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Barriers and facilitators to continuity and co-ordination of healthcare for under 18 years old: a systematic review
  1. Alice Navein1,
  2. Eva Gonzalez-Viana2,
  3. Agnesa Mehmeti1,
  4. Dougal Hargreaves3,
  5. Rachel Elvins4,
  6. Richard Churchill5
  1. 1National Institute for Health and Care Excellence, London, UK
  2. 2Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
  3. 3Mohn Centre for Children's Health & Wellbeing, School of Public Health, Imperial College, London, UK
  4. 4Child and Adolescent Mental Health CSU, Royal Manchester Children’s Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
  5. 5Nottingham City General Practice Alliance, Nottingham, UK
  1. Correspondence to Dr Richard Churchill, Nottingham City General Practice Alliance, Nottingham, NG1 6LD, UK; richard.churchill{at}


Objective To determine views and experiences of babies, children and young people relating to continuity of their healthcare.

Design Qualitative systematic review.

Setting Primary research from UK settings where NHS-commissioned or local authority-commissioned healthcare is provided. Systematic reviews from UK and non-UK high-income countries.

Population Babies, children and young people under 18 years old with experience of healthcare. Parental and/or carer perspectives only included if children are under 5 years old or unable to express their own view.

Interventions Not applicable.

Main outcome measures Thematic analysis of the benefits and facilitators to continuity of care for babies, children and young people.

Results 20 047 abstracts were screened; 186 full-text articles were reviewed; 11 papers fulfilled the review criteria. From these, four main themes and 14 subthemes were identified. The theme ‘individuals’ had four subthemes: ‘knowledge of healthcare system’, ‘support’, ‘personal lives’ and ‘results’. The theme ‘healthcare professionals’ had four subthemes: ‘interservice communication’, ‘collaboration with babies, children and young people’, ‘communications’ and ‘relationships with healthcare professionals’. The theme ‘practical’ had four subthemes: ‘colocation’, ‘appointment times’, ‘referrals’ and ‘waiting times’. The theme ‘technological’ had two subthemes: ‘ease of use’ and ‘complements current healthcare management’.

Conclusions Continuity of healthcare for babies, children and young people can enhance clinical outcomes but requires active facilitation by healthcare providers and services, especially in circumstances where individuals or their families are less able to advocate for themselves. A range of barriers and facilitators were identified together with recommendations for enhancing continuity of care.

PROSPERO registration number CRD42019145566.

  • Child Health
  • Adolescent Health

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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  • Contributors The systematic review was designed by the National Guideline Alliance Technical Team (including AN, EG-V and AM). The search strategies were designed by AM, and the review was completed by AN. Quality appraisal was provided by EG-V. The manuscript was prepared by RC and AN, with assistance from RE and DH.

  • Funding This study was funded by National Institute for Health and Care Excellence.

  • Disclaimer The guideline referred to in this article was produced by the Royal College of Obstetricians and Gynaecologists (RCOG) for the National Institute for Health and Care Excellence (NICE). The views expressed in this article are those of the authors and not necessarily those of NICE.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.