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The role of the home health care physician in mobile integrated care: a qualitative phenomenograpic study
Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). School of Health Sciences, University of Skövde, Skövde, Sweden.ORCID iD: 0000-0001-6484-9239
School of Health Sciences, University of Skövde, Skövde, Sweden.
Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). School of Health Sciences, University of Skövde, Skövde, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0002-6305-8993
School of Health Sciences, University of Skövde, Skövde, Sweden; College of Nursing, University of Rhode Island, Kingston, RI, USA.
2022 (English)In: BMC Geriatrics, E-ISSN 1471-2318, Vol. 22, article id 554Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: An increasing older population, along with the organizational principle of remaining at home, has moved health care from institutions into the older person's home, where several health care providers facilitate care. The Mobile Integrated Care Model strives to provide cost-efficient, coherent, person-centered health care in the home. In the integrated care team, where the home health care physician is the medical authority, several health care professions work across organizational borders. Therefore, the aim of this study was to describe Home Health Care Physicians perceptions of working and providing health care in the Mobile Integrated Care Model, as well as perceptions of participating in and forming health care.

METHODS: A phenomenographic qualitative study design, with semi-structured interviews using an interview guide.

RESULTS: Working within Mobile Integrated Care Model was a different way of working as a physician. The physicians' role was to support the patient by making safe medical decisions. Physicians described themselves as a piece in the team puzzle, where the professional knowledge of others was crucial to give quality health care. Being in the patients' homes was expressed as adding a unique dimension in the provision of health care, and the physicians learned more about the patients by meeting them in their homes than at an institution. This aided the physicians in respecting patient autonomy in medical decision making, even though the physicians sometimes disregarded patient autonomy in favor of their own medical experience. There was a divided view on next of kin participation among the home health care physicians, ranging from always including to total absence of involving next of kin in decision making.

CONCLUSIONS: The home health care physicians described the Mobile Integrated Care Model as the best way to work, but there was still a need for additional resources and structure when working in different organizations. The need for full-time employment, additional time or hours, more equipment, access to each other's medical records, and additional collaboration with other health care providers were expressed, which could contribute to increased work satisfaction and facilitate further development of person-centered care in the Mobile Integrated Care Model.

Place, publisher, year, edition, pages
BioMed Central, 2022. Vol. 22, article id 554
Keywords [en]
Home health care, Home health care physician, Integrated care, Municipality care, Person-centered care, Phenomenography, Qualitative
National Category
Gerontology, specialising in Medical and Health Sciences Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:hj:diva-58045DOI: 10.1186/s12877-022-03211-3ISI: 000820628000002PubMedID: 35787260Scopus ID: 2-s2.0-85133286268Local ID: GOA;;822878OAI: oai:DiVA.org:hj-58045DiVA, id: diva2:1684451
Funder
The Kamprad Family Foundation, 20190175Available from: 2022-07-26 Created: 2022-07-26 Last updated: 2024-07-04Bibliographically approved
In thesis
1. Within an integrated home health care model: Registered nurses’, physicians’, patients’ and their next of kin’s perspectives
Open this publication in new window or tab >>Within an integrated home health care model: Registered nurses’, physicians’, patients’ and their next of kin’s perspectives
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Many older patients receive health care from several different healthcare organizations, which may lead uncertainty about the responsibility for their healthcare needs. Integrated care has been argued to aid the healthcare system by addressing the challenge of the complex care needs of older patients with multiple health problems. Previous research has stated that integrated care models often have been developed with a focus on a single diagnosis, which risks overlooking the extensive and complex care needs of older patients. Prior research has also expressed the need to deepen knowledge about how integrated care models influence health care professionals, patients and their next of kin. Moreover, it is important to understand how the COVID-19 pandemic affected integrated care models which may expand knowledge about integrated home health care in crisis situations.

The overall aim is to study expectations, perceptions and experiences of integrated home health care through the perspective of registered nurses, physicians, patients and their next of kin.

Inductive qualitative designs where data was collected through interviews and field notes in the setting of the mobile integrated care model with a home health care physician (MICM) with registered nurses, physicians and patients and next of kin. Analysis was conducted using qualitative content analysis, phenomenography, and thematic analysis.

The emphasis on person-centered care in the MICM was evident in the perceptions of the healthcare professionals about the patients and their next of kin, whom they viewed as persons, not simply recipients of health care. Differences were found in the health care provided in the MICM and in comparison, to other healthcare organizations which did not align with the person-centered care ethics. However, providing health care to patients in their own home benefited the provision of person-centered care – the value base of the MICM. The MICM was created with the goal of implementing individually tailored and coherent health care with increased continuity. The healthcare professionals viewed individual medical healthcare plans as co-created with each patient, and yet no patient could recall participating in this co-creation. The coherency of the MICM was regarded as having been improved by teamwork between the registered nurse and the home healthcare physician. Collaborations with other healthcare professionals rarely occurred and should be improved in the future. Participants reported varying experiences of continuity in the MICM, which influenced the possibility of building relationships. Providing continuity with a home healthcare physician for patients is therefore preferable. The work described in this thesis was conducted during the COVID-19 pandemic. The thesis provides unique insights into an integrated care model during a crisis situation, which the healthcare system may face in similar or different ways in the future. The MICM was upheld as the best way to work in home health care, especially as patients and their next of kin regarded the model as making their daily lives easier.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare, 2024. p. 104
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 136
Keywords
home health care, home health care physician, municipality nursing, integrated care, person-centered care, qualitative content analysis, phenomenography, thematic analysis
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-64232 (URN)978-91-88669-47-6 (ISBN)978-91-88669-48-3 (ISBN)
Public defence
2024-06-05, G110, University of Skövde, Skövde, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2024-05-16 Created: 2024-05-16 Last updated: 2024-06-04Bibliographically approved

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Hovlin, LinaDahl Aslan, Anna K.

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