery) framework. Study quality was presented using the Mixed Methods Appraisal Tool. Results: The scoping review examined seven articles providing evidence on five unique interventions. The interventions included target both decision-makers and health professionals and aim to strengthen evidence-based cancer control policies and implementation strategies. The interventions documented have all been initiated by external actors, mainly international institutions or researchers from high-income countries, in collaboration with African and Asian stakeholders. In addition, some researchers have been involved in participatory research projects designed to enable decision-makers to implement evidence-based cancer control policies and programmes. Conclusions: This scoping review highlights a critical lack of evidence on knowledge transfer interventions in cancer care across Africa and Asia, partly due to limited funding for non-communicable diseases. It calls for the integration of knowledge transfer components into all cancer research and interventions, supported by robust evaluation strategies, to develop evidence-based, economically feasible, and culturally appropriate policies, guidelines and interventions that can be used in nations with limited healthcare resources to improve cancer outcomes.

目的 评估身体活动对肥胖和超重儿童青少年身体健康、心理健康以及身体活动相关的健康行为的效益。方法 遵循PRISMA指南，系统性检索Web of Science、PubMed、Scopus、PsycINFO、Cochrane Library和中国知网中2016年至2024年间发表在科学引文索引Q4区及以上期刊的系统综述或Meta分析，内容涵盖身体活动或运动干预对6～18岁肥胖或超重儿童和青少年身体或心理健康的影响。采用AMSTAR 2工具对纳入文献进行质量评估，对中高水平质量文献进行系统综述。结果 共纳入8篇系统综述和Meta分析，涉及24 567例儿童和青少年，其中6篇为高质量，2篇为中等质量。在身体健康方面，结合有氧和阻力训练的复合运动干预在降低体质量指数(BMI)和体脂率方面表现最佳。每次60 min以上、每周3次、持续12周或更长时间的中、高强度运动干预可以显著降低肥胖和超重儿童的BMI和体脂率，且能提升心肺耐力和肌肉力量。在心理健康方面，身体活动对缓解儿童青少年抑郁和焦虑、提升自尊心具有积极效果。特别是舞蹈、户外探险活动和团队运动对改善儿童青少年的社交能力和情绪状态具有显著作用...

目的 评估身体活动对肥胖和超重儿童青少年身体健康、心理健康以及身体活动相关的健康行为的效益。方法 遵循PRISMA指南，系统性检索Web of Science、PubMed、Scopus、PsycINFO、Cochrane Library和中国知网中2016年至2024年间发表在科学引文索引Q4区及以上期刊的系统综述或Meta分析，内容涵盖身体活动或运动干预对6～18岁肥胖或超重儿童和青少年身体或心理健康的影响。采用AMSTAR 2工具对纳入文献进行质量评估，对中高水平质量文献进行系统综述。结果 共纳入8篇系统综述和Meta分析，涉及24 567例儿童和青少年，其中6篇为高质量，2篇为中等质量。在身体健康方面，结合有氧和阻力训练的复合运动干预在降低体质量指数(BMI)和体脂率方面表现最佳。每次60 min以上、每周3次、持续12周或更长时间的中、高强度运动干预可以显著降低肥胖和超重儿童的BMI和体脂率，且能提升心肺耐力和肌肉力量。在心理健康方面，身体活动对缓解儿童青少年抑郁和焦虑、提升自尊心具有积极效果。特别是舞蹈、户外探险活动和团队运动对改善儿童青少年的社交能力和情绪状态具有显著作用...

目的 系统评价基于格林模式的健康教育对脑卒中患者的干预效果。方法 计算机检索PubMed、Embase、Cochrane library、Web of Science、中国知网、维普数据库、万方数据库和中国生物医学文献数据库，检索格林模式健康教育对脑卒中患者干预效果影响的随机对照试验，时限为建库～2023年11月20日。由2名研究者独立筛选文献、资料提取和文献质量评价。采用RevMan 5.4软件进行Meta分析。结果 共纳入11篇文献，包括982例患者。Meta分析结果显示，与传统健康教育相比，格林模式的健康教育能有效改善脑卒中患者的整体健康行为水平（自我实现、健康责任、锻炼依从性、营养、人际关系、压力应对）、肢体运动功能、神经功能和自我感受负担。但在提升脑卒中患者日常生活能力方面，两组间未见显著差异。此外，根据亚组分析结果显示，干预时间≥6个月时，试验组锻炼依从性与对照组之间比较无明显差异[SMD=1.590,95%CI(-0.380,3.570),P=0.110]。结论 格林模式的健康教育有助于改善脑卒中患者整体健康行为水平，促进患者身体功能恢复和提升其生活质量。

