To provide a systematic synthesis and overview of facilitators and barriers to implementing multidisciplinary transitional care interventions, which could be considered before developing implementation strategies.
Embase, CINAHL, and Medline were searched for qualitative studies evaluating multidisciplinary transitional care interventions through patients', family members', and healthcare professionals' experiences and views from inception until June 2024. The studies’ methodological rigor was assessed with the Critical Appraisal Skills Program. We inductively generated codes by examining participants’ direct quotes and study authors’ interpretations. Facilitators and barriers to the successful implementation of multidisciplinary transitional care interventions were identified by deductively mapping the generated codes to the Consolidated Framework for Implementation Research (CFIR). Facilitators and barriers were categorized into pre- or post-discharge or general factors.
Twelve studies were included and appraised. We identified 79 factors, mostly linked to three domains of the Consolidated Framework for Implementation Research: Innovation, Inner setting, and Individuals involved. Facilitators included "comprehensive follow-up care needs assessment"(pre-discharge), "immediate, tailored follow-up care"(post-discharge), and "improved communication between stakeholders"(general). Barriers included "shortage of hospital beds" and "lack of time"(pre-discharge), "lack of available primary care professionals"(post-discharge), "inconsistencies of stakeholders' schedules" and "intervention costs"(general).
The factors identified could serve as a non-exhaustive inventory list to inspire readers who wish to implement a multidisciplinary transitional care intervention in their settings. Digital tools and alternative financing models might overcome cost and reimbursement issues, the increasing complexity of patient care, and shortcomings, such as the lack of available hospital beds or professionals. Further research should identify effective implementation strategies, considering the pre-, post-discharge, and general factors identified.
To successfully implement multidisciplinary transitional care interventions, it is imperative to address systemic, organizational, and individual barriers such as intervention costs not covered by health insurance, a shortage of hospital beds, a lack of available (allied) healthcare professionals in the community, and inconsistencies between stakeholders' schedules. Further investigations should examine whether digital tools and alternative financing models can overcome these barriers and identify effective implementation strategies, considering all pre-, post-discharge, and general factors identified in this review.
Implementation Science
Continuity of Patient Care
