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Kim H, Yoon NH, Seo D, Kim Y. Development of a practical framework and indicators for monitoring integrated long-term health and care needs and service use. Health Policy 2024; 149:105167. [PMID: 39326358 DOI: 10.1016/j.healthpol.2024.105167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 09/10/2024] [Accepted: 09/13/2024] [Indexed: 09/28/2024]
Abstract
This case study presents an evidence-building approach to support policy planning for integrated health and care delivery for older adults. We developed an integrated needs-assessment framework to monitor the complex long-term medical and care needs of older individuals, using routinely collected, standardized needs-assessment and utilization data from the public health and long-term care (LTC) insurance systems in South Korea. We also developed a set of misuse indicators and analyzed service utilization patterns, while accounting for their varying types of needs. Approximately 11 % of older Koreans were identified as having complex long-term medical and care needs, which were categorized into four distinct need groups. More than one-third of those in the higher-medical/lower-care needs group stayed in LTC hospitals for six months or more during the year, and about one-third of those in the higher-medical/higher-care needs group inappropriately resided in LTC facilities, where medical services are limited. The newly developed integrated needs-assessment framework and misuse indicator set provide practical tools for monitoring the extent and nature of complex needs, as well as patterns of over- or under-utilization of health and care services over time. The empirical evidence gathered here highlights the need for reforms in South Korea's health and LTC systems.
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Affiliation(s)
- Hongsoo Kim
- Graduate School of Public Health Department of Public Health Sciences, Institute of Health and Environment & Artificial Intelligence Institute, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Nan-He Yoon
- Division of Social Welfare and Health Administration, Wonkwang University, 460 Iksandae-ro, Iksan, Jeollabuk-do, 54538, Republic of Korea.
| | - Dongmin Seo
- Division of Social Welfare, Baekseok University, 1, Baekseokdaehak-ro, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 31065, Republic of Korea
| | - Yoon Kim
- Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
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Cantrell A, Chambers D, Booth A. Interventions to minimise hospital winter pressures related to discharge planning and integrated care: a rapid mapping review of UK evidence. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-116. [PMID: 39267416 DOI: 10.3310/krwh4301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
Background Winter pressures are a familiar phenomenon within the National Health Service and represent the most extreme of many regular demands placed on health and social care service provision. This review focuses on a part of the pathway that is particularly problematic: the discharge process from hospital to social care and the community. Although studies of discharge are plentiful, we identified a need to focus on identifying interventions and initiatives that are a specific response to 'winter pressures'. This mapping review focuses on interventions or initiatives in relation to hospital winter pressures in the United Kingdom with either discharge planning to increase smart discharge (both a reduction in patients waiting to be discharged and patients being discharged to the most appropriate place) and/or integrated care. Methods We conducted a mapping review of United Kingdom evidence published 2018-22. Initially, we searched MEDLINE, Health Management Information Consortium, Social Care Online, Social Sciences Citation Index and the King's Fund Library to find relevant interventions in conjunction with winter pressures. From these interventions we created a taxonomy of intervention types and a draft map. A second broader stage of searching was then undertaken for named candidate interventions on Google Scholar (Google Inc., Mountain View, CA, USA). For each taxonomy heading, we produced a table with definitions, findings from research studies, local initiatives and systematic reviews and evidence gaps. Results The taxonomy developed was split into structural, changing staff behaviour, changing community provision, integrated care, targeting carers, modelling and workforce planning. The last two categories were excluded from the scope. Within the different taxonomy sections we generated a total of 41 headings. These headings were further organised into the different stages of the patient pathway: hospital avoidance, alternative delivery site, facilitated discharge and cross-cutting. The evidence for each heading was summarised in tables and evidence gaps were identified. Conclusions Few initiatives identified were specifically identified as a response to winter pressures. Discharge to assess and hospital at home interventions are heavily used and well supported by the evidence but other responses, while also heavily used, were based on limited evidence. There is a lack of studies considering patient, family and provider needs when developing interventions aimed at improving delayed discharge. Additionally, there is a shortage of studies that measure the longer-term impact of interventions. Hospital avoidance and discharge planning are whole-system approaches. Considering the whole health and social care system is imperative to ensure that implementing an initiative in one setting does not just move the problem to another setting. Limitations Time limitations for completing the review constrained the period available for additional searches. This may carry implications for the completeness of the evidence base identified. Future work Further research to consider a realist review that views approaches across the different sectors within a whole system evaluation frame. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130588) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 31. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Anna Cantrell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Webber J, Finlayson M, Norman KE, Trothen TJ. How Community-Based Health and Social Care Professionals Support Unpaid Caregivers: Experiences From One Health Authority in Ontario, Canada. QUALITATIVE HEALTH RESEARCH 2024; 34:977-988. [PMID: 38419528 PMCID: PMC11375905 DOI: 10.1177/10497323241231425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
In Ontario, Canada, rising rates of caregiver distress have been the 'canary in the coal mine' for a health system out of balance with the needs of an ageing population. Community-based health and social care professionals are well placed to play an important role in the caregiver support process; however, a gap has remained in the understanding of if and how caregiver support strategies are operationalized or experienced by community service providers (CSPs). The goal of this study was to describe how CSPs interpreted policy and how those interpretations may enable their work in supporting unpaid caregivers. Using a qualitative constructionist design, we interviewed 24 participants and reviewed 92 publicly available documents. Braun and Clarke's method of thematic analysis was used for analysis strategy. Four overarching themes were identified: (1) community care as a priority, (2) sidewalk accountability, (3) creative care planning through partnerships, and (4) challenges to care delivery. We found that the importance of caregivers to the health system was reflected in organizational policy and strategy. There is an opportunity to improve health outcome for caregivers and the population alike through strong leadership and a clear shared vision. Our findings also suggested that social capital was a significant factor in enabling providers in their work, leveraging long-standing relationships, and accumulated local knowledge to implement highly creative care plans.
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Affiliation(s)
- Jodi Webber
- School of Social Work, Algoma University, Sault Ste. Marie, ON, Canada
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Kathleen E Norman
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Tracy J Trothen
- School of Rehabilitation Therapy and The School of Religion, Queen's University, Kingston, ON, Canada
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Steele Gray C, Shaw J, Baker GR, Kuluski K, Wodchis WP. The Integrated Care World is a Stage: Applying Goffman's Theory of Dramaturgy to the Activities of Integrated Care. Int J Integr Care 2024; 24:17. [PMID: 39220345 PMCID: PMC11363894 DOI: 10.5334/ijic.8639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 08/01/2024] [Indexed: 09/04/2024] Open
Abstract
Among the challenges in delivering integrated health and social care services is the need to attend to the coordination of tasks, roles, activities, and operations, while considering how these efforts are experienced by patients, carers and communities. The literature has noted an important disconnect between how providers and leaders view their efforts to coordinate service delivery, and how patients perceive these efforts on the receiving end. Our team has provided guidance to integrated care efforts in Ontario, Canada by drawing on Goffman's theory of Dramaturgy to help classify the actions of integrated care delivery as linked to the roles individuals play in the delivery of care. Using this framing helps to uncover how "backstage" processes (such as team-functioning, funding models, and digital infrastructures) create a necessary foundation on which "frontstage" actions (or performances) can be effectively delivered.
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Affiliation(s)
- Carolyn Steele Gray
- Implementing Digital Health Innovation (Tier 2), Canada
- Science of Care Institute, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada
| | - James Shaw
- Responsible Health Innovation (Tier 2), Canada
- Department of Physical Therapy, Canada
- Artificial Intelligence, Ethics & Health, Joint Centre for Bioethics, University of Toronto, Canada
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Canada
| | - G. Ross Baker
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Kerry Kuluski
- Patient and Family-Centered Care, Institute for Better Health, Trillium Health Partners, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Walter P. Wodchis
- Institute of Health Policy Management and Evaluation, University of Toronto, Canada
- Implementation and Evaluation Science, Institute for Better Health, Trillium Health Partners, Canada
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Block H, Tran R, Lockwood K, Manuel K, Laver K, Crotty M, Cameron ID, Kurrle SE. Frailty evidence-practice gaps in acute care hospitals. Australas J Ageing 2024; 43:420-425. [PMID: 38798035 DOI: 10.1111/ajag.13330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/14/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES Frailty is common in hospitalised older people. Clinical practice guidelines for the management of frailty provide recommendations for identification and management; however, adoption into practice in hospitals is limited. This study identified and quantified the evidence-practice gap between frailty guidelines and clinical practice in two hospitals using an audit tool. METHODS A cross-sectional audit of medical records of frail older patients admitted to two hospitals was conducted. Data were collected using an audit tool based on the Asia Pacific Clinical Practice Guidelines for frailty management. Data were analysed using descriptive statistics and inter-rater reliability of the tool was assessed. RESULTS Auditing of n = 70 electronic medical records showed that assessment of frailty in the acute setting did not regularly occur (17%). Few participants received guideline-recommended interventions. Physiotherapy treatment was limited, with 23% of participants receiving progressive resistance strength training. Gaps exist in provision of nutritional supplementation (26%) with limited recordings of weight during the admission for 10% of participants. Pharmacy review of medications was consistently documented on admission (84%) and discharge (93%). Vitamin D was prescribed for 57% of participants. Inter-rater reliability showed a high level of agreement using the audit tool. CONCLUSIONS An audit tool was feasible to assess frailty evidence-practice gaps in the hospital setting. Further understanding of the contextual barriers is needed to inform implementation strategies (dedicated staffing, education and training and ongoing audit of practice cycles) for the uptake of frailty guidelines in hospital settings.
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Affiliation(s)
- Heather Block
- Rehabilitation, Palliative and Aged Care Division, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Rosanna Tran
- Rehabilitation and Aged Care Services, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Keri Lockwood
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kisani Manuel
- Rehabilitation, Palliative and Aged Care Division, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Kate Laver
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Maria Crotty
- Rehabilitation, Palliative and Aged Care Division, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Ian D Cameron
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and University of Sydney, Sydney, New South Wales, Australia
| | - Susan E Kurrle
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Dableh S, Frazer K, Stokes D, Kroll T. Access of older people to primary health care in low and middle-income countries: A systematic scoping review. PLoS One 2024; 19:e0298973. [PMID: 38640096 PMCID: PMC11029620 DOI: 10.1371/journal.pone.0298973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/01/2024] [Indexed: 04/21/2024] Open
Abstract
INTRODUCTION Ensuring access for older people to Primary Health Care (PHC) is vital to achieve universal health coverage, improve health outcomes, and health-system performance. However, older people living in Low-and Middle-Income Countries (LMICs) face barriers constraining their timely access to appropriate care. This review aims to summarize the nature and breadth of literature examining older people's experiences with access to PHC in LMICs, and access barriers and enablers. METHODS Guided by Arksey and O'Malley's framework, four databases [CINAHL, Cochrane, PubMed, and Embase] were systematically searched for all types of peer-reviewed articles published between 2002 and 2023, in any language but with English or French abstract. Gray literature presenting empirical data was also included by searching the United Nations, World Health Organization, and HelpAge websites. Data were independently screened and extracted. RESULTS Of 1165 identified records, 30 are included. Data were generated mostly in Brazil (50%) and through studies adopting quantitative designs (80%). Older people's experiences varied across countries and were shaped by several access barriers and enablers classified according to the Patient-Centered Access to Healthcare framework, featuring the characteristics of the care delivery system at the supply side and older people's attributes from the demand side. The review identifies that most access barriers and enablers pertain to the availability and accommodation dimension, followed by the appropriateness, affordability, acceptability, and approachability of services. Socio-economic level and need perception were the most reported characteristics that affected older people's access to PHC. CONCLUSIONS Older people's experiences with PHC access varied according to local contexts, socioeconomic variables, and the provision of public or private health services. Results inform policymakers and PHC practitioners to generate policies and services that are evidence-based and responsive to older people's needs. Identified knowledge gaps highlight the need for research to further understand older people's access to PHC in different LMICs.
