Service users' and caregivers' perspectives on continuity of care in out-of-hours primary care

Dilemmas and deliberations in managing the care trajectory of elderly patients with complex health needs: a single-case study

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.

Ensuring quality qualitative research reporting in community pharmacy: a systematic literature review

OBJECTIVES

To evaluate the reporting quality for a sample of community pharmacy qualitative research articles based on the Standards for Reporting Qualitative Research (SRQR) guidelines, data interpretation and use of theory.

METHODS

A systematic literature search was conducted using Ovid MEDLINE to identify qualitative research related to community pharmacy. Data were extracted and evaluated based on the SRQR standards, data interpretation level and use of theory. Adherence to standards was analysed using descriptive statistics.

KEY FINDINGS

Eighty-one studies were retrieved through the database search (n = 81). Then, 31 studies met the inclusion criteria after screening abstracts and full texts. Twelve out of 21 SRQR were present in more than 80% of the studies. However, essential standards, such as research approach, reflexivity and trustworthiness techniques, were absent or partially present in 30 (97%) studies, 30 (97%) studies and 21 (68%) studies, respectively. Data interpretation level was descriptive in 27 (87%) studies and interpretive or partially interpretive in 4 (13%) studies. Theory was absent in 19 (60%) and implied, partially integrated or retrospectively applied in 12 (40%) of the studies.

CONCLUSION

Trustworthiness and quality of qualitative inferences within community pharmacy research could be enhanced with increasing awareness about reporting; the approach and paradigm, reflexivity, trustworthiness techniques, data interpretation level and theoretical use.

What do positive and negative experiences of patients, relatives, general practitioners, medical assistants, and nurses tell us about barriers and supporting factors in outpatient palliative care? A critical incident interview study

Background: The strengthening of the general practitioners’ (GPs’) role in palliative care (PC) has been identified as a top priority in order to improve PC in Germany. This study aims at exploring positive and negative experiences in PC in Germany from the perspectives of patients, relatives, and health care professionals in a primary care setting.

Methods: Between March 2017 and August 2017, a total of 16 interviews with patients, relatives, GPs, medical assistants, and nurses were conducted. The Critical Incident Technique (CIT) was used to explore factors that influence excellent versus undesirable events in PC provision. Two researchers independently defined and counted critical incidents (CIs) from interview transcripts, performed a thematic analysis, and clustered the CIs into dimensions.

Results: In summary, 16 interviews contained 280 CIs, divided into 130 positive and 150 negative CIs. The thematic analysis resulted in seven content domains, with each including positive and negative CIs, respectively: 1) way of care provision, 2) availability of care providers, structures, medication, and aids, 3) general formal conditions of care provision, 4) bureaucracy, 5) working practices in health care teams, 6) quality and outcome of care provision, and 7) communication.

Conclusions: The results raise awareness for the aspects that lead to successful or undesirable PC experiences, observed from different perspectives. They open up the potential for primary PC improvement. Future research will facilitate development and implementation of more tailored interventions in order to improve generalists’ PC.

"We Tie Up the Loose Ends": Homecare Nursing in a Changing Health Care Landscape

During the last decades, the work of homecare nurses has been affected by several changes, including an aging population, the decentralization of health care, nursing recruitment crises and the scarcity of public resources. Few scholars have analyzed how these changes have impacted homecare nursing. In this article, we describe and discuss aspects of homecare nurses’ work, with specific focus on nurses “organising work.” We outline three phenomena that are increasingly occurring: (a) homecare nurses are frequently involved in negotiating care level and, consequently, what kind of care the patient will receive; (b) homecare nurses’ clinical practice has become increasingly advanced; and (c) and homecare nurses play an important role in coordinating care among interdependent actors. The article draws on material from participant observation and interviews with homecare nurses in two Norwegian studies. Changes in work practice increase the demand for nurses to be competent and have excellent organizational and collaborative skills.

Continuity of care experiences following the transition from Early Intervention Teams to Primary, Community and Continuous Care Teams in Ireland: A multi-perspective case study exploring the views of caregivers’ of children with Autistic Spectrum Disorder and service providers

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Continuity of care in after-hours house call medical services: An exploration of follow-up patterns in an Australian context

RATIONALE, AIMS AND OBJECTIVES

This study explores the postconsultation follow-up behaviours of patients who used the Australian after-hours house-call (AHHC) medical services. These behaviours provide insights into the nature of the continuity of care (CoC) in the industry and are a measure quality in AHHC service delivery. Understanding the patterns of these CoCs and their predictors will enable stakeholders in the industry, both locally and globally, plan and implement higher quality services.

METHODS

This is a cross-sectional survey of all 10,838 patients who used AHHC during the last week of January 2016. A validated questionnaire was used, distributed through a mix of online and postal questionnaires.

RESULTS

One thousand two hundred twenty-eight questionnaires were returned (11.3%). Had the AHHC not been available, 38.6% of respondents would have gone to their own general practitioners (GPs), 40.1% to an emergency department (ED), 15.9% to an office-based after-hours service, and 5.5% would have done nothing. After the AHHC visits, however, 47.3% followed up with their GPs, 8.4% went to an ED, 4.2% arranged for a further AHHC visit, while 40.0% required no follow-up. Patients who required GP follow-ups were likely to be dissatisfied with aspects of the AHHC care received, while those with no follow-ups were generally satisfied. Patients ≥65 years were more likely to require no follow-ups (P < .001) and, if they did, were unlikely to do so with their GPs (P = .04). Where required, follow-ups for those aged ≤16 years were likely to result in ED attendances (P = .01), while students generally rely on AHHCs for follow-ups (P = .03). Compared to females, males were likely to rely on their GPs (P = .01), and less likely to go to an ED (P = .01).

