A Qualitative Study on Distributed Leadership in Integrated Care: Exploring the Experiences of Elderly Multimorbid Patients with GP Collaboration

Objective

This study explores how the collaboration between elderly multimorbid patients and general practitioners contributes to the patient's experience of integrated care in the municipality. The research also investigates whether the municipality's integrative mechanisms creating integrated care can be understood as distributed leadership.

Method

In this qualitative study, we conducted a thematic analysis of semi-structured interviews with twenty elderly multimorbid patients living at home and their general practitioners.

Results

Analysis of patients' and general practitioners' experience of healthcare service characterized by collective efforts identified four themes: 1) an impression of collective processes as difficult for patients to access and influence; 2) that the fluidity and location of leadership is dependent on the individual patient and his or her health condition; 3) that collective implementation of healthcare services is separated in time, geography and between organizations; and 4) that patients experience individual healthcare workers as specialized and unable to support the medical and holistic goals of the collective. The Direction, Alignment, and Commitment or DAC framework, is used to investigate the capabilities of the collective.

Conclusion

To promote distributed leadership and create a patient experience of integrated care in the municipality, healthcare organizations must develop collective processes that enhance patient participation to a greater extent. General practitioners and other healthcare personnel should be encouraged to play a more central role in solving elderly multimorbid patients' healthcare needs in the municipality.

Older Adults' Experiences With Participation and eHealth in Care Coordination: Qualitative Interview Study in a Primary Care Setting

BACKGROUND

Owing to the demographic changes in the elderly population worldwide, delivering coordinated care at home to multimorbid older adults is of great importance. Older adults living with multiple chronic conditions need information to manage and coordinate their care. eHealth can be effective for gaining sufficient information, communicating, and self-managing chronic conditions. However, incorporating older adults' health preferences and ensuring active involvement remain challenging. More knowledge is needed to ensure successful participation and eHealth use in care coordination.

OBJECTIVE

This study aimed to explore multimorbid older adults' experiences with participation and eHealth in care coordination with general practitioners (GPs) and district nurses (DNs).

METHODS

The study had a qualitative explorative approach. Data collection included semistructured interviews with 20 older adults with multimorbidity receiving primary care services from their GPs and DNs. The participants were included by their GPs or nurses at a local intermunicipal acute inpatient care unit. The data analysis was guided by systematic text condensation.

RESULTS

We identified 2 categories: (1) older adults in charge of and using eHealth in care coordination, and (2) older adults with a loss of control in care coordination. The first category describes how communication with GPs and DNs can facilitate participation, the importance of managing own medication, and how eHealth can support older adults' information needs. The second category focuses on older adults who depend on guidance and help from their GPs and DNs to manage their health, describing how a lack of capacity and system support to be involved makes these adults lose control of their care coordination.

CONCLUSIONS

Being in charge of care coordination is important for older multimorbid adults. The results show that older adults are willing to use eHealth to be informed and to seek information, which ensures high levels of participation in care coordination. Future research should investigate how older adults can be involved in electronic information sharing with health care providers.

General practitioners' perceptions of distributed leadership in providing integrated care for elderly chronic multi-morbid patients: a qualitative study

Background

Distributed Leadership (DL) has been suggested as being helpful when different health care professionals and patients need to work together across professional and organizational boundaries to provide integrated care (IC). This study explores whether General Practitioners (GPs) adopt leadership actions that transcend organizational boundaries to provide IC for patients and discusses whether the GPs’ leadership actions in collaboration with patients and health care professionals contribute to DL.

Methods

We interviewed GPs (n = 20) of elderly multimorbid patients in a municipality in Norway. A qualitative interpretive case design and Gioia methodology was applied to the collection and analysis of data from semi-structured interviews.

Results

GPs are involved in three processes when contributing to IC for elderly multimorbidity patients; the process of creating an integrated patient experience, the workflow process and the process of maneuvering organizational structures and medical culture. GPs take part in processes comparable to configurations of DL described in the literature. Patient micro-context and health care macro-context are related to observed configurations of DL.

Conclusion

Initiating or moving between different configurations of DL in IC requires awareness of patient context and the health care macro-context, of ways of working, capacity of digital tools and use of health care personnel.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08460-x.

Non-response in telephone surveys of COPD patients does not introduce bias

We examined the telephone response rates in a 2-year study of patients with COPD to identify factors associated with non-response. A total of 381 patients received monthly telephone calls to assess symptoms and treatment in 2007 and 2008. A total of 9019 calls were made over 24 months, of which 73% were answered. The highest response rate was obtained in February 2007 (81%), and the lowest in July 2008 (48%). The monthly response rate was lower in the second year of follow up. There were 39 patients (10%) who were less frequent responders, with 10 or fewer responses. Less frequent responders were more likely to be current smokers and have hypoxaemia. The median number of answered calls was 18 (interquartile range 16-20). In bivariate models the median number of responses was significantly lower in subjects with chronic cough. In multivariate models neither demographic nor disease characteristics were significantly associated with non-response. We found less frequent responders to monthly telephone calls to be similar in characteristics to frequent responders. This suggests that non-response does not necessarily introduce bias in telephone surveys of patients with COPD.

[Transfusion therapy and volume treatment in elective surgery and traumas]

New light has recently been shed on transfusion therapy. Early recurrence of cancer, ill effects on the immune system and increased incidence of postoperative infections have all been suggested as possible complications of overenthusiastic transfusion therapy. The need for perioperative transfusions has been overestimated in the past, since new physiological investigations show that a hemoglobin level of 8 g/100 ml can be tolerated at elective surgery provided that the patient is normovolemic and normothermic. Neither has the danger of virus contamination been entirely eliminated. With this in mind, blood component therapy, giving erythrocytes and plasma components according to documented need, has been started. The article describes our institution's suggested policy for transfusion therapy and volume treatment in elective and trauma surgery.