Development of a patient-centred care pathway across healthcare providers: a qualitative study (original) (raw)
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BMC health services research, 2015
In Central Norway a generic care pathway was developed in collaboration between general hospitals and primary care with the intention of implementing it into everyday practice. The care pathway targeted elderly patients who were in need of home care services after discharge from hospital. The aim of the present study was to investigate the implementation process of the care pathway by comparing the experiences of health care professionals and managers in home care services between the participating municipalities. This was a qualitative comparative process evaluation using data from individual and focus group interviews. The Normalization Process Theory, which provides a framework for understanding how a new intervention becomes part of normal practice, was applied in our analysis. In all of the municipalities there were expectations that the generic care pathway would improve care coordination and quality of follow-up, but a substantial amount of work was needed to make the regular...
Elderly patients with complex health problems in the care trajectory: a qualitative case study
BMC Health Services Research, 2020
Background Elderly patients with multiple health problems often experience disease complications and functional failure, resulting in a need for health care across different health care systems during care trajectory. The patients’ perspective of the care trajectory has been insufficiently described, and thus there is a need for new insights and understanding. The study aims to explore how elderly patients with complex health problems engage in and interact with their care trajectory across different health care systems where several health care personnel are involved. Methods The study had an explorative design with a qualitative multi-case approach. Eleven patients (n = 11) aged 65–91 years participated. Patients were recruited from two hospitals in Norway. Observations and repeated interviews were conducted during patients’ hospital stays, discharge and after they returned to their homes. A thematic analysis method was undertaken. Results Patients engaged and positioned themselve...
Care pathway for the elderly: detailing the model
Revista Brasileira de Geriatria e Gerontologia, 2016
Greater knowlegde of patient history among health professionals leads to improved results. This is how the contemporary and resolutive models of care recommended by the most important national and international health agencies work. Current models of care stem from a time when Brazil was a country of young people and acute diseases. But the desire for a higher quality, more efficient and more cost-effective model of care is not only a Brazilian phenomenon. The whole world is debating the issue, recognizing the need for change and proposing improvements in their health systems. The same thing is occurring here. The theme of this text, as Dr. Martha de Oliveira, director of the Agência Nacional de Saúde Suplementar (National Agency Of Supplementary Health) (ANS) comments below, is in agreement with this movement. We advocate a logic that prioritizes low-intensity interventions and constant monitoring, with the doctor responsible for a portfolio of clients who he or she accompanies thr...
BMC Health Services Research, 2022
Background: Today, the ageing population is larger than ever before, and people who are living longer with chronic illnesses and multimorbidity need support from multiple healthcare service levels. Similarly, healthcare systems are becoming increasingly specialised and fragmented. The World Health Organization has highlighted novel policies for developing integrated and person-centred services. However, patients, next of kin and health professionals face several challenges in managing healthcare during the care trajectory. Limited literature has addressed the challenges experienced by these groups. Therefore, this study aimed to identify the dilemmas and deliberations faced by patients, next of kin and health professionals during the care trajectory of elderly patients with complex healthcare needs. Method: The study had a qualitative single-case design. The case was taken from a multi-case study exploring the care trajectory of elderly patients. The participants were the patient, their next of kin and the health professionals involved in the patient's care trajectory. Data were obtained via observation and individual interviews conducted during the patient's hospital stay and after the patient returned home. Results: The dilemmas and deliberations in managing the care trajectory were divided into four main themes: the health professionals' pursuit of appropriate and feasible healthcare services, the next of kin's planning horizons, being the person left in limbo and reorganising the home for comprehensive healthcare. Conclusion: The pursuit of a tailored and suitable healthcare service lead to a comprehensive mobilisation of and work by all actors involved. Having a comprehensive understanding of these conditions are of importance in developing an appropriate care trajectory for the elderly patient with complex need.
Introduction to the Strategy for Chronic Care
2015
Currently, an estimated 50 million people in the European Union live with multiple chronic diseases (multimorbidity) and this number is expected to further increase in the near future. As multimorbidity deeply impacts on people’s quality of life – not only physically, but also mentally and socially, there is a growing demand for multidisciplinary care that is tailored to the specific health and social needs of these people. Integrated care programmes have the potential to adequately respond to the comprehensive needs of people with multimorbidity by taking a holistic approach while making efficient use of resources. Such programmes are characterised by providing patient centred, proactive and coordinated multidisciplinary care, using new technologies to support patients’ self-management and improve collaboration between caregivers. To inform policymakers, managers and professionals working in health and social care as well as patients’ and informal carers’ representatives throughout...
2013
Chapter Policy and scientific background Chapter Structure of the CAPITOL study Chapter Care plans and care planning: conceptual and empirical review Chapter Care plans and care planning: preliminary qualitative work Chapter Care plans and care planning: evidence from GPPS Chapter Care plans and care planning: cohort study Chapter Care plans and care planning: patient perspectives Chapter Care plans and care planning: professional perspectives Chapter Summary and conclusions Executive summary Background The global burden of disease is shifting to long-term conditions. Long-term conditions require patients to make changes to lifestyle and adopt self management, which needs an active partnership between patient and professional. To achieve this, services need to support personalised care, shared decision making and choice. This has the potential to improve concordance and empowerment, support effective behaviour change, and lead to improved patient experience, better health outcomes and reduced costs. The Department of Health has made previous policy commitments to ensure that 'everyone with a long-term condition has a personalised care plan' and the approach has been supported by other patient and professional organisations. Care plans are designed to record agreements between patient and professional about goals and preferences, and to help to organise services around the needs of individual patients and ensure that needs are regularly reviewed. However, care plans are potentially complex in design, implementation and evaluation. There is a need to understand how the care planning process can contribute to the achievement of key goals in health care and to explore the patient, professional and system barriers which can frustrate achievement of those goals. Aims and objectives The aim of the CAPITOL project was to provide a comprehensive evaluation of the implementation and outcomes of care plans and care planning in the NHS. Box 1.2 The content of tiers of NHS model: Level 3: Case management This requires the identification of the very high intensity users of unplanned secondary care. Care for these patients is to be managed using a community matron or other professional using a case management approach, to anticipate, coordinate and join up health and social care. Level 2: Disease-specific care management This involves providing people who have a complex single need or multiple conditions with responsive, specialist services using multidisciplinary teams and disease-specific protocols and pathways, such as the National Service Frameworks and Quality and Outcomes Framework. Disease management refers to the provision of 'pro-active' care, with 'systematic and tailored programmes for individual patients'. 1 This is essentially achieved through the 'three Rs'-register, recall and review. Disease management in primary care is expected to entail general practice teams identifying patients with long-term conditions through disease registers, following clinical protocols through regular clinical review, and supporting self-management.