CONCLUSION

Most patients seen by Australian AHHC services either end up requiring no further follow-up, or do so with their own GPs, with few relying on further AHHC visits for follow-up. The real reasons for follow-up differences observed by age and gender may need to be explored further so as to ensure that the AHHC services are better used.

Patients with multimorbidity and their experiences with the healthcare process: a scoping review

BACKGROUND

The number of patients with multimorbidity (two or more conditions) is increasing. Observational research has shown that having multiple health problems is associated with poorer outcomes in terms of health, quality of care, and costs. Thus, it is imperative to understand how patients with multimorbidity experience their healthcare process. Insight into patient experiences can be used to tailor healthcare provision specifically to the needs of patients with multimorbidity.

OBJECTIVE

To synthesize self-reported experiences with the healthcare process of patients with multimorbidity, and identify overarching themes.

DESIGN

A scoping literature review that evaluates both qualitative and quantitative studies published in PubMed, Embase, MEDLINE, and PsycINFO. No restrictions were applied to healthcare setting or year of publication. Studies were included if they reported experiences with the healthcare process of patients with multimorbidity. Patient experiences were extracted and subjected to thematic analysis (interpretative), which revealed overarching themes by mapping their interrelatedness.

RESULTS

Overall, 22 empirical studies reported experiences of patients with multimorbidity. Thematic analysis identified 12 themes within these studies. The key overarching theme was the experience of a lack of holistic care. Patients also experienced insufficient guidance from healthcare providers. Patients also perceived system-related issues such as problems stemming from poor professional-to-professional communication.

CONCLUSIONS

Patients with multimorbidity experience a range of system- and professional-related issues with healthcare delivery. This overview illustrates the diversity of aspects that should be considered in designing healthcare services for patients with multimorbidity.

How theory is used and articulated in qualitative research: development of a new typology

There is a long tradition within qualitative research of theory being central and of critical importance. Qualitative research theory often equates with the methodologies used but this is a complex relationship, plagued by lack of consensus among scholars regarding how theory and methodology are related. This article furthers the debates on how theories are used in qualitative research, how they might influence a study and how they are articulated in publications. The aim is to provide a framework through which the relationship between theory and qualitative research can be understood. We propose a five-point typology on the levels of theoretical visibility, testing this against a range of published research from five key international health, medicine and social science journals. The typology captures a range of visibility--from seemingly absent through to highly visible and applied throughout. There was a clear gradient in this assessment--only a minority appeared to use theory consistently throughout a study. We outline several challenges to consistently applying theory in qualitative research and suggest potential solutions. This article is based on the argument that lack of theory in qualitative research undermines its quality. The typology is offered to assist researchers in applying theory in their own research and critiquing its use in the work of others.

Methodology or method? A critical review of qualitative case study reports

Despite on-going debate about credibility, and reported limitations in comparison to other approaches, case study is an increasingly popular approach among qualitative researchers. We critically analysed the methodological descriptions of published case studies. Three high-impact qualitative methods journals were searched to locate case studies published in the past 5 years; 34 were selected for analysis. Articles were categorized as health and health services (n=12), social sciences and anthropology (n=7), or methods (n=15) case studies. The articles were reviewed using an adapted version of established criteria to determine whether adequate methodological justification was present, and if study aims, methods, and reported findings were consistent with a qualitative case study approach. Findings were grouped into five themes outlining key methodological issues: case study methodology or method, case of something particular and case selection, contextually bound case study, researcher and case interactions and triangulation, and study design inconsistent with methodology reported. Improved reporting of case studies by qualitative researchers will advance the methodology for the benefit of researchers and practitioners.

Patient loyalty in a mature IDS market: is population health management worth it?

OBJECTIVE

To understand patient loyalty to providers over time, informing effective population health management.

STUDY SETTING

Patient care-seeking patterns over a 6-year timeframe in Minnesota, where care systems have a significant portion of their revenue generated by shared-saving contracts with public and private payers.

STUDY DESIGN

Weibull duration and probit models were used to examine patterns of patient attribution to a care system and the continuity of patient affiliation with a care system. Clustering of errors within family unit was used to account for within-family correlation in unobserved characteristics that affect patient loyalty.

DATA COLLECTION

The payer provided data from health plan administrative files, matched to U.S. Census-based characteristics of the patient's neighborhood. Patients were retrospectively attributed to health care systems based on patterns of primary care.

PRINCIPAL FINDINGS

I find significant patient loyalty, with past loyalty a very strong predictor of future relationship. Relationships were shorter when the patient's health status was complex and when the patient's care system was smaller.

CONCLUSIONS

Population health management can be beneficial to the care system making this investment, particularly for patients exhibiting prior continuity in care system choice. The results suggest that co-located primary and specialty services are important in maintaining primary care loyalty.