Introduction: Multimorbidity is associated with adverse clinical outcomes, including increased symptom burden and healthcare utilisation, particularly towards the end of life. Despite this, there is no accepted method to identify the point at which individuals with deteriorating health due to long-term conditions are nearing the end of life or might benefit from a palliative care approach - conceptualised as 'Advanced Multimorbidity'. This scoping review explored how Advanced Multimorbidity is described and operationalised within the literature. Methods: Multiple electronic databases and Grey Literature sources were searched following scoping review frameworks. Two reviewers independently performed screening and data extraction. Content analysis was used to examine the different descriptions of Advanced Multimorbidity. Stakeholder consultations were undertaken with clinicians, academics and public participants. Patient and public involvement was separately integrated throughout this review from conceptualisation, design and reporting. Results: Forty-four different descriptions of Advanced Multimorbidity were identified from 38 publications. These varied in terms of the clinical conditions and descriptors used. Eighteen descriptions relied on a single indicator to identify Advanced Multimorbidity; 24 used a multidimensional approach. Stakeholder consultations highlighted the need for descriptions that are user-friendly and actionable. Conclusion: The lack of a standardised definition of Advanced Multimorbidity risks variance in clinical and research practice, potentially affecting patient care. A consensus on defining Advanced Multimorbidity would enable better identification of patients who could benefit from a palliative care approach, ensuring more consistent and person-centred care, as well as supporting research and policy development.

目的：检索、评价并总结终末期肝病病人营养管理的最佳证据，为临床应用提供参考。方法：根据“6S”证据模型，自上而下检索数据库中有关终末期病人术后营养管理的临床决策、指南、专业共识、系统评价和原始研究等证据。由4名研究者对文献的方法学质量进行独立评价，并根据主题提取和汇总证据。结果：共纳入文献23篇，包括指南及专家共识5篇、系统评价及Meta分析6篇，随机对照试验12篇，从多学科营养管理、营养筛查与评估、营养物质推荐量、营养支持与评价、健康教育5个维度汇总30条证据。结论：总结了终末期肝病病人营养管理的最佳证据，建议临床人员结合医疗情境及病人自身情况等制订符合个体化营养管理方案。

Containment policies were essential in controlling the spread of the COVID-19 pandemic in the United States, but they also introduced significant economic challenges. This scoping review aimed to examine the macroeconomic indicators used to assess COVID-19 closure and containment policies in the United States. We reviewed 42 eligible studies from 4516 records identified across PubMed, Web of Science, and EconLit. These studies explored various economic impacts, focusing on employment, labor market indicators, consumer spendings, etc., primarily using publicly available sources. During the pandemic, high-frequency data (eg, mobility and card transactions) became newly accessible and played a key role in evaluating the real-time effects of mitigation policies. Our review summarizes macroeconomic indicators investigated and provides researchers and policymakers with a list of data sources for assessment of economic impacts in the future. This review emphasizes the need for comprehensive evaluations to balance public health measures with economic considerations in future pandemic responses.