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Affiliation(s)
- Saydeh Dableh
- School of Nursing, Midwifery, and Health Systems, University College Dublin, Dublin, Ireland
| | - Kate Frazer
- School of Nursing, Midwifery, and Health Systems, University College Dublin, Dublin, Ireland
| | | | - Thilo Kroll
- School of Nursing, Midwifery, and Health Systems, University College Dublin, Dublin, Ireland
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Xie Y, Hamilton M, Peisah C, Anstey KJ, Sinclair C. Navigating Community-Based Aged Care Services From the Consumer Perspective: A Scoping Review. THE GERONTOLOGIST 2024; 64:gnad017. [PMID: 37120292 DOI: 10.1093/geront/gnad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The shift to consumer-directed aged care means that older adults need to play a more active role in navigating the complex aged care system for adequate health and social services. Challenges in the navigation process result in unmet needs and difficulty accessing available resources. This scoping review investigates how aged care navigation is conceptualized in literature and interrogates research on the experiences of older adults navigating community-based aged care services with or without support from their informal carers. RESEARCH DESIGN AND METHODS This review follows the Joanna Briggs Institute methodological guidelines. PubMed, Scopus, and ProQuest were searched for relevant literature published from 2008 to 2021, supplemented by grey literature and manual reference list searching. Data were extracted using a predefined data-extraction table and synthesized with an inductive thematic analysis. RESULTS The current conceptualization of aged care navigation focuses on the support provided to older adults, rather than actions taken by older adults themselves. Thematic analysis from the included studies (n = 26) revealed shared themes (lack of knowledge, social networks as information providers, complex care systems) among older adults and informal carers; unique challenges faced by older adults (difficulties with technology, waiting game), and informal carers (structural burden) in aged care navigation. DISCUSSION AND IMPLICATIONS Findings suggest the need to comprehensively assess individual circumstances including social networks and access to informal carers as predictors of successful navigation. Changes that reduce the complexity of the aged care system and improve coordination will relieve the structural burden experienced by consumers.
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Affiliation(s)
- Yuchen Xie
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Myra Hamilton
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia
| | - Carmelle Peisah
- Discipline of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Specialty of Psychiatry, University of Sydney, Sydney, New South Wales, Australia
| | - Kaarin J Anstey
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia
| | - Craig Sinclair
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
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Tian Y, Wang S, Zhang Y, Meng L, Li X. Effectiveness of information and communication technology-based integrated care for older adults: a systematic review and meta-analysis. Front Public Health 2024; 11:1276574. [PMID: 38249380 PMCID: PMC10797014 DOI: 10.3389/fpubh.2023.1276574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024] Open
Abstract
Background Information and communication technology (ICT) is a key factor in advancing the implementation of integrated care for older adults in the context of an aging society and the normalization of epidemics. This systematic review aims to comprehensively evaluate the effectiveness of ICT-based integrated care for older adults to provide input for the construction of intelligent integrated care models suitable for the context of an aging population in China. Methods A systematic review and meta-analysis were conducted using PubMed, Web of Science Core Collection, Scopus, MEDLINE, EBSCO, EMBASE, CINAHL with full text, ProQuest, and Cochrane Library databases, along with the Google Scholar search engine, for papers published between January 1, 2000, and July 25, 2022, to include randomized controlled trials and quasi-experimental studies of ICT-based integrated care for older adults. Two reviewers independently performed literature screening, quality assessment (JBI standardized critical appraisal tool), and data extraction. The results were pooled using a random effects model, and narrative synthesis was used for studies with insufficient outcome data. Results We included 32 studies (21 interventions) with a total of 30,200 participants (14,289 in the control group and 15,911 in the intervention group). However, the quality of the literature could be improved. The meta-analysis results showed that ICT-based integrated care significantly improved the overall perceived health status of older adults (n=3 studies, MD 1.29 (CI 0.11 to 2.46), no heterogeneity) and reduced the number of emergency department visits (n=11 studies, OR 0.46 (CI 0.25 to 0.86), high heterogeneity) but had no significant effect on improving quality of life, mobility, depression, hospital admissions and readmissions, or mortality in older adults, with a high degree of study heterogeneity. Narrative analysis showed that the overall quality of care, primary care service use, and functional status of older adults in the intervention group improved, but the cost-effectiveness was unclear. Conclusions ICT-based integrated care is effective in improving health outcomes for older adults, but the quality and homogeneity of the evidence base need to be improved. Researchers should develop intelligent integrated care programs in the context of local health and care welfare provision systems for older adults, along with the preferences and priorities of the older adults.
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Affiliation(s)
- Yutong Tian
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Shanshan Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yan Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Lixue Meng
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaohua Li
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
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Thomson LJM, Chatterjee HJ. Barriers and enablers of integrated care in the UK: a rapid evidence review of review articles and grey literature 2018-2022. Front Public Health 2024; 11:1286479. [PMID: 38239795 PMCID: PMC10794528 DOI: 10.3389/fpubh.2023.1286479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/27/2023] [Indexed: 01/22/2024] Open
Abstract
Integrated care refers to person-centered and coordinated, health and social care, and community services. Integrated care systems are partnerships of organizations that deliver health and care services which were placed on a statutory footing in England, April 2022. Due to the need for fast, accessible, and relevant evidence, a rapid review was conducted according to World Health Organization methods to determine barriers and enablers of integrated care across the United Kingdom, 2018-2022. Nine databases were searched for review articles reporting evaluation of integrated care interventions involving medical (clinical and diagnostic) and nonmedical (public health services and community-based or social care/person-centred care) approaches, quality checked with the Critical Appraisal Skills Program qualitative checklist. OpenGrey and hand searches were used to identify grey literature, quality checked with the Authority, Accuracy, Coverage, Objectivity, Date, and Significance checklist. Thirty-four reviews and 21 grey literature reports fitted inclusion criteria of adult physical/mental health outcomes/multiple morbidities. Thematic analysis revealed six themes (collaborative approach; costs; evidence and evaluation; integration of care; professional roles; service user factors) with 20 subthemes including key barriers (cost effectiveness; effectiveness of integrated care; evaluation methods; focus of evidence; future research; impact of integration) and enablers (accessing care; collaboration and partnership; concept of integration; inter-professional relationships; person-centered ethos). Findings indicated a paucity of robust research to evaluate such interventions and lack of standardized methodology to assess cost effectiveness, although there is growing interest in co-production that has engendered information sharing and reduced duplication, and inter-professional collaborations that have bridged task-related gaps and overlaps. The importance of identifying elements of integrated care associated with successful outcomes and determining sustainability of interventions meeting joined-up care and preventive population health objectives was highlighted.
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Affiliation(s)
- Linda J. M. Thomson
- Department of Biosciences and Arts & Sciences, University College London, London, United Kingdom
| | - Helen J. Chatterjee
- Department of Biosciences and Arts & Sciences, University College London, London, United Kingdom
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Kim B, Wister A, O'dea E, Mitchell BA, Li L, Kadowaki L. Roles and experiences of informal caregivers of older adults in community and healthcare system navigation: a scoping review. BMJ Open 2023; 13:e077641. [PMID: 38070939 PMCID: PMC10729038 DOI: 10.1136/bmjopen-2023-077641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/10/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE Informal caregivers are playing a vital role in improving the degree to which older adults access community and healthcare systems in a more seamless and timely manner, thereby fulfilling their complex needs. It is critical to understand their experiences and perspectives while navigating these systems. This review aimed to identify and organise the research findings on the roles and experiences of informal caregivers of older adults while navigating community and healthcare systems. DESIGN This scoping review was undertaken according to the Joanna Briggs Institute's Reviewer manual. Four databases were used: AgeLine, PsycINFO, CINAHL and Medline to capture literature with a focus on informal caregivers whose care recipients are aged 55 years or older. Articles were included if they focused on examining the experience, perspective and/or role of informal caregivers in providing care for their older care recipients, while articles were excluded if they only focused on healthcare professionals or older adults. RESULTS A total of 24 studies were identified that met the study inclusion criteria. This review elucidated the roles of caregivers as a primary system navigator and as an advocate for older adults. Numerous challenges/barriers in system navigation were uncovered, such as lack of consistency in fragmented systems, as well as facilitators, including interface/coordination roles. Finally, recommendations for better system navigation such as caregiver engagement and integration of continuity of care services were identified. CONCLUSION The need to raise the visibility of the roles and experiences of informal caregivers in system navigation was highlighted. Further research needs to focus on implementing interventions for informal caregivers incorporating a care coordinator to fill the care gap within community and healthcare systems. This review has the potential to foster greater integration of community and healthcare systems.
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Affiliation(s)
- Boah Kim
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Andrew Wister
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Eireann O'dea
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Barbara A Mitchell
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
- Gerontology & Sociology/Anthropology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Lun Li
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
- MacEwan University, Edmonton, Alberta, Canada
| | - Laura Kadowaki
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
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Kattouw CE, Aase K, Viksveen P. Stakeholder perspectives on the preferred service ecosystem for senior citizens living at home: a qualitative interview study. BMC Geriatr 2023; 23:576. [PMID: 37726648 PMCID: PMC10508029 DOI: 10.1186/s12877-023-04303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Most senior citizens want to live independently at home as long as possible. The World Health Organization recommends an age-friendly community approach by transforming the service ecosystem for senior citizens and basing it on the question "What matters to you?". However, there is limited research-based knowledge to determine the characteristics of the preferred service ecosystem from the perspectives of multiple stakeholders. Therefore, the aim of the study was to gain a deeper understanding of multiple stakeholder perspectives on the preferred service ecosystem for senior citizens living at home. METHODS Four stakeholder groups (n = 57) from a Norwegian municipality participated in an interview study in 2019 and 2020: senior citizens, carers, healthcare professionals, and managers. Data were analysed according to qualitative content analysis. RESULTS Overall, there was considerable correspondence between the four stakeholder groups' perspectives on the preferred service ecosystem for senior citizens. Six themes were developed: (1) "self-reliance - living independently at home as long as possible"; (2) "remaining active and social within the community"; (3) "support for living at home as long as possible"; (4) "accessible information and services"; (5) "continuity of services"; and (6) "compassionate and competent healthcare professionals". CONCLUSIONS In order to adapt and meet changing needs, the preferred service ecosystem should support senior citizens' autonomy through interpersonal relationships and involvement. Healthcare managers and decision makers should consider a broader range of practical and social support services. Municipalities should plan for and develop age-friendly infrastructures, while healthcare professionals should rely on their compassion and competence to meet senior citizens' needs.
