An integrated approach for individualised support: carers' views

Patient experiences of integrated care within the United Kingdom: A systematic review

Introduction

Integrated care and patient experience are central to the coordination and delivery of high quality health and social care in the UK, but their joint application is poorly understood. This systematic review aimed to gain an understanding of patient experience within current integrated care services in the UK, and specifically, whether they reflect person-centred coordinated care (PCCC).

Methods

Following PRISMA, electronic databases (ProQuest, EBSCO and Cochrane Library) were searched from 2012 to 2019 for primary, peer-reviewed literature. Papers were included where patients’ or carers’ experiences of integrated care were reported. Papers were excluded where they focused on acute integrated care interventions, measured experience via satisfaction scores only, or findings lacked sufficient depth to answer the research question. Quality was assessed using Mixed Methods Appraisal Tool, and findings synthesised using a framework approach, incorporating the Rainbow Model of Integrated Care and Measuring Integrated Care Patient Framework.

Results

Sixteen studies were included. Person-centred and shared responsibility experiences were most often discussed. Experiences were not always described as positive and some patients experienced a lack of PCCC. Clinical, professional/organisational and functional integration processes were associated with experiencing domains of PCCC.

Discussion

People with complex needs experience a lack of coordination across teams and wider community resources, and limited associations were made between integration processes and patient experience. Further research which gives context to individual experience, provides greater detail of integration processes and utilises validated patient experience measures of PCCC is required to understand the association between integration processes and domains of PCCC.

Cocreating Meaning Through Expressive Writing and Reading for Cancer Caregivers

PURPOSE

Caregivers of patients with cancer cope with socioemotional challenges, which can adversely affect their well-being. We developed an intervention, expressive writing and reading (EWR), to promote emotional processing and social connectedness among caregivers. In a single-arm pilot study, we assessed its feasibility and perceived usefulness.

METHODS

Caregivers participated in weekly 1.5-hour EWR workshops offered over 20 weeks. After 4 sessions, they completed semistructured interviews, which were analyzed using qualitative descriptive analysis.

FINDINGS

Of 65 caregivers approached, 25 were eligible, 18 consented, and 9 (50%) caregivers completed at least 4 workshops and the interview. Their responses revealed 3 themes: "inner processing," "interpersonal learning," and "enhanced processing and preparedness." Perceived benefits of EWR included emotional and cognitive processing (individual and collaborative), learning from the emotions and experiences of other caregivers, and preparing for upcoming challenges.

CONCLUSIONS

Expressive writing and reading can be a safe and cost-effective supportive intervention for caregivers of patients with cancer.

Perceptions on technology for volunteer respite care for bedridden elders in Chile

PURPOSE

 Informal caregivers of bedridden elders need a respite. One form of obtaining a respite is through volunteers who are contacted by means of information and communication technology (ICT).

METHOD

 A qualitative study was carried out in a low-income district in Santiago, Chile, to learn about how caregivers of bedridden elders perceive the possibility of using ICT to access this respite. In-depth interviews were carried out and transcribed verbatim, then analysed using open coding. Results: The results reveal that caregivers are willing to receive a volunteer in their home and use ICT to communicate with them, although a discrepancy exists between the use of devices connected to the Internet and feature phones. Conclusion: This study concludes that informal caregivers of bedridden elders have a favourable disposition towards accessing a respite system by means of ICT based on a peer-to-peer economy.

Measuring quality in community nursing: a mixed-methods study

Background

High-quality nursing care is crucial for patients with complex conditions and comorbidities living at home, but such care is largely invisible to health planners and managers. Nursing care quality in acute settings is typically measured using a range of different quality measures; however, little is known about how service quality is measured in community nursing.

Objective

To establish which quality indicators (QIs) are selected for community nursing; how these are selected and applied; and their usefulness to service users (patients and/or carers), commissioners and provider staff.

Design

A mixed-methods study comprising three phases. (1) A national survey was undertaken of ‘Commissioning for Quality and Innovation’ indicators applied to community nursing care in 2014/15. The data were analysed descriptively using IBM SPSS Statistics 20.0 (IBM Corporation, Armonk, NY, USA). (2) An in-depth case study was conducted in five sites. Qualitative data were collected through observations, interviews, focus groups and documents. A thematic analysis was conducted using QSR NVivo 10 (QSR International, Warrington, UK). The findings from the first two phases were synthesised using a theoretical framework to examine how local and distal contexts affecting care provision impacted on the selection and application of QIs for community nursing. (3) Validity testing the findings and associated draft good practice guidance through a series of stakeholder engagement events held in venues across England.

Setting

The national survey was conducted by telephone and e-mail. Each case study site comprised a Clinical Commissioning Group (CCG) and its associated provider of community nursing services.

Participants

Survey – 145 (68.7%) CCGs across England.

Case study

NHS England national and regional quality leads (n = 5), commissioners (n = 19), provider managers (n = 32), registered community nurses (n = 45); and adult patients (n = 14) receiving care in their own homes and/or carers (n = 7).

Findings

A wide range of indicators was used nationally, with a major focus on organisational processes. Lack of nurse and service user involvement in indicator selection processes had a negative impact on their application and perceived usefulness. Indicator data collection was hampered by problematic information technology (IT) software and connectivity and interorganisational system incompatibility. Front-line staff considered indicators designed for acute settings inappropriate for use in community settings. Indicators did not reflect aspects of care, such as time spent, kindness and respect, that were highly valued by front-line staff and service user participants. Workshop delegates (commissioners, provider managers, front-line staff and service users, n = 242) endorsed the findings and drafted good practice guidance.

Limitations

Ongoing service reorganisation during the study period affected access to participants in some sites. The limited available data precluded an in-depth documentary analysis.

Conclusions

The current QIs for community nursing are of limited use. Indicators will be enhanced by involving service users and front-line staff in identification of suitable measures. Resolution of connectivity and compatibility challenges should assist implementation of new IT packages into practice. Modifications are likely to be required to ensure that indicators developed for acute settings are suitable for community. A mix of qualitative and quantitative methods will better represent community nursing service quality.

Future work

Future research should investigate the appropriate modifications and associated costs of administering QI schemes in integrated care settings.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.