Table 2.

Summary of the results of the included studies

Author/country/year	Research goal
Dunn et al./UK/2021 [7]	The study aims to determine the impact of community nurse-led interventions on the need for hospital use among the elderly
Birke et al./Denmark/2020 [8]	Assess the feasibility of a complex person-centered intervention with multiple long-term problems in primary health care
Askew et al./Australia/2020 [9]	The exploratory case study in the home offered multidisciplinary care focused on the indigenous person with chronic illness in primary health care in an urban setting
Peart et al./Australia/2020 [10]	Explore the experience of health care professionals in coordinating care for people living with multimorbidity who need care coordination to help them manage their health
Sakellarides/Portugal/2020 [11]	The individual care plan is an essential tool for the effective management of people’s pathway through the services they need
Nyberg et al./Sweden/2019 [12]	The study aims to assess the feasibility of an application for people with chronic obstructive pulmonary disease, its design, and study procedures, and to increase understanding of the potential effect of the tool to provide guidance for a future large-scale trial
Costa et al./Portugal/2019 [13]	Health literacy as a driver of people’s activation. Activation represents a person’s knowledge, technical ability, confidence, and motivation to self-manage their health and/or illness
Green and Jester/UK/2019 [14]	The English National Health Service Long-Term Plan outlines the goals for managing the increasing demand for the health service: decreasing hospital admissions, shorter lengths of stay through improved recovery pathways, increased management of people in primary health care, and ensuring a person-centered approach
Lima Toivanen et al./Latin America and Caribbean/2018 [15]	Study to validate the use of a newly developed framework to evaluate the contribution of digital health to improving the delivery of integrated, person-centered services in primary health care in Latin America and the Caribbean
Fortin et al./Canada/2019 [16]	This study aimed to explore the effects of the intervention of chronic disease prevention and management services in primary health care on people with long-term health problems and their families in primary health care
Peterson et al./South Africa/2019 [17]	This study aimed to evaluate an integrated, task-shared collaborative care package for people with chronic illness and coexisting symptoms of depressive disorder and alcohol use
Lukewich et al./Canada/2018 [18]	The purpose of this study was to understand better the organizational attributes of teams in primary health care, focusing specifically on team composition, nursing roles, and strategies that support chronic disease management
Srinivasan et al./India/2018 [19]	The study evaluates the effects of integrating people’s mental health and chronic disease management in primary health care through a collaborative care model to improve the screening, diagnosis, and treatment of depression in rural India
Askerud and Conder/New Zealand/2017 [20]	The research synthesizes the experiences of people with long-term health problems about the quality of care of the case management model by nurses in primary health care
Khan et al./UK/2017 [21]	The study aimed to describe self-care and support behavior among people with chronic obstructive pulmonary disease and explore the behavior associated with a self-care plan
Bauer and Bodenheimer/USA/2017 [22]	This article explores the challenges and opportunities for nurses in primary health care in the 21st century. It examines the likelihood of expanded roles for nurses to improve quality and add capacity to the primary health care workforce
Leine et al./Norway/2017 [23]	The study explores the experiences of people with the chronic obstructive pulmonary disease with a partnership-based nursing practice program in the home
Housden et al./Canada/2017 [24]	In Canada, primary health care reform has encouraged innovations, including nurse-led and group medical visits. Nurse-led visits provide an opportunity to examine the barriers and facilitating factors for implementing this innovation in primary health care
Sharma et al./USA/2016 [25]	An observational whether health coaching, whether it is effective for self-management and maintenance of cardiovascular risk factors after a health coaching intervention
Kvale et al./USA/2016 [26]	The study examined the person-owned survivor transition treatment for activated and empowered survivors, which is a coaching encounter based on the chronic treatment model that uses motivational interviewing techniques to engage breast cancer survivors
Ostlund et al./Sweden/2016 [27]	The purpose of this study was to describe what verbal behaviors/conversation types were recorded during motivational interviewing sessions between primary health care nurses and people with multiple health problems
Gálvez-Cano et al./Peru/2016 [28]	The study aims to gain insight into the person’s health status through a comprehensive geriatric assessment and allows the nurse to develop an individualized care plan in conjunction with the person/family’s interests and values