The study was conducted in two phases in order to meet both objectives: the first phase was an integrative literature review (10) (11)(12); the second phase consisted of reaching a qualitative consensus among the research team based on the literature. By applying this method, we sought to answer two questions:
What are the characteristics and trends of the social care practices of the 6 participating countries in the TEC-MED European Project?
What are the 20 most promising initiatives directed towards older people who are dependent and/or at risk of social exclusion in European and Mediterranean Basin countries?
Databases
We used the following electronic databases to select the scientific literature: Scopus, Pubmed and Cochrane library. For grey literature, we included white papers, (social) care models, academic papers, research and committee reports, government reports, conference papers, and ongoing research. The “grey” evidence was accessed through Open Grey, the Google Scholar Database, ProQuest, Web of Science (Conference Proceedings) and platforms/websites of local/national authorities.
Selection criteria
The general selection criteria applied were as follow:
- Timeframe: documents published between 2000 and 2019.
- Languages: English, Spanish, French, Italian, Greek, Arabic.
- Articles referring to countries in Europe and the Mediterranean Basin.
- Design: qualitative, quantitative, case studies, theoretical.
Study selection
To ensure the reliability of the review, two investigators in each team conducted the searches following the same strategies between December 2019 and January 2020. Figure 1 illustrates the literature review workflow. Full texts were retrieved from publications that met the eligibility criteria according to the opinion of at least one of the investigators and based on their abstracts. Subsequently, disagreements were resolved via joint discussions and consensus-reaching. The PRISMA Statement was used for the final selection of the study sample and also served as the basis to report the results of the integrative review (13).
[Figure provide in manuscript file]
MAIN FINDINGS
Studies and document selection procedure
The flow chart shows the global results of the search performed by the LB and the PPs. A total of 10,940 documents (10,107 from official databases and 833 from other sources) were found. A final selection of 378 studies was then included in the qualitative synthesis (see Figure 1).
Characteristics and trends of the social care practices of the six countries participating in the European TEC-MED Project
The characteristics and trends of the social care practices of the 6 countries participating in the TEC-MED are summarised in Table 1.
[Table provide in manusctipt file]
The most promising initiatives
A summary of the 20 most promising models (11 models were representative of the project countries and 9 were international models) is shown in Table 1. The table includes the links to the websites of the main references which explain each of them (Table 2).
[Table 2]
I. The theoretical-ethical basis of the initiative
It is worth noting that the most promising models shared several common characteristics, such as a holistic and interdisciplinary approach (e.g., Sustain (14) and Fundación Matia(15)).The most efficient models were based on person-centred care at all levels, i.e., at the clinical, professional, normative, organisational levels, for example, the Buurtzorg Model (16). We can thus consider that it is essential to improve how services are integrated at a systemic level. This integration should not be limited to medical services but also include psychological assistance, social and spiritual support to patients, as well as help within the family and home environment. Crucially, quality-of-care services must also include the caregiver’s well-being, investing in human capital development, such as in the case of Integrate (16), Selfie (17), and ICARE4EU (18).
It is also important to reflect on the need for social care to be based on the empowerment of older people throughout a development of health promotion activities based on patient-centred, proactive, and well-coordinated multidisciplinary care. Examples include: Selfie (17), Integrate (16), Chrodis (19), the Pilar Foundation (20), the Aging Lab Foundation (21), the Buurtzorg Model (16) and the Sant John of God Model (22).
II. Main objectives of the initiatives
Among the main objectives of the different initiatives, one of the most promising focused on quality of life and prevention. This was achieved through improvements to established integrated care initiatives (at the patient’s residence, by training professionals, and by raising public care awareness) and advances in person-centred care for persons with multi-morbidity, such as in the case of Fundación Matia (15) (23), the Lebanese Center for Palliative Care-Balsam (24), Open Care Centers for older people KAPI (25), and Sekem Medical Center (26).
III. Management and structure of the initiatives
One of the most positive types of evidence-supported management models was the participator implementation process based on the Evidence Integrative Triangle Model (intervention, practical measures, and the participatory implementation process) as well as community-based participatory research (27).
IV. Stakeholders
To satisfy the criteria of exhaustive inclusivity, all actors in society must be considered. In this sense, a successful initiative must involve the participation and vision of the entire community. Therefore, it is essential to include sectors at different levels:
- macro-level: top management positions in social enterprises providing social care services, leadership positions in NGOs providing social care services, leading academic figures studying or working in social/care services)
- meso-level: social professional workers attending older people who are dependent and/or at risk of social exclusion
- micro-level: leadership positions in the public administration providing social care services, such as in the Integrate Project (28).
Va. Strengths
The success of the most promising initiatives was based on common strengths. A multidisciplinary and holistic approach by maintaining or enhancing person centeredness, a prevention orientation, safety, efficiency and health and social care coordination all address the important need to develop national health promotion programmes for the senior population, creating a common framework of public funds and support.
Another fundamental aspect of social care was to improve the quality of the caregivers' work. This came with a full and homogenous application of employment contracts in order to increase the workers’ weelbeing. Other measures included: allowing longer visits and follow-up; a work plan in each micro community; improving nurse continuity; guaranteeing continuous training for the professionals involved; and improving contacts with nurses, together with integrated care activities, such as in ICARE4EU (18).
Vb. Weaknesses
A major difficulty in developing a care model was a homogeneous – but diversity-mindful – governance that allowed the creation of a nationwide, coordinated and integrated plan. Such a plan must be supported by policy and legislation that ensure territorial equality, although this latter goal is negatively affected by limited specialised care services. At the same time, there was the financial barrier of insufficient funding and resources such as in the case of the Comunità di Sant’Egidio (29).