The British journal of general practice : the journal of the Royal College of General Practitioners, 2015
In recent years, primary health care for the ageing population has become increasingly complex. This study sought to explore the views and needs of healthcare professionals and older patients relating to primary care in order to identify focal areas for improving primary health care for older people. This research was structured as a mixed interview study with focus groups and individual interviews. Participants were made up of primary healthcare professionals and older patients. Patients were recruited from five elderly care homes in a small city in the southern part of the Netherlands. All interviews were transcribed verbatim and analysed by two individual researchers applying constant comparative analysis. Data collection proceeded until saturation was reached. Participants in the study agreed about the need for primary care for older patients, and showed sympathy with one another's perspectives. They did note, however, a number of obstacles hindering good healthcare provisio...
Primary care models for community-dwelling adults with long-term conditions
JBI database of systematic reviews and implementation reports, 2019
This scoping review aims to map primary care models designed to support adults with long-term conditions. The review will analyze the following in relation to the models identified: characteristics, impact reported, implications for practice and outcome measures. Introduction: Robust solutions to support individuals with long-term conditions need to be established in order to increase health service capacity and provide cost-effective solutions while, most importantly, ensuring they receive the best services to live meaningful and productive lives. Inclusion criteria: The concept to be mapped is primary care models used to support adults living with long-term conditions. This may also encompass services not solely designed for people with long-term conditions; however, they will be services that may be the first port of call for this group. Operational a priori criteria have been designed to assist with distinguishing appropriate literature. Methods: Due to the nature of the scoping review, literature from a range of published and unpublished sources will be utilized from 1995 to 2019. Databases to be searched will include: MEDLINE, Embase, PsycINFO, HMIC, CINAHL, Cochrane Database of Systematic Reviews and Web of Science. Appropriate gray literature will be searched, alongside hand searching selected primary care journals, conference abstracts and professional and government bodies. Articles will be restricted to English. Titles and abstracts will be screened by two independent reviewers for assessment against the inclusion criteria. Charting of the data will include details about the population, concept, context, study methods and key findings relevant to the review objective.
An overview of primary Health care in geriatric and the need of Care Intervention.
Objective: To evaluate the care interventions and approaches for the ageing population in different countries and their perspective of geriatric care. Quality assurance and workforce development the monitoring supervision and evaluation of care progression is very demanding for the sustainable delivery of care and frequent trainings and education of healthcare professionals develop quality geriatric care. This study has underscored the significance of specific building characteristics from Swedish and Canadian care models, such as community care, physical support, authenticity, cognitive well-being, comfort, and personalization, in positively influencing various aspects of resident's quality of life. Methods: The review study conducted in this research paper adhered to the PRISMA (Preferred Reporting Items for the Systematic Reviews and Meta-Analyses) guidelines. Results: The global geriatric care strategy and plan of action on ageing and health, which provide a clear mandate for action across health and social care sectors, where a different set of outcome indicators is neededindicators that reflect intrinsic capacity, functional ability, quality of life and the attainment of goals defined by the older person. Conclusion: There are some loopholes in every care system but continuous intervention leads to success as Sweden, and Canada, they have attributed to increased funding for geriatric care programs, but with the care concern, Czech Republic is avoiding to provide such health care services due to many reasons, mainly lack of funds, services providers, and trained staff to carry such task of dealing health care out of hospital and that is the reason community care centres are still not materialized.
Primary health care for older people: progress towards an integrated strategy?
Health & Social Care in The Community, 1999
The importance of providing integrated, holistic and cohesive primary care for older people has been increasingly emphasized in recent policy initiatives and directives in the UK. These have sometimes proved to be elusive goals, however, as an ageing population and rapidly changing health care environment have increased the pressures on the primary care team to keep pace with the growing level of need. As primary care faces a new set of challenges presented by the development of Primary Care Groups (PCGs), opportunities may be found to address older people's health needs in a more coordinated way. In South Buckinghamshire, a multi-agency group, Health for All (HFA), has been keen to develop collaborative and inter-agency working in older peoples' services and commissioned an evaluation to inform their work. This paper focuses on some of the key findings from the evaluation with reference to primary care. The purpose of the evaluation was to provide a snapshot of service provision for older people, identifying the level of access, availability of services and areas of unmet need. Twelve user groups were consulted and interviews held with 58 service representatives from health and social services agencies in the statutory and voluntary sectors. Primary care was considered in the wider context of service provision and key issues from the perspectives of providers and users were identified. A number of problems specific to primary care were identified which echo experiences in other parts of the country. However, also identified were common issues across a wide range of service provision, suggesting the need for coordinated strategies and more effective user participation. The HFA group is using the recommendations of the evaluation to assist in a priority setting exercise, which will inform the development of a strategy for older people in South Buckinghamshire.