Consolidating International Care Models and Clinical Services for Adult Obesity.

Yan Xue, Menghuan Song, Xianwen Chen, Zhen Ruan, Huimin Zou, Yunfeng Lai, Dongning Yao, Carolina Oi Lam Ung, Hao Hu
Author Information
  1. Yan Xue: State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China.
  2. Menghuan Song: State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China.
  3. Xianwen Chen: State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China.
  4. Zhen Ruan: State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China.
  5. Huimin Zou: State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China.
  6. Yunfeng Lai: School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China.
  7. Dongning Yao: School of Pharmacy, Nanjing Medical University, Nanjing, China.
  8. Carolina Oi Lam Ung: State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China. carolinaung@um.edu.mo.
  9. Hao Hu: State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China. haohu@um.edu.mo.

Abstract

PURPOSE OF REVIEW: This paper aims to analyze and consolidate the existing evidence on models of care and clinical obesity services for adults living with obesity 1) to identify the key components of clinical obesity services, and 2) to propose recommendations for future directions of promoting the international development of clinical obesity care.
RECENT FINDINGS: The key components of clinical obesity services include 1) a contextualized composition of multi-disciplinary teams and mechanisms to empower the healthcare professionals, 2) clear stepwise pathways matching patient needs with appropriate clinical and community resources in a timely manner, 3) comprehensive assessment and individualized treatment plan informed by the evidence-based clinical practice guidelines. Furthermore, clinical information systems and financing resources are instrumental to the effective and sustainable functioning of a comprehensive clinical service with strong connections across primary, secondary and tertiary levels of care. We synthesized these findings to make recommendations for healthcare practitioners, hospital administrations and policymakers in developing and improving comprehensive clinical services to address the needs of adults living with obesity.