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Affiliation(s)
- Christophe Eward Kattouw
- Department of Quality and Health Technology, Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Post Box 8600, Forus, Stavanger, 4036, Norway.
| | - Karina Aase
- Department of Quality and Health Technology, Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Post Box 8600, Forus, Stavanger, 4036, Norway
| | - Petter Viksveen
- Department of Quality and Health Technology, Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Post Box 8600, Forus, Stavanger, 4036, Norway
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Simonetti S, Parker D, Mack HA, Wise S. Managers' experiences of providing end-of-life care under the Home Care Package Program. Australas J Ageing 2023; 42:527-534. [PMID: 36807429 DOI: 10.1111/ajag.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/18/2022] [Accepted: 12/05/2022] [Indexed: 02/23/2023]
Abstract
OBJECTIVE The study explored the experiences of Australian aged care providers in supporting clients on a home care package to die at home. METHODS Semistructured interviews were conducted with 13 aged care managers responsible for delivering services under the Home Care Package Program. Interviews were analysed thematically. RESULTS Four themes emerged that illuminated managers' experiences: struggling to meet a preference to die at home; lack of opportunities to build workforce capacity in end-of-life care; challenges in negotiating fragmented funding arrangements between health and aged care providers; and mixed success in collaborating across sectors. CONCLUSIONS Aged care providers want to support older Australians who prefer to stay at home at the end of life. However, most clients are admitted to a residential facility when their care needs exceed a home care budget long before a specialist palliative care team will intervene. Budgets for health and aged care providers must be sufficient and flexible to support timely access to end-of-life care, to reward collaboration across sectors and to invest in building palliative care skills in the nursing and personal care workforce.
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Affiliation(s)
- Simone Simonetti
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Deborah Parker
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Holly A Mack
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Sarah Wise
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Shafiq S, Haith-Cooper M, Hawkins R, Parveen S. What are lay UK public perceptions of frailty: a scoping review. Age Ageing 2023; 52:7099134. [PMID: 37002930 PMCID: PMC10066724 DOI: 10.1093/ageing/afad045] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Indexed: 04/04/2023] Open
Abstract
RATIONALE AND OBJECTIVE Perceptions of frailty can influence how families cope, quality of life and access to support services. Yet little is known of how lay members of the UK general public perceive frailty. This scoping review aimed to explore how frailty is perceived among the lay public in the United Kingdom. METHODS The established scoping review methodology by Arksey and O'Malley was followed and searches were conducted across eight electronic databases and grey literature websites for articles published between 1990 and August 2022. In total, 6,705 articles were identified, of which six were included in the review. Data were analysed using Braun and Clarke's thematic analysis framework. RESULTS Three key themes were identified; frailty as a normal part of ageing, perceived consequences of frailty and coping with frailty. Overall, frailty has negative connotations and is perceived as linked to a natural part of the ageing process, increased dependency, loss of identity and social exclusion and stigma. However, it is unclear whether these perceptions have a direct bearing on access to support services for communities. CONCLUSION AND IMPLICATIONS This review identifies that it is imperative for health and social care service providers to consider the individual meaning of frailty for older people and families, to understand and integrate their particular needs and preferences when planning and delivering person centred frailty care and support. There is also a need for development of interventions that focus on increasing education and reducing stigma around frailty in order to change frailty perceptions in the UK.
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Affiliation(s)
| | - Melanie Haith-Cooper
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford BD7 1DP, UK
| | - Rebecca Hawkins
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9LH, UK
| | - Sahdia Parveen
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford BD7 1DP, UK
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Fakha A, Leithaus M, de Boer B, van Achterberg T, Hamers JP, Verbeek H. Implementing Four Transitional Care Interventions for Older Adults: A Retrospective Collective Case Study. THE GERONTOLOGIST 2023; 63:451-466. [PMID: 36001088 PMCID: PMC10028228 DOI: 10.1093/geront/gnac128] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Four interventions to improve care transitions between hospital and home or community settings for older adults were implemented in Leuven, Belgium over the past 4 years. These complex interventions consist of multiple components that challenge their implementation in practice. This study examines the influencing factors, strategies used to address challenges in implementing these interventions, and implementation outcomes from the perspectives of health care professionals involved. RESEARCH DESIGN AND METHODS This was a qualitative, collective case study that was part of the TRANS-SENIOR research network. Authors conducted semistructured interviews with health care professionals about their perceptions regarding the implementation. Thematic analysis was used, and the Consolidated Framework for Implementation Research guided the final data interpretation. RESULTS Thirteen participants were interviewed. Participants reported major implementation bottlenecks at the organizational level (resources, structure, and information continuity), while facilitators were at the individual level (personal attributes and champions). They identified engagement as the primary strategy used, and suggested other important strategies for the future sustainability of the interventions (building strategic partnerships and lobbying for policies to support transitional care). They perceived the overall implementation favorably, with high uptake as a key outcome. DISCUSSION AND IMPLICATIONS This study highlights the strong role of health care providers, being motivated and self-driven, to foster the implementation of interventions in transitional care in a bottom-up way. It is important to use implementation strategies targeting both the individual-level factors as well as the organizational barriers for transitional care interventions in the future.
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Affiliation(s)
- Amal Fakha
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Merel Leithaus
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Bram de Boer
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Theo van Achterberg
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Jan P Hamers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
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15
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Barreira LF, Paiva A, Araújo B, Campos MJ. Challenges to Systems of Long-Term Care: Mapping of the Central Concepts from an Umbrella Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1698. [PMID: 36767064 PMCID: PMC9914432 DOI: 10.3390/ijerph20031698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
The ageing of the population poses urgent challenges to the health and social protection sectors, including the need for greater adequacy and integration of health care services provided to older people. It is considered necessary and urgent to understand the state-of-the-art of community-based models of care for older people in institutional care and at home. This study aims to map the concepts that politicians and providers need to address through an umbrella review as a review method. Articles describing the structuring aspects of care models appropriate to the needs in long-term care and systematic reviews or meta-analyses targeting people aged 65 years or more were considered. A total of 350 studies met the inclusion criteria and were included in the review. The results identified the need to contribute to effective and more efficient integration and articulation of all the stakeholders, based essentially on professional care at the patient's homes, focused on their needs using the available technologies, empowering patients and families. Eight categories emerged that addressed factors and variables involved in care models for the long-term care needs of institutionalised and home-based older people as a guarantee of accessibility to healthcare and to enhance the well-being and quality of life of patients and family caregivers.
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Affiliation(s)
- Luís Filipe Barreira
- Center for Interdisciplinary Research in Health, Instituto Ciências da Saúde, Universidade Católica Portuguesa, Rua de Diogo Botelho 1327, 4169-005 Porto, Portugal
- Instituto de Ciências da Saúde do Porto, Universidade Católica Portuguesa, R. de Diogo Botelho 1327, 4169-005 Porto, Portugal
| | - Abel Paiva
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal
| | - Beatriz Araújo
- Center for Interdisciplinary Research in Health, Instituto Ciências da Saúde, Universidade Católica Portuguesa, Rua de Diogo Botelho 1327, 4169-005 Porto, Portugal
- Instituto de Ciências da Saúde do Porto, Universidade Católica Portuguesa, R. de Diogo Botelho 1327, 4169-005 Porto, Portugal
| | - Maria Joana Campos
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal
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Zuluaga Quintero M, Indrasena BSH, Fox L, Subedi P, Aylott J. Upstreamist leaders: how risk factors for unscheduled return visits (URV) to the emergency department can inform integrated healthcare. Leadersh Health Serv (Bradf Engl) 2022; ahead-of-print. [PMID: 36573622 DOI: 10.1108/lhs-06-2022-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE This paper aims to report on research undertaken in an National Health Service (NHS) emergency department in the north of England, UK, to identify which patients, with which clinical conditions are returning to the emergency department with an unscheduled return visit (URV) within seven days. This paper analyses the data in relation to the newly introduced Integrated Care Boards (ICBs). The continued upward increase in demand for emergency care services requires a new type of "upstreamist", health system leader from the emergency department, who can report on URV data to influence the development of integrated care services to reduce further demand on the emergency department. DESIGN/METHODOLOGY/APPROACH Patients were identified through the emergency department symphony data base and included patients with at least one return visit to emergency department (ED) within seven days. A sample of 1,000 index visits between 1 January 2019-31 October 2019 was chosen by simple random sampling technique through Excel. Out of 1,000, only 761 entries had complete data in all variables. A statistical analysis was undertaken using Poisson regression using NCSS statistical software. A review of the literature on integrated health care and its relationship with health systems leadership was undertaken to conceptualise a new type of "upstreamist" system leadership to advance the integration of health care. FINDINGS Out of all 83 variables regressed with statistical analysis, only 12 variables were statistically significant on multi-variable regression. The most statistically important factor were patients presenting with gynaecological disorders, whose relative rate ratio (RR) for early-URV was 43% holding the other variables constant. Eye problems were also statistically highly significant (RR = 41%) however, clinically both accounted for just 1% and 2% of the URV, respectively. The URV data combined with "upstreamist" system leadership from the ED is required as a critical mechanism to identify gaps and inform a rationale for integrated care models to lessen further demand on emergency services in the ED. RESEARCH LIMITATIONS/IMPLICATIONS At a time of significant pressure for emergency departments, there needs to be a move towards more collaborative health system leadership with support from statistical analyses of the URV rate, which will continue to provide critical information to influence the development of integrated health and care services. This study identifies areas for further research, particularly for mixed methods studies to ascertain why patients with specific complaints return to the emergency department and if alternative pathways could be developed. The success of the Esther model in Sweden gives hope that patient-centred service development could create meaningful integrated health and care services. PRACTICAL IMPLICATIONS This research was a large-scale quantitative study drawing upon data from one hospital in the UK to identify risk factors for URV. This quality metric can generate important data to inform the development of integrated health and care services. Further research is required to review URV data for the whole of the NHS and with the new Integrated Health and Care Boards, there is a new impetus to push for this metric to provide robust data to prioritise the need to develop integrated services where there are gaps. ORIGINALITY/VALUE To the best of the authors' knowledge, this is the first large-scale study of its kind to generate whole hospital data on risk factors for URVs to the emergency department. The URV is an important global quality metric and will continue to generate important data on those patients with specific complaints who return back to the emergency department. This is a critical time for the NHS and at the same time an important opportunity to develop "Esther" patient-centred approaches in the design of integrated health and care services.
