Mapping Evidence and Constructing an Analytic Framework: An Umbrella Review Summarizing Primary Care Family Physicians' Experiences With Clinical Integration

Olivia L Tseng; Grace Kim; Wan Yu Ho; Esther J Lee; Howard Chang; Diane Lacaille; Christie Newton; Krisztina Vasarhelyi; Iraj Poureslami; Eric Liow; Craig Mitton

doi:10.1370/afm.240118

Mapping Evidence and Constructing an Analytic Framework: An Umbrella Review Summarizing Primary Care Family Physicians' Experiences With Clinical Integration

Ann Fam Med. 2025 Jul 28;23(4):350-362. doi: 10.1370/afm.240118.

Authors

Olivia L Tseng^{1

2

3}, Grace Kim⁴, Wan Yu Ho⁵, Esther J Lee^{6

7

8}, Howard Chang⁹, Diane Lacaille^{10

11}, Christie Newton⁹, Krisztina Vasarhelyi¹², Iraj Poureslami¹³, Eric Liow³, Craig Mitton^{2

14}

Affiliations

¹ Department of Family Practice, University of British Columbia, Vancouver, BC Canada otseng@alumni.ubc.ca.
² Centre for Clinical Epidemiology & Evaluation, Vancouver, BC Canada.
³ Vancouver Coastal Health Research Institute, Vancouver, BC Canada.
⁴ Doctors of Medicine Program, University of British Columbia, Vancouver, BC Canada.
⁵ Whitehorse General Hospital, Whitehorse, YT Canada.
⁶ Complex Care Program, British Columbia Children's Hospital, Vancouver, BC Canada.
⁷ Pediatric Palliative Medicine Program, Canuck Place Children's Hospice, Vancouver, BC Canada.
⁸ Department of Pediatrics, Division of Pediatric Hospital Medicine, Division of Palliative Medicine, University of British Columbia, Vancouver, BC Canada.
⁹ Department of Family Practice, University of British Columbia, Vancouver, BC Canada.
¹⁰ Arthritis Research Canada, Vancouver, BC Canada.
¹¹ Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, BC Canada.
¹² Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
¹³ Division of Respiratory Medicine, University of British Columbia, Vancouver, BC Canada.
¹⁴ School of Population and Public Health, University of British Columbia, Vancouver, BC Canada.

Abstract

Purpose: Strengthening primary care's integration function is a systematic approach to promote integrated care. Understanding the factors influencing the process of integrating care for every patient is crucial for effective intervention planning. The objective of this study was to generate an analytic framework and evidence map of the barriers and facilitators perceived by family physicians (FPs) in clinical integration, a process to coordinate health care services across time, place, discipline, diseases, and patient demographics.

Methods: Using the Joanna Briggs Institute umbrella review methodology, we searched the MEDLINE, Embase, and CINAHL databases, identifying 90 reviews (2010-2022) on primary care FPs and clinical integration. We adopted a best-fit framework approach to group the factors into a customized clinical integration framework, reflecting how a health care system functions. Two evidence maps were created to visualize the reviews' distribution. We validated the framework with another 21 reviews (2022-2024).

Results: The analytic framework consisted of 9 themes and 21 subthemes based on 2,891 factors derived from external and internal sources within primary care practices. Several subthemes were common across themes related to individuals (FPs, physicians other than family physicians and allied health providers, patients) and operating units (systems, organizations, practices), highlighting shared elements. The professional theme was the most significant, appearing in 86% of the reviews and including subthemes related to diseases, clinical guidelines, and teamwork. In contrast, themes related to systems, organizations, and practices were reported less frequently (48%, 22%, and 23%).

Conclusion: The complex interactions among factors, subthemes, and themes elucidate challenges in finding a universal strategy or implementing initiatives. The generated evidence maps indicated knowledge gaps to guide future research work.

Keywords: barriers and facilitators; best-fit framework; clinical integration; primary care; umbrella review.

Publication types

Systematic Review

MeSH terms

Attitude of Health Personnel*
Delivery of Health Care, Integrated* / organization & administration
Humans
Physicians, Family* / psychology
Physicians, Primary Care* / psychology
Primary Health Care* / organization & administration