Keywords

References

  1. Chong B, Jayabaskaran J, Kong G, et al. Trends and predictions of malnutrition and obesity in 204 countries and territories: an analysis of the Global Burden of Disease Study 2019. eClinicalMedicine. 2023;57:101850. https://doi.org/10.1016/j.eclinm.2023.101850 . [DOI: 10.1016/j.eclinm.2023.101850]
  2. Endalifer ML, Diress G. Epidemiology, predisposing factors, biomarkers, and prevention mechanism of obesity: a systematic review. Int J Obes. 2020;2020:1–8. https://doi.org/10.1155/2020/6134362 . [DOI: 10.1155/2020/6134362]
  3. Blüher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol. 2019;15(5):288–98. https://doi.org/10.1038/s41574-019-0176-8 . [DOI: 10.1038/s41574-019-0176-8]
  4. Wolfenden L, Ezzati M, Larijani B, Dietz W. The challenge for global health systems in preventing and managing obesity. Obes Rev. 2019;20(S2):185–93. https://doi.org/10.1111/obr.12872 . [DOI: 10.1111/obr.12872]
  5. Malik VS, Willet WC, Hu FB. Nearly a decade on — trends, risk factors and policy implications in global obesity. Nat Rev Endocrinol. 2020;16(11):615–6. https://doi.org/10.1038/s41574-020-00411-y . [DOI: 10.1038/s41574-020-00411-y]
  6. Senthilingam M. Covid-19 has made the obesity epidemic worse, but failed to ignite enough action. BMJ. 2021;372:n411. https://doi.org/10.1136/bmj.n411 .
  7. Tamara A, Tahapary DL. Obesity as a predictor for a poor prognosis of COVID-19: a systematic review. Diabetes Metab Syndr. 2020;14(4):655–9. https://doi.org/10.1016/j.dsx.2020.05.020 . [DOI: 10.1016/j.dsx.2020.05.020]
  8. Popkin BM, Du S, Green WD, et al. Individuals with obesity and COVID‐19: a global perspective on the epidemiology and biological relationships. Obes Rev. 2020;21:e13128. https://doi.org/10.1111/obr.13128 .
  9. Hill JO, Peters JC, Wyatt HR. The role of public policy in treating the epidemic of global obesity. Clin Pharmacol Ther. 2007;81(5):772–5. https://doi.org/10.1038/sj.clpt.6100107 . [DOI: 10.1038/sj.clpt.6100107]
  10. Burki T. European Commission classifies obesity as a chronic disease. Lancet Diabetes Endocrinol. 2021;9(7):418. https://doi.org/10.1016/S2213-8587(21)00145-5 . [DOI: 10.1016/S2213-8587(21)00145-5]
  11. Blüher M, Aras M, Aronne LJ, et al. New insights into the treatment of obesity. Diabetes Obes Metab. 2023;25(8):2058–72. https://doi.org/10.1111/dom.15077 . [DOI: 10.1111/dom.15077]
  12. Wen X, Zhang B, Wu B, et al. Signaling pathways in obesity: mechanisms and therapeutic interventions. Sig Transduct Target Ther. 2022;7(1):298. https://doi.org/10.1038/s41392-022-01149-x . [DOI: 10.1038/s41392-022-01149-x]
  13. Angelidi AM, Belanger MJ, Kokkinos A, Koliaki CC, Mantzoros CS. Novel noninvasive approaches to the treatment of obesity: from pharmacotherapy to gene therapy. Endocr Rev. 2022;43(3):507–57. https://doi.org/10.1210/endrev/bnab034 . [DOI: 10.1210/endrev/bnab034]
  14. Bloom DE, Chen S, Kuhn M, McGovern ME, Oxley L, Prettner K. The economic burden of chronic diseases: Estimates and projections for China, Japan, and South Korea. J Econ Ageing. 2020;17:100163. https://doi.org/10.1016/j.jeoa.2018.09.002 . [DOI: 10.1016/j.jeoa.2018.09.002]
  15. Tremmel M, Gerdtham UG, Nilsson P, Saha S. Economic burden of obesity: a systematic literature review. Int J Environ Res Public Health. 2017;14(4):435. https://doi.org/10.3390/ijerph14040435 . [DOI: 10.3390/ijerph14040435]
  16. Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766–81. https://doi.org/10.1016/S0140-6736(14)60460-8 . [DOI: 10.1016/S0140-6736(14)60460-8]
  17. Lyn R, Heath E, Dubhashi J. Global implementation of obesity prevention policies: a review of progress, politics, and the path forward. Curr Obes Rep. 2019;8(4):504–16. https://doi.org/10.1007/s13679-019-00358-w . [DOI: 10.1007/s13679-019-00358-w]
  18. Russell SJ, Mytton OT, Viner RM. Estimating the effects of preventive and weight-management interventions on the prevalence of childhood obesity in England: a modelling study. Lancet Public Health. 2023;8(11):e878–88. https://doi.org/10.1016/S2468-2667(23)00216-5 . [DOI: 10.1016/S2468-2667(23)00216-5]
