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Improving funding models and implementing policies that facilitate greater interprofessional collaboration and integration at the primary and allied health level could improve the ongoing quality and safety and future sustainability of the wider health care system by reducing inefficiencies and inequalities. Defining these key health care funding–related models, policies, and concepts, identifying research gaps, and systematically mapping the associated literature will inform future research on this topic.
The aim of this scoping review is to provide a descriptive overview of contemporary health care funding models and the key policies involved in the delivery of primary and allied health care. Further, it will investigate the impact these models and policies have on interprofessional collaboration and integrated service delivery at the primary and allied health care levels.
A search of published and grey literature will be conducted using the following databases: the Allied and Complementary Medicine Database, CINAHL, Embase, Emcare, MEDLINE, PsycINFO, Scopus, Open Access Theses and Dissertations, and Web of Science. The search will be limited to resources available in the English language and published since 2011. Following the search, an independent screening of titles and abstracts will be undertaken by 2 independent reviewers, with a third reviewer available to resolve any potential disagreements. Full-text resources will then be assessed against the inclusion criteria following the same process. Extracted data will be presented using a convergent narrative approach, accompanied by tables and figures.
Electronic database searches have retrieved 8013 articles. The results of this scoping review are expected in May 2022.
The findings from this review will be used to inform future research projects investigating the role of primary health care funding, interprofessional collaboration, and service integration in improving health care access, efficiency, effectiveness, and sustainability.
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According to the World Health Organization (WHO), to meet current and predicted future global health care needs, governments and health care funding bodies worldwide must prioritize health care funding models and policies that embrace universal health coverage (UHC) [
Interprofessional collaboration, by definition, uses the collective knowledge and expertise of 2 or more health care professions working together to offer more appropriate, timely, comprehensive, and person-centered health care to consumers [
Since 1978’s Declaration of Alma-Ata, which was more recently renewed and ratified with 2018’s Declaration of Astana, the WHO has strongly endorsed commitments to increase health care funding and improve funding models and policies at the primary level [
However, despite many varied and concerted international efforts to commit to UHC goals and improve primary health care funding models and policies [
Since the beginning of the COVID-19 pandemic, existing health care inequities embedded within contemporary funding models and policies have become increasingly apparent [
Although these issues present substantial challenges to global economic and health systems, they also offer governments a unique window of opportunity to rethink health care funding models and policies. By reorienting health systems to better reflect the fundamental values of UHC as part of the pandemic recovery process, there is potential to instill greater ongoing financial and workforce sustainability [
A preliminary search of MEDLINE, CINAHL, Open Science Framework, and JMIR Research Protocols identified no current or in-progress reviews focusing on the role of health care funding in relation to interprofessional collaboration or integrated health care. Instead, previous works have considered the impact of reimbursement systems on equity in access to primary care, the quality of primary care [
How do health care funding policies and models impact interprofessional collaboration and integrated service delivery in primary and allied care?
The secondary research questions are as follows:
Which key health care funding models and policies determine health care funding in primary and allied health care?
Which key characteristics of interprofessional collaboration and integrated health care have been researched in relation to health care funding in primary and allied care?
What impact does funding have on professional roles and responsibilities when working in an integrated primary or allied health care role?
The proposed scoping review will be conducted in accordance with the JBI Institute methodology for scoping reviews [
This review will consider literature pertaining to adults (defined as individuals ages 18 years and older) who are employed within the specified primary and allied health care disciplines or are the recipients of care provided by these disciplines.
For the purposes of this review, primary health care professions will include physicians, physician assistants, nurses, and allied health professionals identified as working in primary health care settings. There is no international consensus on what constitutes allied health or the specific professions and disciplines included within the allied health field [
Therefore, the allied health professionals selected for inclusion in this scoping review are audiologists, chiropractors, dietitians, exercise physiologists, hand therapists, myotherapists, occupational therapists, optometrists, orthoptists, orthotists, osteopaths, physiotherapists, podiatrists, prosthetists, psychologists, rehabilitation counselors, social workers, and speech and language therapists.