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Affiliation(s)
- Martha Zuluaga Quintero
- Department of Emergency Medicine, Doncaste and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Buddhike Sri Harsha Indrasena
- Institute for Quality Improvement, World Academy of Medical Leadership, Sheffield, UK and Department of General Surgery, Provincial General Hospital, Badulla, Sri Lanka
| | - Lisa Fox
- Health Informatics Department, Rotherham NHS Foundation Trust, Rotherham, UK
| | - Prakash Subedi
- Department of Emergency Medicine, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Institute of Medicine, QiMET International, Doncaster, UK, and
| | - Jill Aylott
- Institute for Quality Improvement, World Academy of Medical Leadership, Sheffield, UK and Institute of Medicine, QiMET Medical Institute (QMI), QiMET International Ltd., Sheffield, UK
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Yip O, Dhaini S, Esser J, Siqeca F, Mendieta MJ, Huber E, Zeller A, De Geest S, Deschodt M, Zúñiga F, Zullig LL, King HA, Urfer P, Vounatsou P, Obas K, Briel M, Schwenkglenks M, Quinto C, Blozik E. Health and social care of home-dwelling frail older adults in Switzerland: a mixed methods study. BMC Geriatr 2022; 22:857. [PMID: 36376806 PMCID: PMC9663289 DOI: 10.1186/s12877-022-03552-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background Home-dwelling frail older adults are often faced with multimorbidity and complex care needs, requiring health and social care systems that support frail older adults to age in place. The objective of this paper was to investigate the types of formal health and social care as well as informal care and social support used by home-dwelling frail older adults; whether they perceive their support as sufficient; and their experience with and preferences for care and support. Methods Using an explanatory sequential mixed methods design, we first conducted a secondary analysis of a subset of cross-sectional data from the ImplemeNtation of a community-baSed care Program for home dwelling senIoR citizEns (INSPIRE) population survey using descriptive analysis. Subsequently, we analyzed existing data from interviews in the parent study to help explain the survey results using applied thematic analysis. Results were organized according to adapted domains and concepts of the SELFIE framework and integrated via a joint display table. Results Of the parent population survey respondents, 2314 older adults indicating frailty were included in the quantitative arm of this study. Interview data was included from 7 older adults who indicated frailty. Support from health and social, formal and informal caregivers is diverse and anticipated to increase (e.g., for ‘care and assistance at home’ and ‘meal services’). Informal caregivers fulfilled various roles and while some older adults strongly relied on them for support, others feared burdening them. Most participants (93.5%) perceived their overall support to meet their needs; however, findings suggest areas (e.g., assessment of overall needs) which merit attention to optimize future care. Conclusions Given the anticipated demand for future care and support, we recommend efforts to prevent fragmentation between health and social as well as formal and informal care. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03552-z.
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18
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Young HML, Ruddock N, Harrison M, Goodliffe S, Lightfoot CJ, Mayes J, Nixon AC, Greenwood SA, Conroy S, Singh SJ, Burton JO, Smith AC, Eborall H. Living with frailty and haemodialysis: a qualitative study. BMC Nephrol 2022; 23:260. [PMID: 35869436 PMCID: PMC9308309 DOI: 10.1186/s12882-022-02857-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Frailty is highly prevalent in people receiving haemodialysis (HD) and is associated with poor outcomes. Understanding the lived experiences of this group is essential to inform holistic care delivery. METHODS Semi-structured interviews with N = 25 prevalent adults receiving HD from 3 HD units in the UK. Eligibility criteria included a Clinical Frailty Scale (CFS) score of 4-7 and a history of at least one fall in the last 6 months. Sampling began guided by maximum variation sampling to ensure diversity in frailty status; subsequently theoretical sampling enabled exploration of preliminary themes. Analysis was informed by constructivist grounded theory; later we drew upon the socioecological model. RESULTS Participants had a mean age of 69 ± 10 years, 13 were female, and 13 were White British. 14 participants were vulnerable or mildly frail (CFS 4-5), and 11 moderately or severely frail (CFS 6-7). Participants characterised frailty as weight loss, weakness, exhaustion, pain and sleep disturbance arising from multiple long-term conditions. Participants' accounts revealed: the consequences of frailty (variable function and psychological ill-health at the individual level; increasing reliance upon family at the interpersonal level; burdensome health and social care interactions at the organisational level; reduced participation at the community level; challenges with financial support at the societal level); coping strategies (avoidance, vigilance, and resignation); and unmet needs (overprotection from family and healthcare professionals, transactional health and social care exchanges). CONCLUSIONS The implementation of a holistic needs assessment, person-centred health and social care systems, greater family support and enhancing opportunities for community participation may all improve outcomes and experience. An approach which encompasses all these strategies, together with wider public health interventions, may have a greater sustained impact. TRIAL REGISTRATION ISRCTN12840463 .
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Affiliation(s)
- Hannah M L Young
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, England.
- Department of Research and Innovation, University Hospitals of Leicester NHS Trust, Leicester, England.
- Department of Respiratory Sciences, University of Leicester, Leicester, England.
- Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester, England.
| | - Nicki Ruddock
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, England
| | - Mary Harrison
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, England
| | - Samantha Goodliffe
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, England
| | | | - Juliette Mayes
- Department of Physiotherapy and Renal Medicine, King's College Hospital and Department of Renal Medicine, King's College London, London, England
| | - Andrew C Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Sharlene A Greenwood
- Department of Physiotherapy and Renal Medicine, King's College Hospital and Department of Renal Medicine, King's College London, London, England
| | - Simon Conroy
- Central and North West London NHS Foundation Trust - MRC Unit for Lifelong Health and Ageing, University College London, London, England
| | - Sally J Singh
- Centre for Exercise & Rehabilitation Science, NIHR Leicester Biomedical Research Centre, Leicester, England
- Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, England
| | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, England
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, England
| | - Alice C Smith
- Department of Health Sciences, University of Leicester, Leicester, England
| | - Helen Eborall
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
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Tian Y, Zhang Y, Wang S, Cheng Q, Meng L. Integrated care for older people based on information and communication technology: a scoping review protocol. BMJ Open 2022; 12:e061011. [PMID: 35863833 PMCID: PMC9310179 DOI: 10.1136/bmjopen-2022-061011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Integrated care is an effective means of coping with the increasingly complex healthcare needs of elderly and alleviating pressure on national pension services. WHO regards integrated care as a method of providing high-quality healthcare and advocates integrated care based on digital technology. Against the backdrop of the COVID-19 pandemic, information and communication technology (ICT) has become a facilitator for the successful implementation of integrated care by providing a platform for information sharing, team communication and resource integration. This scoping review aims to assess internationally published evidence concerning experiences and practice of ICT-based implementation of integrated care for older people. METHODS AND ANALYSIS The study will follow the research framework developed by Arksey and O'Malley for scoping reviews. We will conduct a systematic search of the literature published from January 2000 to March 2022 via electronic databases, grey literature databases, websites of key organisations and project funding sources, key journals and reference lists included in selected papers, employ the Joanna Briggs Institute Literature Quality Assessment Tool to assess the quality of the included literature and apply thematic analysis to sort and summarise the content of the included studies. This study will begin in March 2022 and will be completed in December 2022. ETHICS AND DISSEMINATION Ethical approval for this scoping review was granted by the Academic Committee of Zhengzhou University (ZZUIRB2021-155). This study will summarise the modes of operation and effects, barriers and facilitators of ICT-based implementation of integrated care for older people. We propose to recruit older people and integrated care service providers in rural primary healthcare centres and use a structured process of concept mapping to consult and discuss the results of our scoping review to construct an integrated care model and service pathway for older adults that is appropriate to the Chinese social context.
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Affiliation(s)
- Yutong Tian
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yan Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Shanshan Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Qingyun Cheng
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Lixue Meng
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
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Tan WS, Nai ZL, Tan HTR, Nicholas S, Choo R, Ginting ML, Tan E, Teng PHJ, Lim WS, Wong CH, Ding YY. Protocol for a mixed-methods and multi-site assessment of the implementation process and outcomes of a new community-based frailty programme. BMC Geriatr 2022; 22:586. [PMID: 35840898 PMCID: PMC9288058 DOI: 10.1186/s12877-022-03254-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background Frailty is increasing in prevalence internationally with population ageing. Frailty can be managed or even reversed through community-based interventions delivered by a multi-disciplinary team of professionals, but to varying degrees of success. However, many of these care models’ implementation insights are contextual and may not be applicable in different cultural contexts. The Geriatric Service Hub (GSH) is a novel frailty care model in Singapore that focuses on identifying and managing frailty in the community. It includes key components of frailty care such as comprehensive geriatric assessments, care coordination and the assembly of a multi-disciplinary team. This study aims to gain insights into the factors influencing the development and implementation of the GSH. We also aim to determine the programme’s effectiveness through patient-reported health-related outcomes. Finally, we will conduct a healthcare utilisation and cost analysis using a propensity score-matched comparator group. Methods We will adopt a mixed-methods approach that includes a qualitative evaluation among key stakeholders and participants in the programme, through in-depth interviews and focus group discussions. The main topics covered include factors that affected the development and implementation of each programme, operations and other contextual factors that influenced implementation outcomes. The quantitative evaluation monitors each programme’s care process through quality indicators. It also includes a multiple-time point survey study to compare programme participants’ pre- and post- outcomes on patient engagement, healthcare services experiences, health status and quality of life, caregiver burden and societal costs. A retrospective cohort study will compare healthcare and cost utilisation between participants of the programme and a propensity score-matched comparator group. Discussion The GSH sites share a common goal to increase the accessibility of essential services to frail older adults and provide comprehensive care. This evaluation study will provide invaluable insights into both the process and outcomes of the GSH and inform the design of similar programmes targeting frail older adults. Trial Registration ClinicalTrials.gov Identifier NCT04866316. Date of Registration April 26, 2021. Retrospectively registered.
