ResearchPad - research-and-theory https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Challenges to Introducing Integrated Diabetes Care to an Inner-Regional Area in South Western Sydney, Australia]]> https://www.researchpad.co/article/elastic_article_8834 Diabetes care often requires collaboration between general practitioners, allied health professionals, nurses, and/or medical specialists. This study aimed to describe the establishment of an integrated diabetes prevention and care approach in an area with limited access to primary and secondary care, and the challenges faced in its initial development.Description:A qualitative research approach to identify challenges was taken. Data included meeting minutes, observational data and reports involving local clinical and non-clinical stakeholders from June 2016- December 2018 and were thematically analysed.Discussion:Key challenges were low patient attendance in general practice, healthcare professional time, low participation at health promotion activities/peer support groups and diabetes education reflecting a low priority among people with and at risk of diabetes. Coordination between services remained a challenge.Conclusion:This study highlights the need to integrate new diabetes services with existing health activities in the community and the importance of allowing flexibility and regular contact with local healthcare professional and community to encourage their involvement. Regular meetings with the funders, internal and external stakeholders are key for sustainability and to adapt programmes to the local situation. Further work is needed to identify and implement strategies to overcome these challenges. ]]> <![CDATA[A “Behind-the-Scenes” Look at Interprofessional Care Coordination: How Person-Centered Care in Safety-Net Health System Complex Care Clinics Produce Better Outcomes]]> https://www.researchpad.co/article/elastic_article_8829 While the effectiveness of team-based care and wrap-around services for high utilizers is clear, how complex care clinics deliver effective, person-centered care to these vulnerable populations is not well understood. This paper describes how interactions among interprofessional team members enabled individualized, rapid responses to the complex needs of vulnerable patients at the Virginia Commonwealth University Health System’s Complex Care Clinic.Methods:Researchers attended twenty weekly care coordination meetings, audio-recorded the proceedings, and wrote brief observational field notes. Researchers also qualitatively interviewed ten clinic team members. Emergent coding based on grounded theory and a consensus process were used to identify and describe key themes.Results:Analysis resulted in three themes that evidence the structures, processes, and interactions which contributed to the ability to provide person-centred care: team-based communication strategies, interprofessional problem-solving, and personalized patient engagement efforts.Conclusion:Our study suggests that in care coordination meetings team members were able to strategize, brainstorm, and reflect on how to better care for patients. Specifically, flexible team leadership opened an inter-disciplinary communicative space to foster conversations, which revealed connections between the physical, and socio-emotional components of patients’ lives and hidden factors undermining progress, while proactive strategies prevented patient’s rapid deterioration and unnecessary use of inappropriate health services. ]]> <![CDATA[Communication and Coordination Processes Supporting Integrated Transitional Care: Australian Healthcare Practitioners’ Perspectives]]> https://www.researchpad.co/article/Nbd6547a5-a556-4874-8045-9dd60d6cda1f

Introduction:

Although a large body of research has identified effective models of transitional care, questions remain about the optimal translation of this knowledge into practice. In Australia, the introduction of a model of consumer-directed care uniquely challenges the practice of integrated care transitions for older adults. This study aimed to identify strengths and weaknesses in transitional care for older adults in an Australian setting by describing healthcare practitioners’ experiences of care provision.

Methods:

The study used a qualitative design in two phases: 1) semi-structured interviews, 2) one focus group. The setting comprised one public health network and five community services in urban Australia. In Phase 1, health practitioners across settings were interviewed about their experience of transitional care. Phase 2 sought feedback about the Phase 1 findings from different practitioners. All data were thematically analysed.

Findings:

In Phase 1), 48 healthcare practitioners were interviewed across multiple settings. Few participants were aware of the introduction of consumer-directed care in community aged care. Four main themes were identified: ‘Rapid and safe care transition’, ‘Discussing as a team’, ‘Questioning the discharge’, and ‘Engaging patients and carers’. In Phase 2), seven participants from different settings reviewed and endorsed the findings from Phase 1.

Discussion and conclusions:

Findings indicate that healthcare practitioners use a range of communication and coordination processes in optimising integrated transitional care. Although participants involved their patients in transitional care planning, most participants were unaware of the recent implementation of consumer-directed care. In contexts of community-based care shaped by multidisciplinary, sub-acute and CDC models, care integration must focus on improved communication with patients and carers to ascertain their needs and to support their increased responsibility in their care transitions.