  19. Salas XR, Forhan M, Caulfield T, Sharma AM, Raine K. A critical analysis of obesity prevention policies and strategies. Can J Public Health. 2017;108(5–6):e598–608. https://doi.org/10.17269/CJPH.108.6044 . [DOI: 10.17269/CJPH.108.6044]
  20. Jackson Leach R, Powis J, Baur LA, et al. Clinical care for obesity: a preliminary survey of sixty‐eight countries. Clin Obes. 2020;10:e12357. https://doi.org/10.1111/cob.12357 .
  21. Rosa Fortin MM, Brown C, Ball GD, Chanoine JP, Langlois MF. Weight management in Canada: an environmental scan of health services for adults with obesity. BMC Health Serv Res. 2014;14(1):69. https://doi.org/10.1186/1472-6963-14-69 . [DOI: 10.1186/1472-6963-14-69]
  22. Gudzune KA, Johnson VR, Bramante CT, Stanford FC. Geographic availability of physicians certified by the American Board of Obesity Medicine relative to obesity prevalence. Obesity. 2019;27(12):1958–66. https://doi.org/10.1002/oby.22628 . [DOI: 10.1002/oby.22628]
  23. Ard J. Obesity in the US: what is the best role for primary care? BMJ. 2015;350(feb05 1):g7846–g7846. https://doi.org/10.1136/bmj.g7846 . [DOI: 10.1136/bmj.g7846]
  24. Rees M, Collins CE, Majellano E, McDonald V. Healthcare professionals’ perspectives of nonsurgical care of older inpatients with Class II or III obesity and comorbidities: a qualitative study. J Multidiscip Healthc. 2023;16:3339–55. https://doi.org/10.2147/JMDH.S421520 . [DOI: 10.2147/JMDH.S421520]
  25. Oshman L, Othman A, Furst W, et al. Primary care providers’ perceived barriers to obesity treatment and opportunities for improvement: A mixed methods study. Suppiah V, ed. PLoS ONE. 2023;18(4):e0284474. https://doi.org/10.1371/journal.pone.0284474 . [DOI: 10.1371/journal.pone.0284474]
  26. Gericke C, Rippy S, D’Lima D. Anticipated barriers and enablers to signing up for a weight management program after receiving an opportunistic referral from a general practitioner. Front Public Health. 2023;11:1226912. https://doi.org/10.3389/fpubh.2023.1226912 . [DOI: 10.3389/fpubh.2023.1226912]
  27. Coulman KD, Margelyte R, Jones T, et al. Access to publicly funded weight management services in England using routine data from primary and secondary care (2007–2020): An observational cohort study. PLoS Med. 2023;20(9):e1004282. https://doi.org/10.1371/journal.pmed.1004282 . [DOI: 10.1371/journal.pmed.1004282]
  28. Cohen J, Alexander S, Signorelli C, et al. Clinician and healthcare managers’ perspectives on the delivery of secondary and tertiary pediatric weight management services. J Child Health Care. 2023;27(1):128–44. https://doi.org/10.1177/13674935211052148 . [DOI: 10.1177/13674935211052148]
  29. Schwenke M, Luppa M, Pabst A, et al. Attitudes and treatment practice of general practitioners towards patients with obesity in primary care. BMC Fam Pract. 2020;21(1):169. https://doi.org/10.1186/s12875-020-01239-1 . [DOI: 10.1186/s12875-020-01239-1]
  30. Morgan C, De Wildt G, Prado RBR, Thanikachalam N, Virmond M, Riley R. Views and experiences of adults who are overweight and obese on the barriers and facilitators to weight loss in Southeast Brazil: a qualitative study. Int J Qual Stud Health Well-being. 2020;15(1):1852705. https://doi.org/10.1080/17482631.2020.1852705 . [DOI: 10.1080/17482631.2020.1852705]
  31. Luig T, Keenan L, Campbell-Scherer DL. Transforming health experience and action through shifting the narrative on obesity in primary care encounters. Qual Health Res. 2020;30(5):730–44. https://doi.org/10.1177/1049732319880551 . [DOI: 10.1177/1049732319880551]
  32. World Health Organization. Health service delivery framework for prevention and management of obesity. 2023. https://www.who.int/publications/i/item/9789240073234 Accessed on 25 June 2023.