Background: Retinal diseases are major contributors to disability, significantly affecting patients' quality of life. Diabetic macular edema (DME) and neovascular age-related macular degeneration (nAMD) represent a significant disease and economic burden in Colombia. Assessing the economic evaluation of available treatments is essential for the efficient allocation of healthcare resources. Objective: To estimate the cost-effectiveness and budget impact of using faricimab for the treatment of patients with DME and nAMD within the Colombian health system. Methods: This study used a 25-year Markov cohort model to estimate the cost-effectiveness of faricimab vs aflibercept, ranibizumab, and brolucizumab. We used the methodological guidelines of the local health technology assessment agency for conducting the cost-effectiveness and budget impact analysis. Transition probabilities and injection frequencies were derived from the literature. Drug prices were retrieved from public local databases. Quality-adjusted life years (QALYs) were assessed. The potential patient population for the budget impact analysis was estimated based on disease prevalence and expert consultations. Results: Faricimab treat-and-extend (T&E) was dominant vs aflibercept T&E (+0.22 QALYs), ranibizumab T&E (+0.55 QALYs), and brolucizumab for 8 to 12 weeks (+0.06 QALYs) in DME, generating cost savings (in US dollars) of 3849 , 1375, and 2824 , r e s p e c t i v e l y . I n n A M D , f a r i c i m a b a l s o s h o w e d d o m i n a n c e v s a f l i b e r c e p t a s n e e d e d ( + 0.12 Q A L Y s ) , r a n i b i z u m a b a s n e e d e d ( + 0.05 Q A L Y s ) , a n d b r o l u c i z u m a b 8 t o 12 w e e k s ( + 0.12 Q A L Y s ) w i t h s a v i n g s i n ( U S ) 7223, 5792 , a n d 6798, respectively. Assuming an annual market share increase for faricimab of 15% for DME and 13% for nAMD, the Colombian Health System could save 144 m i l l i o n o v e r 3 y e a r s . O f t h e s e s a v i n g s , 122.7 million are attributed to drug costs and 21.3 m i l l i o n t o a d m i n i s t r a t i o n c o s t s ( U S 1 = Col$4325). Conclusion: Considering a willingness to pay threshold of $5988 per additional QALY, faricimab is a cost-effective alternative for both DME and nAMD for the Colombian healthcare system, showing dominance over other anti-vascular endothelial growth factor agents. Faricimab provides better health outcomes at lower costs vs other treatments.

Abstract Our review examines the operational dynamics and effectiveness of integrated healthcare models in Australia, focusing on their relevance for older rural adults with preventable chronic diseases. Using Whittemore and Knafl's (2005) systematic integrative review methods, we conducted a search across five databases, including Medline-EBSCO, PubMed, CINAHL, EMBASE, and SCOPUS. The Sustainable Integrated Chronic Care Models for Multimorbidity (SELFIE) framework, established by Leijten et al. (2018), was used for reflexive thematic synthesis. A two-stage screening process identified 15 integrated healthcare models, with five RCTs evaluating their effects on chronic conditions. The analysis revealed two key themes: aspects of care integration (service delivery, leadership, workforce, technology, and finance) and changes in patient and healthcare outcomes. Care coordination and multidisciplinary team care were common features, bridging gaps between health and social services for older patients. Despite challenges such as irregular funding and underutilisation of technology, several models demonstrated positive patient and healthcare outcomes. Virtual care platforms and remote monitoring systems have shown promise in improving patient engagement and enabling real-time care adjustments, particularly in rural areas with limited healthcare access. Our review highlights the need for integrated healthcare for older rural Australians with preventable chronic conditions, revealing the complexity of service models. Policy shifts towards coordinated services and changes in leadership and healthcare practices are essential to ensure this demographic receives integrated care that meets their needs.

Background: Women with a history of hypertensive disorders of pregnancy are at an increased risk of cardiovascular disease. Although clinical practice guidelines for management of hypertensive disorders of pregnancy recommend involvement of a general practitioner for ongoing cardiovascular disease preventative care, there are no intervention strategies embedded within primary care aimed at improving risk assessment or management for women after hypertensive disorders of pregnancy. The study aim was to co-design an intervention to improve implementation of cardiovascular disease risk assessment and management following hypertensive disorders of pregnancy for primary care settings in a local health district in New South Wales, Australia. Method: Using the Integrated Knowledge Translation framework, a series of five co-design meetings with the investigative team and end users were conducted online. Meetings were informed by the Behaviour Change Wheel framework for intervention development and incorporated research findings from a systematic review and meta-analysis, surveys and an online discussion. Data from activities and audio recordings following each meeting were analysed thematically using inductive-deductive thematic analysis. Results were summarized after each meeting, and findings used to inform ongoing intervention development. Results: The 18 end users included women with lived experience of hypertensive disorders of pregnancy (n = 8), obstetricians (n = 2), midwives (n = 5) and general practitioners (n = 3). Target priorities were to improve communication between hospital staff and general practitioners following the occurrence of hypertensive disorders of pregnancy and increase the knowledge of general practitioners and women regarding cardiovascular disease prevention after cardiometabolic pregnancy complications. Part 1 of the intervention is set within the hospital setting and delivered via physical resources to address the communication gap between hospital and primary care providers about the occurrence of hypertensive disorders of pregnancy. Part 2 is delivered via an update to an existing general practice education platform and through resources for use within consultations to provide education for women and general practitioners about cardiovascular disease prevention after hypertensive disorders of pregnancy. Conclusion: The Integrated Knowledge Translation and Behaviour Change Wheel frameworks aided in the development of a targeted intervention to improve implementation of cardiovascular risk assessment and management for women after hypertensive disorders of pregnancy, based on gaps identified in current primary care practice.