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Affiliation(s)
- Woan Shin Tan
- Geriatric Education & Research Institute, 2 Yishun Central 2, 768024, Singapore, Singapore. .,Health Services & Outcomes Research Department, National Healthcare Group, Singapore, Singapore.
| | - Ze Ling Nai
- Geriatric Education & Research Institute, 2 Yishun Central 2, 768024, Singapore, Singapore
| | - Hwee Teng Robyn Tan
- Geriatric Education & Research Institute, 2 Yishun Central 2, 768024, Singapore, Singapore.,Social Service Research Centre, National University of Singapore, Singapore, Singapore
| | - Sean Nicholas
- Geriatric Education & Research Institute, 2 Yishun Central 2, 768024, Singapore, Singapore
| | - Robin Choo
- Geriatric Education & Research Institute, 2 Yishun Central 2, 768024, Singapore, Singapore
| | | | - Edward Tan
- Geriatric Education & Research Institute, 2 Yishun Central 2, 768024, Singapore, Singapore
| | - Poh Hoon June Teng
- Geriatric Education & Research Institute, 2 Yishun Central 2, 768024, Singapore, Singapore
| | - Wee Shiong Lim
- Geriatric Education & Research Institute, 2 Yishun Central 2, 768024, Singapore, Singapore.,Department of Geriatric Medicine, Institute of Geriatrics & Active Ageing, Tock Seng Hospital, Singapore, Singapore
| | | | - Yew Yoong Ding
- Geriatric Education & Research Institute, 2 Yishun Central 2, 768024, Singapore, Singapore.,Department of Geriatric Medicine, Institute of Geriatrics & Active Ageing, Tock Seng Hospital, Singapore, Singapore
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Taylor B, Hewison A, Cross-Sudworth F, Morrell K. Transformational Change in maternity services in England: a longitudinal qualitative study of a national transformation programme 'Early Adopter'. BMC Health Serv Res 2022; 22:57. [PMID: 35022052 PMCID: PMC8753811 DOI: 10.1186/s12913-021-07375-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 11/25/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Large system transformation in health systems is designed to improve quality, outcomes and efficiency. Using empirical data from a longitudinal study of national policy-driven transformation of maternity services in England, we explore the utility of theory-based rules regarding 'what works' in large system transformation. METHODS A longitudinal, qualitative case study was undertaken in a large diverse urban setting involving multiple hospital trusts, local authorities and other key stakeholders. Data was gathered using interviews, focus groups, non-participant observation, and a review of key documents in three phases between 2017 and 2019. The transcripts of the individual and focus group interviews were analysed thematically, using a combined inductive and deductive approach drawing on simple rules for large system transformation derived from evidence synthesis and the findings are reported in this paper. RESULTS Alignment of transformation work with Best et al's rules for 'what works' in large system transformation varied. Interactions between the rules were identified, indicating that the drivers of large system transformation are interdependent. Key challenges included the pace and scale of change that national policy required, complexity of the existing context, a lack of statutory status for the new 'system' limiting system leaders' power and authority, and concurrent implementation of a new overarching system alongside multifaceted service change. CONCLUSIONS Objectives and timescales of transformation policy and plans should be realistic, flexible, responsive to feedback, and account for context. Drivers of large system transformation appear to be interdependent and synergistic. Transformation is likely to be more challenging in recently established systems where the basis of authority is not yet clearly established.
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Affiliation(s)
- Beck Taylor
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Alistair Hewison
- School of Nursing, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Fiona Cross-Sudworth
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Kevin Morrell
- Cranfield School of Management, College Rd, Cranfield, Wharley End, Bedford, MK43 0AL UK
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Dambha-Miller H, Simpson G, Hobson L, Roderick P, Little P, Everitt H, Santer M. Integrated primary care and social services for older adults with multimorbidity in England: a scoping review. BMC Geriatr 2021; 21:674. [PMID: 34861831 PMCID: PMC8642958 DOI: 10.1186/s12877-021-02618-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 11/09/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND As the prevalence of older adults with multimorbidity increases, greater integration of services is necessary to manage the physical and psycho-social needs of this cohort. This study describes and summarises current evidence, clinical provision and progress towards integrated primary care and social services for older adults with multimorbidity in England. METHODS A scoping review was conducted involving systematic searches of a range of electronic academic and policy databases. Articles were screened and extracted in duplicate by two independent reviewers. Data were extracted onto a charting sheet and thematic synthesis was used to summarise findings. Articles were included if published in English and related to primary care, social care and multimorbidity in older adults in England. Conceptually, the review was framed using the Rainbow Model of Integrated Care. RESULTS The search yielded 7656 articles of which 84 were included. Three themes were identified: (1) a focus on individual level services rather than multi-level or multi-sector integration, with an increasing emphasis on the need to consider broader determinants of population health as critical to integrated care for older adults with multimorbidity; (2) the need for policymakers to allow time for integration to embed, to enable new structures and relationships to develop and mature; and (3) the inherent tension between top-down and bottom-up driven approaches to integrated care requires a whole-systems structure, while allowing for local flexibilities. CONCLUSIONS There is limited evidence of multi-level and multi-sector integration of services for older adults with multimorbidity in England. The literature increasingly acknowledges wider determinants of population health that are likely to require integration beyond primary care and social services. Improving clinical care in one or two sectors may not be as effective as simultaneously improving the organisation or design across services as one single system of provision. This may take time to establish and will require local input.
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Affiliation(s)
- Hajira Dambha-Miller
- Primary Care Research Centre, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK.
| | - Glenn Simpson
- Primary Care Research Centre, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Lucy Hobson
- Primary Care Research Centre, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Paul Roderick
- Department of Population Health, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care Research Centre, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Hazel Everitt
- Primary Care Research Centre, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Miriam Santer
- Primary Care Research Centre, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
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Filliettaz SS, Berchtold P, Koch U, Peytremann-Bridevaux I. Integrated Care in Switzerland: Strengths and Weaknesses of a Federal System. Int J Integr Care 2021; 21:10. [PMID: 34754285 PMCID: PMC8555474 DOI: 10.5334/ijic.5668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 09/20/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Switzerland's fragmented healthcare system mirrors its federal structure and mix of cultures and languages. Although the Swiss have a higher life expectancy than most of their neighbours, their healthcare system faces similar challenges that call for more integrated care (IC). AIM/METHOD This article aims to provide insight into the specificities of and latest developments in Switzerland's healthcare system and how they may have influenced the development and implementation of IC there. DESCRIPTION/DISCUSSION The number of local IC initiatives has been growing steadily for 20 years. With a certain lag, various policies supporting IC have been established. Among them, a recent democratic debate on the federal mandatory health insurance law could either induce a radical move towards centralised support for IC or continue to support scattered local IC initiatives. CONCLUSION In the future, Switzerland's healthcare system will probably navigate between local IC initiatives and centralised, federal support for IC initiatives. This will be the reflection of a very Swiss way forward in a world without clear evidence on whether centralised or decentralised initiatives are more successful at developing IC.
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Affiliation(s)
- Séverine Schusselé Filliettaz
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Av. Vinet 30, 1004 Lausanne, Switzerland
- Association for the Promotion of Integrated Patient Care Networks (PRISM), Geneva, Switzerland
- Forum Managed Care (FMC), Zugerstrasse 193, 6314 Neuägeri, Switzerland
| | | | - Ursula Koch
- Forum Managed Care (FMC), Zugerstrasse 193, 6314 Neuägeri, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010 Lausanne, Switzerland
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Urbaniak A, Walsh K. Policy and practise perspectives on older adult critical life-course transitions and place in Ireland. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:e97-e106. [PMID: 33285022 PMCID: PMC8451912 DOI: 10.1111/hsc.13249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/01/2020] [Accepted: 11/06/2020] [Indexed: 06/04/2023]
Abstract
Major transitions in older people's lives can give rise to multifaceted forms of social exclusion, with subsequent impacts for later life health and well-being. With place now a central concept within policy on ageing and community care, there is the potential that it may offer new pathways to support older people undergoing these critical life transitions (CLTs). However, how policy and practice stakeholders working with and on behalf of these population groups understand, conceptualise and capitalise on the involvement of place in CLTs has not been investigated. This paper aims to address this deficit and explores the perspectives of key national and local actors on three CLTs-dementia, bereavement and forced migration-and their relationship with place and exclusion. The analysis involved 18 semi-structured interviews with stakeholders from policy, practice and advocacy spheres related to the CLTs and ageing in general. Interviews highlighted the differences across stakeholders in perceived exclusionary impacts, and the different degrees to which place is conceptualised in relation to these transitions. Findings illustrate the lack of a holistic policy approach to the needs of older people experiencing CLTs that impedes our capacity to truly harness place in supporting older people. The article concludes by arguing for a more nuanced reconstruction of place and its meanings in the context of CLTs.
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Affiliation(s)
- Anna Urbaniak
- Irish Centre for Social GerontologyNUI GalwayGalwayIreland
- Institut für SoziologieUniversität WienWienAustria
| | - Kieran Walsh
- Irish Centre for Social GerontologyNUI GalwayGalwayIreland
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Pereira RB, Brown TL, Guida A, Hyett N, Nolan M, Oppedisano L, Riley K, Walker G. Consumer experiences of care coordination for people living with chronic conditions and other complex needs: an inclusive and co-produced research study. AUST HEALTH REV 2021; 45:472-484. [PMID: 33588988 DOI: 10.1071/ah20108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/06/2020] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to explore consumer experiences of care coordination within Barwon Health's Hospital Admission Risk Program (HARP) located in Geelong, Victoria. Methods The study design was qualitative description informed by phenomenology and inclusive and co-production methodology. Semi-structured interviews were conducted with a purposive sample of six consumers living with chronic conditions and other complex needs. Participants were asked about their lived experience related to accessing the service, communication, and health and supports before and after accessing the service using an interview guide. Interviews were audio-recorded and transcribed verbatim for thematic analysis. Results Five themes were identified: (1) experiencing authentic, values-based care; (2) collaborative care and working together; (3) gaining independence; (4) improved health and quality of life; and (5) limited understanding of HARP at the start. Overall, participants' experiences were positive, which related to improved health, quality of life, and sustainable supports. Although gains were experienced, most of the participants identified that their knowledge of HARP was limited when services commenced, which is an area for service improvement. Conclusion This research begins to address the knowledge gap related to consumer experiences of care coordination. Findings highlight the importance of providing person-centred, authentic and values-based care, listening authentically, and promoting consumer voice within services. The study demonstrates that inclusive, co-design research is feasible in this service context, and further research is recommended into how stakeholders understand the function of care coordination services to promote health and prevent hospital readmissions, and improve consumer participation. What is known about the topic? Care coordination is multifaceted, with the primary purpose of facilitating person-centred care through appropriate and timely delivery of healthcare services. Despite the effectiveness of care coordination programs in preventing avoidable hospital admissions and reducing hospital length of stay, there is a paucity of research that has investigated consumer perspectives. There is also limited research that has adopted an inclusive research design of knowledge co-production where clinicians and consumers are included as equal members of the research team. What does this paper add? The study findings provide evidence into the value of care coordination from the perspective of consumers living with chronic conditions and other complex health and psychosocial issues. The findings also extend evidence into person- and consumer-centred care through understanding the qualities of care coordination practice that promote authenticity, integrity and positive health outcomes. Listening is identified as a critical element of authentic, values-based care, and as a care coordination intervention. Finally, the study demonstrates that inclusive, co-design research is feasible in this service context, and a larger-scale Experience-Based Co-Design study is recommended to investigate how stakeholders understand the function of care coordination services to promote health and prevent hospital readmissions and improve consumer participation. What are the implications for practitioners? The study informs practitioners of consumer lived experience of care coordination. Practitioners are recommended to apply the findings to practice by adopting an authentic, values-based and person-centred care approach described in the study findings. Service improvement initiatives are recommended to focus on increasing awareness of care coordination services through consumer participation and the meaningful inclusion of consumer voice, which could focus on education for referring health and social care professionals.