  33. Allen AM, Younossi ZM, Tsochatzis EA, et al. Measuring NAFLD models of care. Nat Rev Gastroenterol Hepatol. 2023. https://doi.org/10.1038/s41575-023-00798-9 . Published online June 8. [DOI: 10.1038/s41575-023-00798-9]
  34. Lazarus JV, Anstee QM, Hagström H, et al. Defining comprehensive models of care for NAFLD. Nat Rev Gastroenterol Hepatol. 2021;18(10):717–29. https://doi.org/10.1038/s41575-021-00477-7 . [DOI: 10.1038/s41575-021-00477-7]
  35. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288(14):1775–9. https://doi.org/10.1001/jama.288.14.1775 . [DOI: 10.1001/jama.288.14.1775]
  36. Glasgow RE, Tracy Orleans C, Wagner EH, Curry SJ, Solberg LI. Does the chronic care model serve also as a template for improving prevention? Milbank Q. 2001;79(4):579–612. https://doi.org/10.1111/1468-0009.00222 . [DOI: 10.1111/1468-0009.00222]
  37. World Health Organization. Innovative care for chronic conditions: building blocks for action. 2002. https://www.who.int/publications/i/item/innovative-care-for-chronic-conditions-building-blocks-for-actions Accessed on 14 January 2024.
  38. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73. https://doi.org/10.7326/M18-0850 . [DOI: 10.7326/M18-0850]
  39. Anderson J, Deravin-Malone L, Francis K. Frameworks for chronic care management. In: Deravin-Malone L, Anderson J (eds) Chronic care nursing a framework for practice. 2nd edition. Cambridge University Press; 2019. https://doi.org/10.1017/9781108691642 .
  40. NSW Agency for Clinical Innovation Australia. Understanding the process to develop a model of care an ACI Framework. 2013. https://aci.health.nsw.gov.au/__data/assets/pdf_file/0009/181935/HS13-034_Framework-DevelopMoC_D7.pdf Accessed on 14 January 2024.
  41. on behalf of the Guidance Development Group, Welbourn R, Dixon J, et al. NICE-Accredited Commissioning guidance for weight assessment and management clinics: a model for a specialist multidisciplinary team approach for people with severe obesity. Obes Surg. 2016;26(3):649–59. https://doi.org/10.1007/s11695-015-2041-8 . [DOI: 10.1007/s11695-015-2041-8]
  42. Welbourn R, Hopkins J, Dixon JB, Finer N, Hughes C, Viner R, Wass J, on behalf of the Guidance Development Group. Commissioning guidance for weight assessment and management in adults and children with severe complex obesity. Obes Rev. 2018;19(1):14–27. https://doi.org/10.1111/obr.12601 . [DOI: 10.1111/obr.12601]
  43. National Institute for Health and Care Excellence. Overweight and obesity management NICE guideline [NG246]. 2025. https://www.nice.org.uk/guidance/ng246 Accessed on 5 March 2025.
  44. Brauer P, Royall D, Dwyer J, et al. Obesity services planning framework for interprofessional primary care organizations. Prim Health Care Res Dev. 2017;18(02):135–47. https://doi.org/10.1017/S1463423616000372 . [DOI: 10.1017/S1463423616000372]
  45. Dietz WH, Gallagher C. A proposed standard of obesity care for all providers and payers: a proposed standard of obesity care. Obesity. 2019;27(7):1059–62. https://doi.org/10.1002/oby.22507 . [DOI: 10.1002/oby.22507]
  46. Kokkorakis M, Katsarou A, Katsiki N, Mantzoros CS. Milestones in the journey towards addressing obesity; Past trials and triumphs, recent breakthroughs, and an exciting future in the era of emerging effective medical therapies and integration of effective medical therapies with metabolic surgery. Metabolism. 2023;148:155689. https://doi.org/10.1016/j.metabol.2023.155689 . [DOI: 10.1016/j.metabol.2023.155689]
  47. Atlantis E, Kormas N, Samaras K, et al. Clinical obesity services in public hospitals in Australia: a position statement based on expert consensus: Expert consensus on clinical obesity services. Clin Obes. 2018;8(3):203–10. https://doi.org/10.1111/cob.12249 . [DOI: 10.1111/cob.12249]
  48. Tsigos C, Hainer V, Basdevant A, et al. Criteria for EASO-collaborating centres for obesity management. Obes Facts. 2011;4(4):329–33. https://doi.org/10.1159/000331236 . [DOI: 10.1159/000331236]
