Table 2 Characteristics of articles with primary studies

a: Akehurst et al. (2018). UK

To understand what contextual influences, mechanism and outcomes affect the implementation and use of localized, online care pathways (Health Pathways) in primary and secondary care

Mixed-measures design

The study methodology draws on the realist approach to evaluation, providing an explanatory analysis aimed at showing what works for whom, under what circumstances, in what respects and how in order to provide an in-depth understanding of an intervention and how it can be made to work most effectively

Quantitative data included number of page views and conditions viewed. Qualitative data from semi-structured interviews and focus groups were gathered over a 6-month period and analyzed using NVivo software

General practitioners, nurses, practice managers, hospital consultants and system leaders

Find that use of pathways increases over time. Themes developed: showing how online care pathways were used – leadership, pre-existing networks and relationships; development of systems and processes for care pathways, the use of online care pathways to support decision-making and referral, and availability of resources. Inter-related themes: contextual influences, mechanism, and outcomes. Recommendation: improved data collection processes to understand how and why there was variance in the use of pathways

b: Biringer et al. (2017)

Norway

To assess health care personnel’s perceptions of the organization of care processes in the specialist service in Norway. A further goal was to examine whether the staff considered the organization to be better in the care processes that were standardized using clinical procedure compared to pathways without such procedures

Assessing health care personnel’s perceptions of the degree to which the organization was

patient focused, how well the treatment for the patient groups was coordinated, how well communication with patient and family worked, how well the collaboration with primary care worked, and whether the standardization of care processes was followed up

Care Process Self-Evaluation tool (CPSET) was used to evaluate how interprofessional teams in the specialist health service about their experiences with the organization of the treatment for specific patient groups

Staff took part from a total of six somatic hospitals and six psychiatric units in western Norway Regional Health Authority, were asked to complete the CPSET. Analyzes were based on responses from 239 employees in 22 valid care processes (48 per cent response rate)

The CPSET in the sample was higher than comparable international figures. However, Norwegian employees considered the follow-up of the care processes and the collaboration with primary care to be proper than other dimensions of care organization. Care processes with a written clinical procedure were better organized than process without such standardization

c: Hasson-Ohayon et al. (2016) Israel

Gaining a better understanding of the transition phase from psychiatric hospitalization back to the community

Qualitative methodology and narrative analysis. The analytic approach was guided by the interpretative phenomenological approach

Semi-structured interviews,

Focusing on the subjective experience of the transition from the hospital to the community

Personal life stories of 15 people diagnosed with schizophrenia who had just returned to the community following a psychiatric hospitalization

Revealed different characteristics of the transition phase. In addition to oscillation between feelings of strength and vitality to vulnerability and despair, participants reported specific factors included social, familial, employment and professional aspect. The results emphasize the non-linear nature of the transition process and the special challenges involved. Results also stress the importance of supportive relationships and work

d: Khandaker et al. (2013) UK

To evaluate how a model ‘payment by results’ for mental health works out in community mental health practice, including its impact on quality of patient care, mental health professionals and primary care

A theoretical sampling method was used to identify members of community care pathways involved in directly patient care (e.g. inpatient ward, crisis, and home treatment teams)

In total 19 interviews. Each participant took part in a private one-to-one in-depth face to-face interview at his/her own workplace lasting up to an hour. Recorded interviews were coded and analyzed thematically using grounded theory approach

Doctors, multidisciplinary staff and Trust managers

in community and in acute care (e.g. inpatient ward, crisis and home treatment teams)

The model led to more focused interventions being offered and working in pathways was generally seen as a positive change; practitioners being held account over clear standards of care, more cost-effective and allows for active case management and clear clinical leadership. The arbitrary time frame, strict criteria and thresholds for different teams could create issues. Improved communication, flexible and patient-centered approach, staff supervision, and increasing support to primary care were felt to be central to this model working efficiently and effectively

e: Seys et al. (2017) Belgium

Care pathways are better perceived than care processes organized without care pathways. To evaluate the extent to which team scores correlate for care processes with or without care pathways

Multilevel analysis was used

to compare care processes without and with care pathways. Almost all care processes were evaluated either before implementation of a care pathway, during the development phase or after implementation

The statistical analysis included 2692 questionnaires from 87 Belgian organization and 21 organization from Netherlands

Care Process Self-Evaluation tool (CPSET) was used to evaluate how healthcare professionals perceived the organization of care processes

In all 108 organizations from Netherlands/Belgian; acute hospitals, psychiatric hospitals, specialized hospitals and primary care

A significant difference between care processes with and without care pathways was found. A care pathway in use led to significant better scores on the overall CPSET scale and subscales, ‘coordination of care’ and ‘follow-up of care’. Physicians had the highest score on the overall CPSET scale

f: Sather et al. (2016) Norway

Exploring community health personnel’s experiences of care pathways in patient transition between inpatient and community health services