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Affiliation(s)
- Robert B Pereira
- Hospital Admission Risk Program, Barwon Health, Geelong, Vic., Australia; and Discipline of Occupational Therapy, Faculty of Health, University of Canberra, Bruce, ACT, Australia; and Corresponding author.
| | - Timothy L Brown
- Hospital Admission Risk Program, Barwon Health, Geelong, Vic., Australia. Emails: ;
| | - Alison Guida
- Hospital Admission Risk Program, Barwon Health, Geelong, Vic., Australia. Emails: ;
| | - Nerida Hyett
- La Trobe Rural Health School, La Trobe University, Bendigo, Vic., Australia.
| | | | | | | | - Grace Walker
- Complete Rehab Solutions, Margate, Qld, Australia.
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Hodgson S, Simpson G, Roderick P, Everitt H, Little P, Santer M, Dambha-Miller H. Integrating primary care and social services for older adults with multimorbidity: policy implications. BJGP Open 2021; 5:BJGPO.2021.0035. [PMID: 34103309 PMCID: PMC8450888 DOI: 10.3399/bjgpo.2021.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sam Hodgson
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Glenn Simpson
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Paul Roderick
- Department of Population Health, University of Southampton, Southampton, UK
| | - Hazel Everitt
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Miriam Santer
- Primary Care Research Centre, University of Southampton, Southampton, UK
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Yip O, Huber E, Stenz S, Zullig LL, Zeller A, De Geest SM, Deschodt M. A Contextual Analysis and Logic Model for Integrated Care for Frail Older Adults Living at Home: The INSPIRE Project. Int J Integr Care 2021; 21:9. [PMID: 33976598 PMCID: PMC8064293 DOI: 10.5334/ijic.5607] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/03/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Implementation science methods and a theory-driven approach can enhance the understanding of whether, how, and why integrated care for frail older adults is successful in practice. In this study, we aimed to perform a contextual analysis, develop a logic model, and select preliminary implementation strategies for an integrated care model in newly created information and advice centers for older adults in Canton Basel-Landschaft, Switzerland. METHODS We conducted a contextual analysis to determine factors which may influence the integrated care model and implementation strategies needed. A logic model depicting the overall program theory, including inputs, core components, outputs and outcomes, was designed using a deductive approach, and included stakeholders' feedback and preliminary implementation strategies. RESULTS Contextual factors were identified (e.g., lack of integrated care regulations, existing community services, and a care pathway needed). Core components of the care model include screening, referral, assessment, care plan creation and coordination, and follow-up. Outcomes included person-centred coordinated care experiences, hospitalization rate and symptom burden, among others. Implementation strategies (e.g., nurse training and co-developing educational materials) were proposed to facilitate care model adoption. CONCLUSION Contextual understanding and a clear logic model should enhance the potential for successful implementation of the integrated care model.
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Affiliation(s)
- Olivia Yip
- Nursing Science (INS), Department of Public Health, University of Basel, Switzerland
| | - Evelyn Huber
- Nursing Science (INS), Department of Public Health, University of Basel, Switzerland
- Institute of Nursing, School of Health Professions, ZHAW Zurich University of Applied Sciences, CH
| | - Samuel Stenz
- Nursing Science (INS), Department of Public Health, University of Basel, Switzerland
| | - Leah L. Zullig
- Department of Population Health Sciences, Duke University Medical Center, USA
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Switzerland
| | - Sabina M. De Geest
- Nursing Science (INS), Department of Public Health, University of Basel, Switzerland
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Mieke Deschodt
- Nursing Science (INS), Department of Public Health, University of Basel, Switzerland
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Belgium
- Healthcare and Ethics, Faculty of Medicine and Life Sciences, UHasselt, Belgium
| | - the INSPIRE consortium
- Matthias Briel, Matthias Schwenkglenks, Franziska Zúñiga, Penelope Vounatsou, Carlos Quinto, Eva Blozik, Flaka Siqeca, Maria José Mendieta Jara
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28
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Röhnsch G, Heumann M, Vorderwülbecke J, Hämel K. [From nursing home to community-oriented center for health and long-term care : Continuity of care as reflected in an expanded range of services]. Z Gerontol Geriatr 2021; 54:330-335. [PMID: 33885983 DOI: 10.1007/s00391-021-01890-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/21/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Opening nursing homes for and in the community not only promotes the inclusion of the residents. Likewise, older people living close to the homes could benefit if the nursing homes offer support for them as well. This article focuses on the extent to which "nursing homes" succeed in contributing to the continuity of care for older people in the community by developing into "centers". METHODS Episodic interviews with users/relatives and expert interviews were conducted as part of the evaluation of the project "Long-term care institutions - further thinking!". A secondary analysis of interviews was conducted by means of structuring content analysis; the views of users and experts were triangulated on a metalevel. RESULTS Users and relatives refer to three types of continuity of care in the facilities-management, relational and informational. In this respect, sustainable relationships with professionals in the facilities are just as important to them as "custom fitted" care offers even in the case of intensified need for support. Some family caregivers desire a more reliable flow of information between them and the professionals. It is also important for the experts interviewed that the facilities cover the entire spectrum of continuity of care; however, they underestimate the need of relatives in particular to be involved in care as informal carers. CONCLUSION Nursing homes can contribute to strengthening continuity of care in the community by expanding their range of services. They should take the diversity of different user groups into account.
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Affiliation(s)
- Gundula Röhnsch
- AG 6 Versorgungsforschung & Pflegewissenschaft, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Universitätsstr. 25, 33615, Bielefeld, Deutschland.
| | - Marcus Heumann
- AG 6 Versorgungsforschung & Pflegewissenschaft, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Universitätsstr. 25, 33615, Bielefeld, Deutschland
| | - Jonas Vorderwülbecke
- Referat Krankenhäuser und Pflegeausbildung, Caritasverband für die Diözese Münster, Münster, Deutschland
| | - Kerstin Hämel
- AG 6 Versorgungsforschung & Pflegewissenschaft, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Universitätsstr. 25, 33615, Bielefeld, Deutschland
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Bernabeu-Wittel M, Ternero-Vega JE, Nieto-Martín MD, Moreno-Gaviño L, Conde-Guzmán C, Delgado-Cuesta J, Rincón-Gómez M, Díaz-Jiménez P, Giménez-Miranda L, Lomas-Cabezas JM, Muñoz-García MM, Calzón-Fernández S, Ollero-Baturone M. Effectiveness of a On-site Medicalization Program for Nursing Homes With COVID-19 Outbreaks. J Gerontol A Biol Sci Med Sci 2021; 76:e19-e27. [PMID: 32738140 PMCID: PMC7454360 DOI: 10.1093/gerona/glaa192] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Nursing homes are highly vulnerable to the occurrence of COVID-19 outbreaks, which result in high lethality rates. Most of them are not prepared to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. METHOD A coordinated on-site medicalization program (MP) in response to a sizeable COVID-19 outbreak in 4 nursing homes was organized, with the objectives of improving survival, offering humanistic palliative care to residents in their natural environment, and reducing hospital referrals. Ten key processes and interventions were established (provision of informatics infrastructure, medical equipment, and human resources, universal testing, separation of "clean" and "contaminated" areas, epidemiological surveys, and unified protocols stratifying for active or palliative care approach, among others). Main outcomes were a composite endpoint of survival or optimal palliative care (SOPC), survival, and referral to hospital. RESULTS Two hundred and seventy-two of 457 (59.5%) residents and 85 of 320 (26.5%) staff members were affected. The SOPC, survival, and referrals to hospital occurred in 77%, 72.5%, and 29% of patients diagnosed before the start of MP, with respect to 97%, 83.7%, and 17% of those diagnosed during the program, respectively. The SOPC was independently associated to MP (OR = 15 [3-81]); and survival in patients stratified to active approach, to the use of any antiviral treatment (OR = 28 [5-160]). All outbreaks were controlled in 39 [37-42] days. CONCLUSIONS A coordinated on-site MP of nursing homes with COVID-19 outbreaks achieved a higher SOPC rate, and a reduction in referrals to hospital, thus ensuring rigorous but also humanistic and gentle care to residents.
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Affiliation(s)
- M Bernabeu-Wittel
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain.,Department of Medicine, University of Seville, Spain
| | - J E Ternero-Vega
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - M D Nieto-Martín
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - L Moreno-Gaviño
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - C Conde-Guzmán
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - J Delgado-Cuesta
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - M Rincón-Gómez
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - P Díaz-Jiménez
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - L Giménez-Miranda
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - J M Lomas-Cabezas
- Infectious Diseases Department, University Hospital Virgen del Rocío, Seville, Spain
| | - M M Muñoz-García
- Bermejales Primary Care Center, Primary Care District of Seville, Spain
| | - S Calzón-Fernández
- Epidemiology and Public Health Department, Primary Care District of Seville, Spain
| | - M Ollero-Baturone
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
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Kennedy F, Galvin R, Horgan NF. Managing frailty in an Irish primary care setting: A qualitative study of perspectives of healthcare professionals and frail older patients. J Frailty Sarcopenia Falls 2021; 6:1-8. [PMID: 33817445 PMCID: PMC8017349 DOI: 10.22540/jfsf-06-001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Little is known about the views of key stakeholders on frailty in Primary Care in Ireland. The aim of this study was to explore the views of Irish healthcare professionals and patients on frailty and its management in Primary Care. METHODS A qualitative descriptive design was used. Seventeen healthcare professionals and three patients were recruited using purposive sampling. Data were collected using semi-structured interviews which were analysed thematically. RESULTS Three themes were identified: (i) Perceptions of Frailty (ii) Current Management of Frailty and (iii) Comprehensive Geriatric Assessment in Primary Care. The results demonstrated variability in perspectives on frailty. Healthcare professionals described a fragmented service often delivering substandard care to frail older patients. The general consensus was that frailty management required an adequately resourced Primary Care service. Support for frailty screening and Comprehensive Geriatric Assessment was evident while the suitability of the current pathway for patients requiring assessment was questioned. CONCLUSION This study highlights an absence of a shared and complete understanding of frailty among healthcare professionals and a fragmented model of care for community-dwelling frail older patients. Based on these findings, inter-professional training, investment in Primary Care, the development of a frailty pathway and an interface service is recommended.
