Occupational Therapy Within Integrated Community Care Systems: A Systematic Review and Narrative Synthesis of Policy and System-Level Evidence

Background/Objectives: Population aging and rising long-term-care demand require community-based systems that support function and participation. Occupational therapy (OT) is provided across community-care settings, yet its policy- and system-level position remains inconsistently defined. This review examined how OT is positioned, financed, accessed, coordinated, staffed, and implemented within integrated community care. Methods: PubMed, CINAHL, Scopus, ProQuest Central, and APA PsycINFO were searched for English-language peer-reviewed literature published from 1 January 2010 to 29 July 2026. Two reviewers independently conducted study selection, data extraction, and design-matched critical appraisal. GRADE-CERQual and GRADE were applied to eligible qualitative and quantitative findings, respectively. The review synthesized peer-reviewed evidence describing policy- and system-level arrangements rather than systematically reviewing primary policy documents themselves. Results: Of 15,402 records, 5131 duplicates were removed, 10,271 screened, and 38 reports assessed in full text; 21 reports representing 20 unique studies/datasets were included. Framework synthesis refined the initial deductive categories into five higher-order domains: institutional positioning; financing/coverage; referral/coordination; service-delivery roles/infrastructure; and workforce/implementation support, with accessibility, equity, and user participation as cross-cutting themes. CERQual confidence was moderate for role clarity/team understanding, organizational integration supports, and service context/workforce capacity, and low for reimbursement/billing constraints, referral-prioritization/fairness judgments, and service-redesign tensions. Waiting-time change, waiting-list association, and OT integration feasibility had very low GRADE certainty. Conclusions: OT integration reflected interrelated policy-system arrangements rather than a validated model. Downstream system effects remain insufficiently established.