Background: Diabetes mellitus requires ongoing management and care coordination. The majority of patients with diabetes were managed in primary healthcare settings. Several quality improvement programs have introduced specialist involvement in primary healthcare teams. However, synthesized evidence is needed to support policy improvements regarding the impact of specialist-primary healthcare coordination on glycemic control in diabetes care. Objective: This systematic review and meta-analysis aimed to assess the effectiveness of specialist involvement in primary healthcare teams on glycemic control of patients with diabetes. Methods: A search of five electronic databases (PubMed, Embase, Web of Science Core Collection, CNKI, and Wanfang Database) was conducted to identify relevant studies published until October 21st, 2023. We assessed the methodological quality of the included studies using the suggested risk of bias criteria for EPOC (Cochrane Effective Practice and Organization of Care). We conducted the certainty assessment using the GRADE guideline. The outcome measured was the HbA1c level. Meta-analyses were performed using random-effects models. Results: A total of 12 studies (7 randomized controlled trials and 5 controlled before-after studies) were included in the meta-analysis. The involvement of specialists in primary healthcare teams was associated with a statistically significant reduction in HbA1c level compared to usual or standard care (mean difference - 0.57, 95% CI: -0.86 to -0.27, I2 = 88.17%). Conclusion: The findings revealed that the interventions might improve the care delivered and patients' health outcomes. However, due to the very low certainty of evidence on the effectiveness on glycemic control, the interventions implemented in the included studies should be employed with caution in future policy-making to achieve improved HbA1c levels. Further research with a more rigorous design is needed to provide evidence of higher certainty and quality. Registration: The systematic review and meta-analysis was registered in the PROSPERO International Prospective Register of Systematic Reviews (registration No. CRD42022384589 available at https://www.crd.york.ac.uk/prospero/#searchadvanced ).

目的 系统评价不同干预措施对慢性阻塞性肺病（以下简称“慢阻肺”）的疾病负担情况。方法 计算机检索CNKI、VIP、WanFang Data、PubMed、Web of Science和Cochrane Library等数据库，搜集慢阻肺疾病负担相关的随机对照试验（RCT），检索时限均从建库至2023年10月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用Stata 16软件和R语言进行网状Meta分析。结果 最终纳入69个RCT，包括6 689例患者，涉及常规治疗、无创正压通气治疗、有创通气治疗、营养支持方案等26项干预措施，偏倚风险评估均为“风险未知”。网状Meta分析结果显示，和有创通气治疗相比，无创正压通气治疗[SMD=-3.84,95%CI（-5.16，-2.52）]和二陈止咳清肺颗粒[SMD=-3.04,95%CI（-5.89，-0.20）]能够降低慢阻肺患者的住院经济费用，差异有统计学意义（P<0.05）。健脾益肺冲剂、咪达唑仑、目标氧疗、无创正压通气治疗和营养支持方案对降低慢阻肺患者死亡率的效果优于常规治疗[RR=4.50,95%CI(1.02,...

目的 总结糖尿病前期人群生活方式管理的最佳证据，为医护人员对糖尿病前期人群生活方式干预提供参考。方法 应用循证护理方法，对国内外循证资源和文献数据库进行检索，对符合质量评价的文献，由2名研究者独立对证据进行提取并总结出最佳证据。结果 最终纳入16篇文献，包括2篇指南、6篇专家共识、6篇系统评价、2篇证据总结。共提炼出生活方式干预目标、体质量管理、饮食管理、运动管理、健康教育、睡眠管理、社会支持、定期随访8个主题共30条证据。结论 本研究总结的最佳证据可为医护人员、患者及家属对糖尿病前期人群生活方式管理提供参考。在证据转化过程中应充分考虑个体的差异性，为目标人群制订个体化的生活干预方案。