A descriptive qualitative design was chosen

Four focus groups interviews were conducted. Interviews were analyzed thematically

Twelve health employees from 7 community health care settings shared their experiences (1 urban and 6 rural)

Main themes were identified: integrated care and patient activation. Promoting factors affecting smooth CP were identified for successful patient transition: opportunities for information sharing, implementation of systematic plans, use of e-messages, around-the clock care, designing one responsible health person in each system for each patient, and involvement of patients and their families. Barriers to impede the patient’ transition between levels of care: the lack of a single responsible person at each level, insufficient meetings, the absence of systematic plans, difficulties in identifying the right staff at different levels, delays in information sharing, and the complexity of welfare systems negatively affecting patient dignity

g: Sather et al

(2018) Norway

Exploring community health personnel’s experiences of care pathways in patient transition between inpatient and community health services

A descriptive qualitative design was chosen

Four focus groups interviews were conducted. Interviews were analyzed thematically

Twelve health employees from 7 community health care settings shared their experiences (1 urban and 6 rural)

Main themes were identified: integrated care and patient activation. Promoting factors affecting smooth CP were identified for successful patient transition: opportunities for information sharing, implementation of systematic plans, use of e-messages, around-the clock care, designing one responsible health person in each system for each patient, and involvement of patients and their families. Barriers to impede the patient’ transition between levels of care: the lack of a single responsible person at each level, insufficient meetings, the absence of systematic plans, difficulties in identifying the right staff at different levels, delays in information sharing, and the complexity of welfare systems negatively affecting patient dignity

h: Sather et al. (2019) Norway

Exploring former patients’ views of pathways in transition between psychiatric hospitalization and the community

A descriptive qualitative design was chosen

Interviews from three focus groups were transcribed and analyzed thematically where themes describe promoting or inhibitory factors to the transition phase

Three focus group interviews with former patients were with a total of 10 informants from five different communities were conducted

Four main paired themes were identified: (a) patient participation versus paternalism and institutionalization, (b) patient-centered care versus interpreted as humiliation, (c) interprofessional collaboration or teamwork versus unsafe patient pathways in mental health services, and (d) sustainable integrated care versus fragmented, noncollaborative care

i: Steinacher et al. (2012) Germany

To determine whether the implementation of a pathway would improve diagnosis and treatment in conformity with published guidelines

Quantitative study with a prospective, controlled design (a two-year process)

Questionnaires (before and after pathways). Differences between patients in ward A and B and longitudinal (pre and post) between patient groups

In all 114 patients with schizophrenia in open, general psychiatric wards, where treatment pathways were implemented in two different ways

The patients reported less treatment satisfaction after the implementation of the pathways. They offered no explanation for their findings. No significant intergroup differences between groups in ward A and B were found

j: Teshager et al. (2020)

Northern Ethiopia

To assess pathways to psychiatric care and factors associated with delayed help-seeking among patients with mental illness using the WHO Pathway Study Encounter Form

A cross-sectional study was used

Data were collected using face-to-face interview from patients with various diagnosis of mental illness

Participants who attend outpatient treatment during the study period were included in the study using consecutive sampling technique

Significant delay in seeking modern psychiatric treatment. Religious healers were first source of help, due to mental illness was supernatural causes. Stigma and lack of awareness about where treatment is available were barriers to seeking appropriate care

k: Van Houdt et al. (2013) Belgium

To assess the extent to which care pathways support or create elements of the multi-level framework necessary to improve care coordination across the primary-hospital care continuum

An in-dept analysis of five local community projects located in four different regions to determine whether the available empirical evidence supported or refuted the theoretical expectations from the multi-level framework

Data were gathered using mixed methods, included structured face-to-face interviews, participant observations, documentation, and a focus group. Multiple cases were analyzed performing a cross case synthesis to strengthen the results

Staff from five local community projects located in four different regions in Belgium (hospitals and home care)

The construction of a new and use of an existing structure had a positive effect on exchanging information, formulating and sharing goals, defining and knowing each other’s roles, expectations and competences and building qualitative relationships

l: Wright et al. (2015)

UK

To explore the nature of service user involvement in the admission and discharge process into and out of acute inpatient mental health care

A qualitative study using focus group interviews were conducted winter 2013–2014

Focused on knowledge sharing at the points of transition of care in and

out of inpatient mental

health services in seven

focus group interviews. A semi-structured interview-guide were used and lasted for approximately 60 min

Staff from acute, inpatient mental health ward, community staff and service user (total number of participants = 52)

Due to the lack of resources (inpatient beds and community care follow-up), the role service users could play was diminished. In their narratives, clinical staff associated the person with the process and used language which dehumanized the individuals