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Open Access Protocol

The effectiveness and cost-effectiveness of shared care: protocol for a realist review

Rebecca Hardwick1*, Mark Pearson1, Richard Byng2 and Rob Anderson1

Author Affiliations

1 PenTAG, Institute of Health Services Research, University of Exeter Medical School, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, UK

2 Primary Care Group, National Institute for Health Research Collaborative for Leadership in Applied Health Research and Care for the South West Peninsula, Peninsula Medical and Dental School, Plymouth University, Plymouth, UK

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Systematic Reviews 2013, 2:12  doi:10.1186/2046-4053-2-12

Published: 12 February 2013

Abstract

Background

Shared care (an enhanced information exchange over and above routine outpatient letters) is commonly used to improve care coordination and communication between a specialist and primary care services for people with long-term conditions. Evidence of the effectiveness and cost-effectiveness of shared care is mixed. Informed decision-making for targeting shared care requires a greater understanding of how it works, for whom it works, in what contexts and why. This protocol outlines how realist review methods can be used to synthesise evidence on shared care for long-term conditions.

A further aim of the review is to explore economic evaluations of shared care. Economic evaluations are difficult to synthesise due to problems in accounting for contextual differences that impact on resource use and opportunity costs. Realist review methods have been suggested as a way to overcome some of these issues, so this review will also assess whether realist review methods are amenable to synthesising economic evidence.

Methods/Design

Database and web searching will be carried out in order to find relevant evidence to develop and test programme theories about how shared care works. The review will have two phases. Phase 1 will concentrate on the contextual conditions and mechanisms that influence how shared care works, in order to develop programme theories, which partially explain how it works. Phase 2 will focus on testing these programme theories. A Project Reference Group made up of health service professionals and people with actual experience of long-term conditions will be used to ground the study in real-life experience. Review findings will be disseminated through local and sub-national networks for integrated care and long-term conditions.

Discussion

This realist review will explore why and for whom shared care works, in order to support decision-makers working to improve the effectiveness of care for people outside hospital. The development of realist review methods to take into account cost and cost-effectiveness evidence is particularly innovative and challenging, and if successful will offer a new approach to synthesising economic evidence. This systematic review protocol is registered on the PROSPERO database (registration number: CRD42012002842).

Keywords:
Shared care; Long-term conditions; Cost-effectiveness; Economic evaluation; Realist review; Integrated care; Primary care