Objective: This scoping review aimed to map the volume (number of studies) and nature (topics and designs) of chiropractic education research and scholarly publications on chiropractic learners and programs worldwide. Introduction: Despite the expansion of the chiropractic profession and its recognition by entities such as the World Health Organization, a gap exists in comprehending the international landscape of chiropractic education. No prior studies have systematically mapped the volume and nature of chiropractic education research and scholarly publications. A scoping review of chiropractic education research and scholarly publications is needed to guide future policy development, research agendas, and educational initiatives within the chiropractic profession. Inclusion criteria: Publications in the indexed literature on chiropractic students, graduates, academics, and programs in any chiropractic education setting were included. Studies focused on chiropractic programs and education for chiropractic students or chiropractors worldwide. All research designs, literature reviews, descriptive studies, and commentaries were included. Methods: This scoping review was conducted according to JBI methodology for scoping reviews and was reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The databases PubMed (NLM), Scopus, CINAHL via EBSCOhost, Index to Chiropractic Literature, Biblioteca Virtual em Saúde, and Educational Resources Information Center were searched from their inception to November 5 and 6, 2023, with no language limits. Data were extracted for primary topics, study designs, and regions of the included documents and entered in Covidence by paired independent reviewers. The findings were organized into figures and tables with a narrative description. Results: The search identified 7494 documents. After deduplication, 5041 were screened for relevance, of which 667 were selected for full-text review. From these, 598 were selected for data extraction. The chiropractic education topics included values/ethical competence (n=3), personal/behavioral competence (n=34), knowledge and cognitive competence (n=49), functional and clinical competence (n=93), and program-relevant research (n=419). Most designs were quantitative (n=391), followed by descriptive reports (n=91), qualitative (n=43), mixed methods (n=40), commentaries (n=22), and literature reviews (n=11). Chiropractic education was most studied in the United States (n=359), Australia (n=116), and Canada (n=106). Conclusions: This scoping review reports the volume and nature of indexed publications relating to chiropractic learners and programs worldwide. This body of literature contains learner competencies in knowledge, skills, and attitudes, as well as studies about chiropractic programs. The increasing number of publications and proportion of study designs over time show that chiropractic scholars and programs are engaged in collecting, analyzing, and distributing data relevant to education and training. The map of professional competencies in the chiropractic education literature shows that the profession possesses the fundamental traits needed to contribute to the global health care workforce. Review registration: Open Science Frameworkhttps://osf.io/9b3ap.

Abstract Background: Integrated care attempts to address multiple care needs, but barriers to implementation remain. The service user perspective can guide policy and practice to advance implementation. Objective: To map barriers and facilitators to integrated primary care from the perspective of people with chronic conditions and multiple care needs. Methods: A scoping review was conducted by searching PubMed, Embase, Web of Science, CINAHL, and grey literature. Eligible studies were analysed by categorising barriers and facilitators at the micro, meso, and macro levels of the healthcare system. They were further mapped by the components retrieved from the SELFIE framework for integrated care for multimorbidity. Results: Across the 34 included studies, people with multiple care needs identified more barriers and facilitators at the micro level than at the meso and macro levels. Mapped under 'the individual and their environment', social and personal barriers (e.g. socioeconomic disadvantages, lack of social support) hindered integrated care. Mapped under 'service delivery' and 'workforce', a trusting relationship with a key care provider as part of a multidisciplinary care team was identified to facilitate integrated care. Conclusions: Our findings show that 'soft' relational and social factors are critical to integrated care. These 'soft' factors are primarily created at the micro level, but seem actionable at meso and macro levels. The unique perspective of people with multiple care needs suggests that more rigorous involvement of service users at higher levels is needed to inform policymakers and care providers on how to shape enabling conditions for the implementation of integrated care.

Abstract Chronic kidney disease (CKD) is a global health challenge that affects patients, caregivers, healthcare systems, the environment and national economies. Despite its far-reaching impact, there is no framework to systematically evaluate national CKD prevention and management programmes or evaluate the societal burden of disease. This paper has two objectives: first, to introduce a comprehensive framework to assess national programmes, which recognises gaps and weaknesses and identifies feasible policy interventions to reduce overall CKD burden; second, to present some key challenges and success stories in delivering CKD services delivered in eight different country settings. A literature review informed an initial version of the framework, which was further developed and refined via collaboration with a panel of UK experts across relevant disciplines. This framework was then presented to seven other country expert panels (Australia, Brazil, China, Germany, the Netherlands, Spain and the USA) that made further refinements based on their country perspective. The resultant framework covers all health system levels, from preventive public health measures to primary, secondary and tertiary care, including dialysis, transplantation and palliative care. Furthermore, it evaluates the disease burden from economic, social and environmental perspectives. Each panel also discussed challenges regarding providing CKD services in their country and provided success stories, generating valuable insights into areas where policy initiatives could have positive impact on the various components of burden of disease.