The following 3 concepts will be explored in this scoping review: health care funding, interprofessional collaboration, and integrated service delivery. Regarding health care funding, factors of particular interest will include health care funding models (eg, compensable, noncompensable, public, and private funding models) and health care funding policies (eg, governmental, nongovernmental, health system, organizational, or professional funding policies). Health care funding characteristics are also of interest. These will include units of funding (eg, per service, per hour, per case, or per capita funding), funding principles (eg, input-based, output-based, performance-based, or achievement-based funding), the timing of funding (eg, prospective, or retrospective funding), and funding modes (eg, cash, recourses, assets, or in-kind services) [
The elements of interprofessional collaboration addressed by this review will focus on the relationships, interactions, and collaborative processes between primary and allied health clinicians (eg, writing and receiving referrals and participating in case conferences, clinical discussions, and multipractitioner appointments, assessments, and interventions) [
This scoping review will consider health care funding policies and funding models operating at the primary health care level only. The primary level was selected as it has long been stipulated that improving health care funding and implementing policies that facilitate greater interprofessional collaboration and service integration between primary and allied health care at this level could improve the ongoing quality and safety and future sustainability of the wider health care system [
All classifications of primary studies inclusive of quantitative, qualitative, and mixed-methods designs will be considered for inclusion. In addition, grey literature (including policy documents, government and organizational reports, academic theses and dissertations, white papers, book chapters, conference abstracts and proceedings, policy and procedure documents, and opinion papers) will also be considered. Due to feasibility constraints, the scoping review inclusion criteria will be limited to digitally available contemporary literature accessible in the English language (due to the absence of dedicated funding that would typically cover the cost of translation services). A contemporary period of 10 years (from 2011 to 2021) was selected for this review to capture the increased interest in health care funding models and policies post economic recovery from the global financial crisis between 2007 and 2009 [
The search strategy will aim to locate published and unpublished literature. An initial limited search of MEDLINE and CINAHL identified relevant articles and the index terms were used to develop a search strategy for MEDLINE (Ovid), with input from a professional research librarian (
A search of published literature will be conducted using the following electronic databases: Ovid (Allied and Complementary Medicine Database, EMBASE, Emcare, MEDLINE, and PsycINFO), EBSCOhost (CINAHL), Scopus, and Web of Science. Sources of unpublished studies and grey literature to be searched will include GreyLit, Google Scholar, Open Access Theses and Dissertations, ProQuest Dissertations & Theses Global, Public Affairs Information Service Index, the WHO, and government health departments of primarily English-speaking countries (eg, Australia, Canada, New Zealand, the Republic of Ireland, South Africa, the United Kingdom, and the United States of America).
Following search strategy implementation, the literature will be collated and uploaded into EndNote version X9 (Clarivate Analytics) for the removal of duplicate entries. Citations will then be exported to Covidence (Veritas Health Innovation), for screening of the titles and abstracts. Screening will be conducted against the inclusion criteria by 2 independent reviewers, with a third independent reviewer available to resolve any potential disagreements. Literature that the reviewers agree has met the inclusion criteria in the initial round of screening will be retrieved in full text and assessed against the inclusion criteria by the same independent reviewers, noting the reasons for any exclusions. The final search results (including reasons for exclusion) will be reported in full and presented using a PRISMA-ScR flow diagram [
A total of 2 independent reviewers will use a custom data extraction tool developed by the authors to extract data from the included studies. Data for extraction (
Although not a requirement of scoping review methodology [
Author(s)
Date
Country of origin
Aims or purpose
Research methodology
Funding type, level, unit, principle, timing, and mode
Type and purpose of interprofessional collaboration and service integration
Number and disciplines of primary and allied health care professionals
Key findings related to how health care funding policies or characteristics impact interprofessional collaboration and service integration
Level of evidence and quality rating will be performed using the Research Evidence Appraisal Tool and Non-Research Evidence Appraisal Tool [
Critical appraisal will be performed using the Crowe Critical Appraisal Tool Form (v1.4) [
Due to the broad nature of the research questions and the descriptive purpose of this scoping review, considerable heterogeneity of the literature is expected. It is anticipated that data presentation and analysis will need to accommodate for heterogeneity in the following factors:
Research methodology and approaches (ie, qualitative, quantitative, mixed-methods, and nonexperimental literature will be considered, as will academic and grey literature)
Funding model characteristics (ie, the funding model type, level, and scope)
Funding policy characteristics (ie, the policy type, level, and scope)
Interprofessional collaboration and service integration characteristics (ie, the type and purpose for collaboration and the type of service integration)
Health care practitioner characteristics (ie, a range of primary and allied health care disciplines will be considered)
To meaningfully account for this complexity in the literature and provide a clear and accurate map of the evidence, a descriptive narrative analysis method of translating the research findings is proposed. Based on the 4-element convergent narrative synthesis framework outlined by Popay et al [
The preliminary analysis will be conducted at the data extraction stage of the review. It will entail organizing and presenting the extracted data (
Electronic database searches were conducted in November 2021, and 8013 results were retrieved. Title and abstract screening, full-text screening, data extraction, and manuscript completion are expected in May 2022. Upon completion of the final manuscript, the scoping review is intended for publication in a peer-reviewed academic journal.
The findings from this review will identify the extent and nature of evidence regarding health care funding and how it impacts interprofessional collaboration and service integration at the primary and allied health care levels. These findings will be used to inform future research projects investigating the role of primary health care funding, interprofessional collaboration, and service integration in improving health care access, efficiency, effectiveness, and sustainability.
Examples of excluded health professions.
Database search strategy.
Crowe Critical Appraisal Tool
Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews
Universal Health Care
World Health Organization
The authors would like to acknowledge and thank Paula Todd for her assistance with the development of the search strategy.
JA designed and wrote the scoping review protocol. LR and TB contributed to refining the protocol, search strategy, and data extraction methods. All authors have made substantive contributions to the development of this scoping review protocol and have approved the final manuscript.
None declared.