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Affiliation(s)
- Fiona Kennedy
- Meath Primary Care Services, Community Health Organisation (CHO) 8, Health Service Executive (HSE), Ireland
| | - Rose Galvin
- School of Allied Health, University of Limerick (UL), Ireland
| | - N. Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), Ireland
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McDonald AP, Rizzotti R, Rivera JM, D'Arcy RCN, Park G, Song X. Toward improved homecare of frail older adults: A focus group study synthesizing patient and caregiver perspectives. Aging Med (Milton) 2021; 4:4-11. [PMID: 33738374 PMCID: PMC7954833 DOI: 10.1002/agm2.12144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Adopting a better understanding of how both older adults and health care providers view the community management of frailty is necessary for improving home health, especially facing the coronavirus disease 2019 (COVID-19) pandemic. We conducted a qualitative focus group study to assess how both older adults and health care providers view frailty and virtual health care in home health. METHODS Two focus groups enrolled home-living older adults and health care professionals, respectively (n = 15). Questions targeting the use of virtual / telehealth technologies in-home care for frail older adults were administered at audio-recorded group interviews. Transcribed discussions were coded and analyzed using NVivo software. RESULTS The older adult group emphasized the autonomy related to increasing frailty and social isolation and the need for transparent dissemination of health care planning. They were optimistic about remote technology-based supports and suggested that telehealth / health-monitoring/tracking were in high demand. Health care professionals emphasized the importance of a holistic biopsychosocial approach to frailty management. They highlighted the need for standardized early assessment and management of frailty. CONCLUSIONS The integrated perspectives provided an updated understanding of what older adults and practitioners value in home-living supports. This knowledge is helpful to advancing virtual home care, providing better care for frail individuals with complex health care needs.
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Affiliation(s)
- Andrew P. McDonald
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBritish ColumbiaCanada
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Joanna M. Rivera
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBritish ColumbiaCanada
- Faculty of Health SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada
| | - Ryan C. N. D'Arcy
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBritish ColumbiaCanada
- Faculty of Applied SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada
| | - Grace Park
- Community Actions and Resources Empowering Seniors (CARES)Fraser HealthSurreyBritish ColumbiaCanada
- Home and Community Care MedicineFraser HealthSurreyBritish ColumbiaCanada
| | - Xiaowei Song
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBritish ColumbiaCanada
- Faculty of ScienceSimon Fraser UniversityBurnabyBritish ColumbiaCanada
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Co-Design Process of a Virtual Community of Practice for the Empowerment of People with Ischemic Heart Disease. Int J Integr Care 2020; 20:9. [PMID: 33250674 PMCID: PMC7664302 DOI: 10.5334/ijic.5514] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction Virtual Communities of Practices (vCoP) offer patients the possibility to interact and share tools and knowledge necessary for their empowerment. This paper describes the co-design process of a vCoP for the empowerment of people with ischemic heart disease (IHD). Methods We used a modified experience-based design approach to co-design the vCoP in collaboration with people with IHD and health professionals consisting of two phases: exploratory and development phase. Data collection techniques included listening labs, workshops, and online participation. Results Twenty-five people with IHD and ten health professionals participated. Experiences and needs for empowerment in IHD were identified in the exploratory phase allowing for the development of a Patient Journey Map. In the development phase, people with IHD prioritized needs to be addressed by the vCoP content framework in addition to content proposals. Discussion The Patient Journey Map helped to easily visualize the empowerment needs of people with IHD and it might be transferable for the development of other people-centred interventions. The co-design process also allowed the development of training materials adapted to the priorities of people with IHD. Conclusion A people-centred co-design process of a vCoP may facilitate the empowerment of people with IHD.
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Rasmussen RL, Holst M, Nielsen L, Villumsen M, Andreasen J. The perspectives of health professionals in Denmark on physical exercise and nutritional interventions for acutely admitted frail older people during and after hospitalisation. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2140-2149. [PMID: 32483900 DOI: 10.1111/hsc.13025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/03/2020] [Accepted: 04/21/2020] [Indexed: 06/11/2023]
Abstract
Frailty is associated with several negative health outcomes, such as readmissions to hospital. Physical exercise, including strength training and nutritional optimisation are essential parts of documented interventions for frail older people in preventing or minimising frailty. Further knowledge is necessary to ensure feasible and successful interventions encompassing both physical exercise and nutritional optimisation. The aim of this qualitative study was to investigate the perspectives of health professionals on which factors may affect interventions, including physical exercise and nutrition, for frail older people in relation to discharge after acute admission to hospital. Data were gathered in two semi-structured focus groups, totalling 11 health professionals working with frail older people in a Danish university hospital and a municipality. The sampling of participants was purposive and the interviews were facilitated by a semi-structured interview guide. Data were analysed applying a six-step data-driven thematic analysis. Findings showed that health professionals experienced working with nutritional optimisation and physical exercise within a frail older population as challenging, and they mostly used extrinsic motivation, such as incentives, deals or intensified messages, as external factors in their approaches as to affect specific behaviours. A discourse on the importance of activity- and functional training was prevalent, while diverging perspectives were present in relation to strength training, which was considered less feasible or meaningful in a community-dwelling setting. Organisational barriers such as communication between sectors and time limitations affected negatively the work of health professionals, as they hindered co-ordinated and adequate interventions from the health professionals. Findings and theory-based knowledge indicate that health professionals should work towards a person-centred approach, which includes goal-setting, to improve physical training and nutritional interventions for frail older people. Furthermore, health professionals may need more support in order to incorporate strength training in interventions. In addition to this, improved co-ordination between sectors is warranted.
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Affiliation(s)
- Rikke L Rasmussen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
| | - Mette Holst
- Center for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurine Nielsen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
| | - Morten Villumsen
- Department of Elderly and Health, Section of Training and Activity, Aalborg Municipality, Aalborg, Denmark
- SMI®, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jane Andreasen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
- Public Health and Epidemiology Group, Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark
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Khan N, Hewson D, Randhawa G. Effectiveness of integrated chronic care interventions for older people with different frailty levels: a systematic review protocol. BMJ Open 2020; 10:e038437. [PMID: 32912991 PMCID: PMC7485241 DOI: 10.1136/bmjopen-2020-038437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/14/2020] [Accepted: 07/31/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Frailty poses a huge burden to individuals, their families and to healthcare systems. Several interventions have been evaluated for the improvement of outcomes for older people with frailty, including integrated care interventions. Reviews synthesising evidence on the effectiveness of integrated care for older people with frailty have treated them as a single population, without considering the heterogeneity between different frailty levels such as non-frail, mild frailty, moderate frailty and severe frailty. Findings from these studies have shown inconsistent results on the various outcomes assessed. People with different frailty status have different care needs, which should be addressed accordingly. The aim of this study is to synthesise evidence on the effectiveness of integrated care interventions on older people with different frailty status who are community dwelling or living in retirement housing or residential setting but not in care homes or in nursing homes. METHODS AND ANALYSIS This is a protocol for a systematic review assessing the effectiveness of integrated chronic care interventions on older people with different frailty status. A literature search will be conducted on the databases Cochrane Central Register of Controlled Trials, PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and clinical trial registers. Two authors will independently conduct search and screening for eligible studies. Full-text screening will be used to include only studies that fulfil the inclusion criteria. Data extraction will be done on a data extraction form and methodological quality of studies will be assessed using the Effective Practice and Organisation of Care risk of bias tool. The interventions will be described following Wagner's Chronic Care Model. ETHICS AND DISSEMINATION Ethical approval for this study was obtained from the Institute for Health Research Ethics Committee of the University of Bedfordshire (IHREC934). The results of the review will be disseminated through a peer-reviewed journal article, conferences and also with local provider and user stakeholders. PROSPERO REGISTRATION NUMBER CRD42020166908.
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Affiliation(s)
- Nimra Khan
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, UK
| | - David Hewson
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, UK
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, UK
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Tsiachristas A, Potter CM, Rocks S, Peters M, Cundell M, McShane R, Batchelder L, Fox D, Forder JE, Jones K, Waite F, Freeman D, Fitzpatrick R. Estimating EQ-5D utilities based on the Short-Form Long Term Conditions Questionnaire (LTCQ-8). Health Qual Life Outcomes 2020; 18:279. [PMID: 32795317 PMCID: PMC7427949 DOI: 10.1186/s12955-020-01506-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 07/22/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose The aim of this work was to develop a mapping algorithm for estimating EuroQoL 5 Dimension (EQ-5D) utilities from responses to the Long-Term Conditions Questionnaire (LTCQ), thus increasing LTCQ’s potential as a comprehensive outcome measure for evaluating integrated care initiatives. Methods We combined data from three studies to give a total sample of 1334 responses. In each of the three datasets, we randomly selected 75% of the sample and combined the selected random samples to generate the estimation dataset, which consisted of 1001 patients. The unselected 25% observations from each dataset were combined to generate an internal validation dataset of 333 patients. We used direct mapping models by regressing responses to the LTCQ-8 directly onto EQ-5D-5L and EQ-5D-3L utilities as well as response (or indirect) mapping to predict the response level that patients selected for each of the five EQ-5D-5L domains. Several models were proposed and compared on mean squared error and mean absolute error. Results A two-part model with OLS was the best performing based on the mean squared error (0.038) and mean absolute error (0.147) when estimating the EQ-5D-5L utilities. A multinomial response mapping model using LTCQ-8 responses was used to predict EQ-5D-5L responses levels. Conclusions This study provides a mapping algorithm for estimating EQ-5D utilities from LTCQ responses. The results from this study can help broaden the applicability of the LTCQ by producing utility values for use in economic analyses.
