Exploring interprofessional, interagency multimorbidity care: case study based observational research

When do physicians perceive the success of a new care model differently?

BACKGROUND

The health care innovation "MamBo - people with multimorbidity in outpatient care: patient-focused and needs-oriented healthcare management" aims to improve the efficiency and quality of care for multimorbid patients by delegating tasks (e.g. taking over house calls or coordinating specialist appointments) to a monitoring and coordination assistant (MoniKa). Participating physicians are very important for the success of the health care innovation due to their direct involvement as practitioners and their task of enrolling patients. The aim of this part of the evaluation study is therefore to identify the physicians' personal values, which influence the individual perception of the project's advantages and thus possibly the acceptance and sustainable implementation of new care structures.

METHODS

Two Focus groups (n = 4; n = 6) and three individual interviews with general practitioners and specialists who decided to implement the health care innovation within the first year were conducted. The semi-structured guidelines were developed by the research team. The interviews were analysed according to the content analysis by Mayring. We used the learning model of operant conditioning to place our study results in a theoretical context.

RESULT

Two central personal values of the participants, which determine the desired advantages of the health care innovation were identified: More patient-oriented and more economic-oriented values. Participants with more patient-oriented values quickly perceived advantages, which seems to be beneficial for the acceptance of the new care structures. Economic-oriented participants tended to be more critical. The benefits of the health care innovation, which was expressed, for example, in an improvement of the practice routine, has not yet been perceived by this group, or only to a limited extent.

CONCLUSIONS

The results suggest that the respective values of the participants define the individual perceived advantages and thus, the assessment of the success of the health care innovation in general. These findings could be used in the implementation process by increasing the motivation of the project participants through typified supervision.

TRIAL REGISTRATION

The study has been registered in the German Clinical Trials Register ( DRKS00014047 ).

Collaborative care in 'Youth One Stop Shops' in New Zealand: Hidden, time-consuming, essential

Young people in New Zealand have high morbidity but low service utilization rates. Dedicated youth services 'Youth One Stop Shops' provide 'wraparound' health and social care. However, little is understood about how staff within these services interact with each other or with external agencies to provide this specialist care. This article reports on volume and type of internal and inter-agency health and social service staff-staff interactions, to better understand elements of potential collaboration in day-to-day practice. An observational, case-study approach was utilized. Four dedicated youth services recorded data over three-month periods about a selected number of high-use clients. Youth service staff recorded all interactions with colleagues within their organization and staff from external services. A large volume of non-patient contact work was revealed, with a high proportion of 'complex/involved' interactions recorded. The range and diversity of external agencies with which youth service staff interacted with to meet the needs of young people was extensive and complex. The focus on 'information sharing' and 'complex/involved' interactions demonstrates a well-coordinated, wraparound service delivery model. Current funding formulae take inadequate account of the volume of non-patient contact work that youth services provide for high-needs young people.