]]>
<![CDATA[Financial Barriers Decrease Benefits of Interprofessional Collaboration within Integrated Care Programs: Results of a Nationwide Survey]]> https://www.researchpad.co/article/N448cf7e4-7084-4230-8735-33c828612c73

Introduction:

Interprofessional collaboration (IPC) is a key ingredient of integrated care. Nevertheless, IPC benefits remain unclear and its implementation within integrated care initiatives is not straightforward. In this study, we first explored whether IPC was associated with organisational and patient care improvements in Swiss integrated care initiatives; we then investigated the effect of various barriers faced by these initiatives, on these associations.

Methods:

Self-reported data from 153 integrated care initiatives included in the Swiss Integrated Care Survey was used. We conducted moderated mediation analyses in which patient care improvements were the outcome, the degree of IPC implementation was the predictor, organisational improvements were the mediator, and professional, patient and financial barriers to integrated care, the moderators.

Results:

IPC implementation within integrated care was associated with organisational improvements, which in turn were associated with patient care improvements; this path no longer existed when financial barriers to integrated care were considered.

Conclusion:

Organisational improvements should be considered a priority when implementing IPC within integrated care initiatives since patient care improvements due to IPC can be expected mainly when organisational aspects are improved. More importantly, the role of financial barriers should be acknowledged, and actions taken to reduce their impact on integrated care.

]]>
<![CDATA[Perceptive Dialogue for Linking Stakeholders and Units During Care Transitions – A Qualitative Study of People with Stroke, Significant Others and Healthcare Professionals in Sweden]]> https://www.researchpad.co/article/N8e34e1ef-dd6b-4316-98d6-0c422a115c21

Introduction:

Care transitions are a complex set of actions that risk poor quality outcomes for patients and their significant others. This study explored the transition process between hospital and continued rehabilitation in the home. The process is explored from the perspectives of people with stroke, significant others and healthcare professionals in Stockholm, Sweden.

Method:

Focus group interviews (n = 10), semi-structured individual interviews (n = 23) and interviews in dyad (n = 4) were conducted with healthcare professionals, people with stroke and significant others, altogether 71 participants. Data was collected and analyzed using Grounded Theory.

Results:

One core category “Perceptive dialogue for a coordinated transition”, and two categories “Synthesis of parallel processes for common understanding” and “The forced transformation from passive attendant to uninformed agent” emerged from the analysis. The transition consisted of several parallel processes which made it difficult for the stakeholders to get a common understanding of the transition as a whole. Enabling a perceptive dialogue was as a prerequisite for the creation of a common understanding of the care transition.

Conclusion:

This study elucidates that a perceptive dialogue with patients/significant others as well as within and across organizations is part of a coordinated and person-centred transition. There is an extensive need for increased involvement of patients and significant others regarding dialogue about health conditions, procedures at the hospital and preparation for self-management after discharge.

]]>
<![CDATA[Evidence of Inter-Professional and Multi-Professional Interventions for Geriatric Patients: A Systematic Review]]> https://www.researchpad.co/article/N34eea5ba-053a-4345-a920-7eee999c5807

The current demographic shift raises the demand for provision of health care tailored to the complex care needs for older adults. Given the growing number of national care plans and best practice models there is an urgent need to build evidence for inter- and multiprofessional care provision for older people when offered an integrated care approach.

The aim of this study was to determine whether an inter-professional or multi-professional care intervention, can improve geriatric patients’ health determinants.

A systematic review was performed according to PRISMA Guidelines. Databases were searched for clinical trials which compare inter-professional or multi-professional complex care interventions with usual care among people aged ≥60 years, in hospital or emergency care settings.

Based on nine studies, inter-professional or multi-professional intervention has no impact on mortality rate but either positive or neutral effects on physical health, psychosocial wellbeing and utilization of health care service. It shows that these inter-professional or multi-professional interventions were feasible.

This systematic review highlights the scarcity of evidence showing either positive or neutral impact of intervention based on inter-professional or multi-professional teamwork across care settings on the health determinants among geriatric patients. International harmonization of assessment tools may allow direct comparisons for future interventions.

]]>
<![CDATA[The Odyssey of Integration: Is Management its Achilles’ Heel?]]> https://www.researchpad.co/article/Nc0c786f0-1554-490b-85df-2f194c29c13f

Introduction:

The importance of management to the implementation of integrated care is recognised in evidence and practice. Despite this recognition, there is a lack of clarity about what ‘good’ management of integrated care looks like, if the competences are different to management for ‘traditional’ care, and how such competences can be acquired.

Theory and methods:

This exploratory study is based on qualitative interviews with participants with extensive experience of implementing integrated care in senior professional, research, administrative and/or policy roles. It conceptualises management as working at ‘strategic’ and ‘operational’ levels.