  49. Caixàs A, Villaró M, Arraiza C, et al. SEEDO-SEMERGEN consensus document on continuous care of obesity between primary care and specialist Hospital units 2019. Med Clín (English Edition). 2020;155(6):267.e1–267.e11. https://doi.org/10.1016/j.medcle.2019.10.010 . [DOI: 10.1016/j.medcle.2019.10.010]
  50. Morrison DS, Boyle S, Morrison C, Allardice G, Greenlaw N, Forde L. Evaluation of the first phase of a specialist weight management programme in the UK National Health Service: prospective cohort study. Public Health Nutr. 2012;15(1):28–38. https://doi.org/10.1017/S1368980011001625 . [DOI: 10.1017/S1368980011001625]
  51. Logue J, Allardice G, Gillies M, Forde L, Morrison DS. Outcomes of a specialist weight management programme in the UK National Health Service: prospective study of 1838 patients. BMJ Open. 2014;4(1):e003747. https://doi.org/10.1136/bmjopen-2013-003747 . [DOI: 10.1136/bmjopen-2013-003747]
  52. Turner D, Haboubi N. Qualitative and quantitative outcomes of a 1:1 multidisciplinary weight management clinic. Healthcare. 2015;3(2):429–51. https://doi.org/10.3390/healthcare3020429 . [DOI: 10.3390/healthcare3020429]
  53. Jennings A, Hughes CA, Kumaravel B, et al. Evaluation of a multidisciplinary Tier 3 weight management service for adults with morbid obesity, or obesity and comorbidities, based in primary care. Clin Obes. 2014;4(5):254–66. https://doi.org/10.1111/cob.12066 . [DOI: 10.1111/cob.12066]
  54. Brightman L, Huang HC, Dugdale P. Determining patient attendance, access to interventions and clinical outcomes in a publicly funded obesity programme: results from the canberra obesity management service. Clin Obes. 2019;9:e12325. https://doi.org/10.1111/cob.12325 .
  55. Burns R, Firman E, Huang HC. Assessing service provision and outcomes at the Canberra Obesity Management Service: a retrospective chart review. Obesity. 2022;30(11):2146–55. https://doi.org/10.1002/oby.23575 . [DOI: 10.1002/oby.23575]
  56. Atlantis E, Langford K, Piya M, et al. Physical capacity outcomes in patients with severe obesity after 12 months of physician‐led multidisciplinary team care: a case series from a public hospital clinical obesity service. Clin Obes. 2019;9:e12337. https://doi.org/10.1111/cob.12337 .
  57. Atlantis E, Lin F, Anandabaskaran S, Fahey P, Kormas N. A predictive model for non-completion of an intensive specialist obesity service in a public hospital: a case-control study. BMC Health Serv Res. 2019;19(1):748. https://doi.org/10.1186/s12913-019-4531-1 . [DOI: 10.1186/s12913-019-4531-1]
  58. Chen J, Kaur H, Jaques J, et al. Association of clinically significant weight loss with number of patient visits and months of attendance at an Australian multidisciplinary weight management clinic. Clin Obes. 2022;12:e12520. https://doi.org/10.1111/cob.12520 .
  59. Srivastava G, Buffington C. Early weight loss outcomes from a newly established hospital-affiliated specialized obesity care delivery model in Central Florida. Int J Obes. 2019;43(1):132–8. https://doi.org/10.1038/s41366-018-0092-3 . [DOI: 10.1038/s41366-018-0092-3]
  60. Srivastava G, Paris C, Johnson J, et al. Specialized medical weight management intervention for high-risk obesity. J Health Econ Outcomes Res. 2021;8(2):1–5. https://doi.org/10.36469/jheor.2021.24896 . [DOI: 10.36469/jheor.2021.24896]
  61. Wharton S, VanderLelie S, Sharma AM, Sharma S, Kuk JL. Feasibility of an interdisciplinary program for obesity management in Canada. Can Fam Physician. 2012;58(1):e32–8. [PMID: 22267637]
  62. Morer C, Úbeda M, Ovejas A, et al. Integrative and collaborative approach in the chronic management of obesity in primary and tertiary care setting: Vall Hebron-SAP Muntanya healthcare route. Obes Facts. 2023;16(3):249–54. https://doi.org/10.1159/000528207 . [DOI: 10.1159/000528207]
  63. Gooey M, Bacus C, Ramachandran | D, Piya M, Baur L. Health service approaches to providing care for people who seek treatment for obesity: identifying challenges and ways forward. Public Health Res Pract. 2022;32(3):e3232228. https://doi.org/10.17061/phrp3232228 .