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Affiliation(s)
- Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Caroline M Potter
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stephen Rocks
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Michele Peters
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | - Laurie Batchelder
- Personal Social Services Research Unit, School of Social Policy Sociology and Social Research, University of Kent, Canterbury, UK
| | - Diane Fox
- Personal Social Services Research Unit, School of Social Policy Sociology and Social Research, University of Kent, Canterbury, UK
| | - Julien E Forder
- Personal Social Services Research Unit, School of Social Policy Sociology and Social Research, University of Kent, Canterbury, UK
| | - Karen Jones
- Personal Social Services Research Unit, School of Social Policy Sociology and Social Research, University of Kent, Canterbury, UK
| | - Felicity Waite
- Oxford Health NHS Foundation Trust, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Daniel Freeman
- Oxford Health NHS Foundation Trust, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ray Fitzpatrick
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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The Over 75 Service: Continuity of Integrated Care for Older People in a United Kingdom Primary Care Setting. Int J Integr Care 2020; 20:2. [PMID: 32742248 PMCID: PMC7366863 DOI: 10.5334/ijic.5457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Continuity of care is concerned with quality of care over a period of time. It describes a process by which service users and their families are co-operatively involved with health and social care professionals in managing their care needs. Continuity of care can be divided into informational, managerial and relational and has been associated with improved user- and service-related outcomes. To date, there have been few studies which examine how continuity of care is developed and maintained in integrated primary care systems. This paper explores continuity of care in an integrated Over 75 Service for people living at home with complex health and social care needs. Using a case study approach, qualitative data was collected from multiple sources including interviews with managers and professionals, users and carers, care plans, steering group minutes and field notes. Data was analysed thematically. A number of factors are identified which characterise continuity of care, namely: information sharing through direct communication between providers and the development of trusted relationships within the team; identified care co-ordinators who acted as a conduit for information and communication; the development of ongoing relationships with users and carers requiring dedicated time and accessible and flexible services delivered in the users’ own home.
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Rudnicka E, Napierała P, Podfigurna A, Męczekalski B, Smolarczyk R, Grymowicz M. The World Health Organization (WHO) approach to healthy ageing. Maturitas 2020; 139:6-11. [PMID: 32747042 PMCID: PMC7250103 DOI: 10.1016/j.maturitas.2020.05.018] [Citation(s) in RCA: 451] [Impact Index Per Article: 112.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 12/25/2022]
Abstract
The ageing global population is the important medical and social demographic problem. WHO underlines the importance of maintaining functional ability in older age. WHO identified strategic objectives and priorities to promote healthy ageing. Person-oriented long-term integrated care is the key issue.
The ageing of the global population is the most important medical and social demographic problem worldwide. The World Health Organization (WHO) has defined healthy ageing as a process of maintaining functional ability to enable wellbeing in older age. The WHO, Member States and Partners for Sustainable Development Goals have created a Global Strategy and Action Plan for Ageing and Health for 2016–2020 and its continuation with the WHO programme The Decade of Healthy Ageing 2020–2030. The WHO has established main priorities such as supporting country planning and action, collecting better global data and promoting research on healthy ageing, aligning health systems to the needs of older people, laying the foundations and ensuring the human resources necessary for long-term integrated care, undertaking a global campaign to combat ageism, and enhancing the global network for age-friendly cities and communities. There are several reports of coordinated preventive health and social health initiatives in well developed countries. However, there is little evidence on the application of the active ageing frameworks in developing countries. Greater national capacities and closer monitoring of the progress through age-disaggregated data is needed to effectively implement the intended programmes on healthy ageing.
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Affiliation(s)
- Ewa Rudnicka
- Medical University of Warsaw, Department of Gynecological Endocrinology, Warsaw, Poland
| | - Paulina Napierała
- Poznan University of Medical Sciences, Department of Gynecological Endocrinology, Poznan, Poland
| | - Agnieszka Podfigurna
- Poznan University of Medical Sciences, Department of Gynecological Endocrinology, Poznan, Poland
| | - Błażej Męczekalski
- Poznan University of Medical Sciences, Department of Gynecological Endocrinology, Poznan, Poland
| | - Roman Smolarczyk
- Medical University of Warsaw, Department of Gynecological Endocrinology, Warsaw, Poland
| | - Monika Grymowicz
- Medical University of Warsaw, Department of Gynecological Endocrinology, Warsaw, Poland.
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Jorgensen MG, Rodrigo-Domingo M, Andersen S, Riis J, Jakobsen DB, Lerche M, Hostrup H, Andreasen J. A cohort study of the effects of multidisciplinary in-patient primary care in older adults. Eur Geriatr Med 2020; 11:677-684. [PMID: 32297278 DOI: 10.1007/s41999-020-00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/02/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate short and long-term effects of a multifactorial and multidisciplinary in-patient municipality intervention including training of activities of daily living, cardiovascular exercise, resistance training and social activities on quality-of-life, need-of-care, and physical function in older adults at risk of further functional decline. METHOD A cohort study including data collected rigorously during 3.5 years at an in-patient municipality rehabilitation center in Aalborg, Denmark. Patients received a multifactorial and multidisciplinary intervention. Outcomes were quality-of-life (EQ5D), weekly need-of-care hours, and test of physical functioning (sit-to-stand, 6-min walking test, tandem balance). RESULTS Data was collected from 532 patients (63.3% women). The median [5; 95 percentiles] age was 79 [55; 92] years with a length-of-stay of 21 [8; 55] days. The mean (95% CI) EQ5D index score showed a clinically relevant improvement from admission 0.46 (0.44; 0.48) to discharge 0.69 (0.67; 0.71) and there was no decline 6-month postdischarge 0.67 (0.64; 0.70). The weekly need-of-care decreased significantly by 7.2 (6.6, 7.9) h from a mean of 9.8 h before admission to 2.6 h 6-month postdischarge. Sit-to-stand improved from 6.3 (6.0; 6.7) to 9.3 (8.9; 9.6) repetitions, 6-min walking test from 147 (138; 156) to 217 (207; 227) m, and tandem balance from 20.7 (19.8; 21.6) to 25.2 (24.8; 26.2) s. CONCLUSION Our results were remarkable and highlight that a well-structured multifactorial and interdisciplinary intervention with a clear aim and inclusion criteria related to functional decline may lead to long-term clinically relevant improvements in functionally declining older adults. Future studies should, however, explore similar interventions in comparable populations preferably in randomized controlled designs.
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Affiliation(s)
- Martin Gronbech Jorgensen
- Department of Geriatric and Internal Medicine, Aalborg University Hospital, Hobrovej 18, 9000, Aalborg, Denmark
| | | | - Stig Andersen
- Department of Geriatric and Internal Medicine, Aalborg University Hospital, Hobrovej 18, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Johannes Riis
- Department of Geriatric and Internal Medicine, Aalborg University Hospital, Hobrovej 18, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Dorthe Bruun Jakobsen
- Unit of Quality and Innovation, Department of Care for the Elderly and Disabled, Aalborg Municipality, Aalborg, Denmark
| | - Mikkel Lerche
- Unit of Quality and Innovation, Department of Care for the Elderly and Disabled, Aalborg Municipality, Aalborg, Denmark
| | - Hanne Hostrup
- Rehabilitation Center Aalborg (Mou), Aalborg, Denmark
| | - Jane Andreasen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark.,Public Health and Epidemiology Group, Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark
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Kumpunen S, Edwards N, Georghiou T, Hughes G. Why do evaluations of integrated care not produce the results we expect? INTERNATIONAL JOURNAL OF CARE COORDINATION 2020. [DOI: 10.1177/2053434520909089] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A number of evaluations of models of integrated care have not produced the expected result of reduced hospital admissions, and in some cases have even found people receiving integrated care services using hospitals more than matched controls. We tested three hypotheses for these surprising results with a group of 50 integrated care experts in a seminar: (1) problems with the model; (2) problems of implementation; and (3) problems of evaluation. Our group of experts did not rule out any of these hypotheses and came up with some advice as to manage these issues. For example, model designers should rigorously test the underlying logic; commissioners should seek out advice from experts and patients/professionals; and evaluators should choose outcomes wisely, use mixed methods approaches, and provide regular feedback loops to implementation sites. Evaluating integrated care is a skilled task that requires multiple approaches in terms of the design and implementation of the models. National research funders or other appropriate bodies might consider developing an advisory service to provide support to local systems planning evaluations.
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Peters M, Rand S, Fitzpatrick R. Enhancing primary care support for informal carers: A scoping study with professional stakeholders. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:642-650. [PMID: 31770820 PMCID: PMC7027470 DOI: 10.1111/hsc.12898] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/21/2019] [Accepted: 11/07/2019] [Indexed: 06/10/2023]
Abstract
Informal carers (i.e. people who provide unpaid care to family and/or friends) are crucial in supporting people with long-term conditions. Caring negatively impacts on carers' health and experiences of health services. Internationally and nationally, policies, legislation, professional guidance and research advocate for health and care services to do more to support carers. This study explored the views of health and social care providers, commissioners and policy makers about the role and scope for strengthening health service support for carers. Twenty-four semi-structured interviews, with 25 participants were conducted, audio-recorded, transcribed verbatim and analysed by thematic analysis. Three main themes emerged: (a) identifying carers, (b) carer support, and (c) assessing and addressing carer needs. Primary care, and other services, were seen as not doing enough for carers but having an important role in identifying and supporting carers. Two issues with carer identification were described, first people not self-identifying as carers and second most services not being proactive in identifying carers. Participants thought that carer needs should be supported by primary care in collaboration with other health services, social care and the voluntary sector. Concerns were raised about primary care, which is under enormous strain, being asked to take on yet another task. There was a clear message that it was only useful to involve primary care in identifying carers and their needs, if benefit could be achieved through direct benefits such as better provision of support to the carer or indirect benefit such as better recognition of the carer role. This study highlights that more could be done to address carers' needs through primary care in close collaboration with other health and care services. The findings indicate the need for pilots and experiments to develop the evidence base. Given the crucial importance of carers, such studies should be a high priority.
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Affiliation(s)
- Michele Peters
- Health Services Research UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Stacey Rand
- Personal Social Services Research UnitSchool of Social Policy, Sociology and Social ResearchUniversity of KentCanterburyUK
| | - Ray Fitzpatrick
- Health Services Research UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
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Multiple Perspectives Analysis of the Implementation of an Integrated Care Model for Older Adults in Quebec. Int J Integr Care 2019; 19:6. [PMID: 31798357 PMCID: PMC6857522 DOI: 10.5334/ijic.4634] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Integrated care models for older adults are increasingly utilised in healthcare systems to overcome fragmentations. Several groups of stakeholders are involved in the implementation of integrated care. The aim of this study is to identify the main concerns, convergences and divergences in perspectives of stakeholders involved in the implementation of a centralised system-wide integrated care model for older adults in Quebec. Theory and methods: Qualitative multiple-case study. Semi-structured interviews of key stakeholders: policymakers (n = 11), providers (n = 29), managers (n = 34), older adult patients (n = 14) and caregivers (n = 9), including document analysis. Thematic analysis of the views of stakeholders along the lines of the six dimensions of the Rainbow Model of Integrated Care. Results: While patients/caregivers were mostly concerned by their unmet individual needs, policymakers, managers and providers were concerned by structural barriers to integrating care. Stakeholders’ diverse perspectives indicated implementation gaps in a top-down implementation context. Conclusion: Mandated system-wide integration appears to have structural, organizational, functional, and normative transformations, but its clinical changes are more uncertain in view of the observed divergent perspectives of actors. It will be interesting to explore if the systemic changes are precursors of clinical changes or, on the contrary, explains the lack of clinical changes.
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