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Patients’ and next of kin’s expectations and experiences of a mobile integrated care model with a home health care physician: a qualitative thematic 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; College of Nursing, University of Rhode Island, Kingston, RI, USA.
School of Health Sciences, University of Skövde, Skövde, Sweden.ORCID iD: 0000-0002-6305-8993
School of Health Sciences, University of Skövde, Skövde, Sweden.
2023 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 921Article in journal (Refereed) Published
Abstract [en]

Background: The organizational principle of remaining at home has offset care from the hospital to the home of the older person where care from formal and informal caregivers is needed. Globally, formal care is often organized to handle singular and sporadic health problems, leading to the need for several health care providers. The need for an integrated care model was therefore recognized by health care authorities in one county in Sweden, who created a cross-organisational integrated care model to meet these challenges. The Mobile integrated care model with a home health care physician (MICM) is a collaboration between regional and municipal health care. Descriptions of patients’ and next of kin’s experiences of integrated care is however lacking, motivating exploration.

Method: A qualitative thematic study. Data collection was done before the patients met the MICM physician, and again six months later.

Results: The participants expected a sense of relief when admitted to MICM, and hoped for shared responsibility, building a personal contact and continuity but experienced lack of information about what MICM was. At the follow-up interview, participants described having an easier daily life. The increased access to the health care personnel (HCP) allowed participants to let go of responsibility, and created a sense of safety through the personalised contact and continuity. However, some felt ignored and that the personnel teamed up against the patient. The MICM structure was experienced as hierarchical, which influenced the possibility to participate. However, the home visits opened up the possibility for shared decision making.

Conclusion: Participants had an expectation of receiving safe and coherent health care, to share responsibility, personal contact and continuity. After six months, the participants expressed that MICM had provided an easier daily life. The direct access to HCP reduced their responsibility and they had created a personalised contact with the HCP and that the individual HCP mattered to them, which could be perceived as in line with the goals in the shift to local health care. The MICM was experienced as a hierarchic structure with impact on participation, indicating that all dimensions of person-centred care were not fulfilled.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023. Vol. 23, no 1, article id 921
Keywords [en]
Home health care, Home health care physician, Municipal care, Next of kin, Nursing, Patient, Qualitative, Thematic analysis, aged, article, drug safety, expectation, follow up, health care access, health care personnel, home care, home visit, human, interview, physician, responsibility, shared decision making, caregiver, controlled study, Sweden
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-62383DOI: 10.1186/s12913-023-09932-4ISI: 001057696200008PubMedID: 37644455Scopus ID: 2-s2.0-85168928826Local ID: GOA;;901449OAI: oai:DiVA.org:hj-62383DiVA, id: diva2:1794020
Funder
Foundation for the Memory of Ragnhild and Einar LundströmAvailable from: 2023-09-04 Created: 2023-09-04 Last updated: 2024-05-16Bibliographically 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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Emmesjö, LinaDahl Aslan, Anna K.

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