  64. Baptista DR, Wiens A, Pontarolo R, Regis L, Reis WCT, Correr CJ. The chronic care model for type 2 diabetes: a systematic review. Diabetol Metab Syndr. 2016;8(1):7. https://doi.org/10.1186/s13098-015-0119-z . [DOI: 10.1186/s13098-015-0119-z]
  65. Hazlehurst JM, Logue J, Parretti HM, et al. Developing integrated clinical pathways for the management of clinically severe adult obesity: a critique of NHS England policy. Curr Obes Rep. 2020;9(4):530–43. https://doi.org/10.1007/s13679-020-00416-8 . [DOI: 10.1007/s13679-020-00416-8]
  66. Savoy A, Khazvand S, Mathew A, et al. Consultants’ and referrers’ perceived barriers to closing the cross-institutional referral loop, and perceived impact on clinical care. Int J Med Inform. 2023;180:105265. https://doi.org/10.1016/j.ijmedinf.2023.105265 . [DOI: 10.1016/j.ijmedinf.2023.105265]
  67. Vasconcelos Silva C, Bird D, Clemensen J, et al. A qualitative analysis of the needs and wishes of people with type 2 diabetes and healthcare professionals for optimal diabetes care. Diabet Med. 2022;39(9):e14886. https://doi.org/10.1111/dme.14886 . [DOI: 10.1111/dme.14886]
  68. Ozkaynak M, Valdez R, Hannah K, Woodhouse G, Klem P. Understanding gaps between daily living and clinical settings in chronic disease management: qualitative study. J Med Internet Res. 2021;23(2):e17590. https://doi.org/10.2196/17590 . [DOI: 10.2196/17590]
  69. Dietz WH, Solomon LS, Pronk N, et al. An integrated framework for the prevention and treatment of obesity and its related chronic diseases. Health Aff. 2015;34(9):1456–63. https://doi.org/10.1377/hlthaff.2015.0371 . [DOI: 10.1377/hlthaff.2015.0371]
  70. Chen F, Su W, Ramasamy A, et al. Ten-year Medicare budget impact of increased coverage for anti-obesity intervention. J Med Econ. 2019;22(10):1096–104. https://doi.org/10.1080/13696998.2019.1652185 . [DOI: 10.1080/13696998.2019.1652185]
  71. Alkharaiji M, Anyanwagu U, Donnelly R, Idris I. Tier 3 specialist weight management service and pre-bariatric multicomponent weight management programmes for adults with obesity living in the UK: a systematic review. Endocrinol Diab Metab. 2019;2(1):e00042. https://doi.org/10.1002/edm2.42 . [DOI: 10.1002/edm2.42]
  72. Brown TJ, O’Malley C, Blackshaw J, et al. Exploring the evidence base for Tier 3 weight management interventions for adults: a systematic review: multidisciplinary adult weight management. Clin Obes. 2017;7(5):260–72. https://doi.org/10.1111/cob.12204 . [DOI: 10.1111/cob.12204]
  73. Xue Y, Zou H, Ruan Z, et al. Pharmacoeconomic evaluation of anti-obesity drugs for chronic weight management: a systematic review of literature. Front Endocrinol. 2023;14:1254398. https://doi.org/10.3389/fendo.2023.1254398 . [DOI: 10.3389/fendo.2023.1254398]
  74. Stoops H, Dar M. Equity and obesity treatment — expanding Medicaid-covered interventions. N Engl J Med. 2023;388(25):2309–11. https://doi.org/10.1056/NEJMp2303 . [DOI: 10.1056/NEJMp2303]

Grants

  1. MYRG2022-00113-ICMS/Universidade de Macau

MeSH Term

Humans
Obesity
Adult
Delivery of Health Care

Word Cloud

Created with Highcharts 10.0.0clinicalobesityservicescarecomprehensiveadultsliving1keycomponents2recommendationshealthcareneedsresourcesCareClinicalObesityPURPOSEOFREVIEW:paperaimsanalyzeconsolidateexistingevidencemodelsidentifyproposefuturedirectionspromotinginternationaldevelopmentRECENTFINDINGS:includecontextualizedcompositionmulti-disciplinaryteamsmechanismsempowerprofessionalsclearstepwisepathwaysmatchingpatientappropriatecommunitytimelymanner3assessmentindividualizedtreatmentplaninformedevidence-basedpracticeguidelinesFurthermoreinformationsystemsfinancinginstrumentaleffectivesustainablefunctioningservicestrongconnectionsacrossprimarysecondarytertiarylevelssynthesizedfindingsmakepractitionershospitaladministrationspolicymakersdevelopingimprovingaddressConsolidatingInternationalModelsServicesAdultServiceModel

Similar Articles

Cited By