Results:

Management of integrated care was seen to require an ability to create networks across professions and organisations, to be comfortable with distributing responsibilities, and to thoroughly understand the wider system. Competences to support these new ways of working included an understanding of how to implement people-centredness, to have courage to challenge the status quo, and to demonstrate humility to learn from others. Structured development opportunities for managers were lacking, but seen as vital for the sustainability of change.

Discussion and conclusion:

Management for integrated care remains an underdeveloped concept and practice. A first formulation of the competences necessary was achieved, but more work is urgently required to understand how to better prepare and support managers to achieve necessary changes in practice and culture.

]]>
<![CDATA[Measuring chronic care management experience of patients with diabetes: PACIC and PACIC+ validation]]> https://www.researchpad.co/article/5acae85f463d7e4f31309cc1

Background

The patient assessment of chronic illness care (PACIC) is a promising instrument to evaluate the chronic care experiences of patients, yet additional validation is needed to improve its usefulness.

Methods

A total of 1941 patients with diabetes completed the questionnaire. Reliability coefficients and factor analyses were used to psychometrically test the PACIC and PACIC+ (i.e. PACIC extended with six additional multidisciplinary team functioning items to improve content validity). Intra-class correlations were computed to identify the extent to which variation in scores can be attributed to GP practices.

Results

The PACIC and PACIC+ showed a good psychometric quality (Cronbach’s alpha’s >0.9). Explorative factor analyses showed inconclusive results. Confirmative factor analysis showed that none of the factor structures had an acceptable fit (RMSEA>0.10). In addition, 5.1 to 5.4% of the total variation was identified at the GP practice level.

Conclusion

The PACIC and PACIC+ are reliable instruments to measure the chronic care management experiences of patients. The PACIC+ is preferred because it also includes multidisciplinary coordination and cooperation—one of the central pillars of chronic care management—with good psychometric quality. Previously identified subscales should be used with caution. Both PACIC instruments are useful in identifying GP practice variation.

]]>
<![CDATA[The Development of Integrated Stroke Care in the Netherlands a Benchmark Study]]> https://www.researchpad.co/article/5b3784b8463d7e6b6e6f5904

Introduction:

Integrated stroke care in the Netherlands is constantly changing to strive to better care for stroke patients. The aim of this study was to explore if and on what topics integrated stroke care has been improved in the past three years and if stroke services were further developed.

Methods:

A web based self-assessment instrument, based on the validated Development Model for Integrated Care, was used to collect data. In total 53 coordinators of stroke services completed the questionnaire with 98 elements and four phases of development concerning the organisation of the stroke service. Data were collected in 2012 and 2015. Descriptive-comparative statistics were used to analyse the data.

Results:

In 2012, stroke services on average had implemented 56 of the 89 elements of integrated care (range 15–88). In 2015 this was increased up to 70 elements on average (range 37–89). In total, stroke services showed development on all clusters of integrated care. In 2015, more stroke services were in further phases of development like in the consolidation and transformation phase and less were in the initiative and design phase. The results show large differences between individual stroke services. Priorities to further develop stroke services changed over the three years of data collection.

Conclusions:

Based on the assessment instrument, it was shown that stroke services in the Netherlands were further developed in terms of implemented elements of integrated care and their phase of development. This three year comparison showed unique first analyses over time of integrated stroke care in the Netherlands on a large scale. Interesting further questions are to research the outcomes of stroke care in relation to this development, and if benefits on patient level can be assessed.

]]>
<![CDATA[Outcome Indicators on Interprofessional Collaboration Interventions for Elderly]]> https://www.researchpad.co/article/5b028e80463d7e5a66bcf405

Background:

Geriatric care increasingly needs more multidisciplinary health care services to deliver the necessary complex and continuous care. The aim of this study is to summarize indicators of effective interprofessional outcomes for this population.

Method:

A systematic review is performed in the Cochrane Library, Pubmed (Medline), Embase, Cinahl and Psychinfo with a search until June 2014.

Results:

Overall, 689 references were identified of which 29 studies met the inclusion criteria. All outcome indicators were summarized in three categories: collaboration, patient level outcome and costs. Seventeen out of 24 outcome indicators within the category of ‘collaboration’ reached significant difference in advantage of the intervention group. On ‘patient outcome level’ only 15 out of 32 outcome parameters met statistical significance. In the category of ‘costs’ only one study reached statistical significance.

Discussion and conclusion:

The overall effects of interprofessional interventions for elderly are positive, but based on heterogeneous outcomes. Outcome indicators of interprofessional collaboration for elderly with a significant effect can be summarized in three main categories: ‘collaboration’, patient level’ and ‘costs’. For ‘collaboration’ the outcome indicators are key elements of collaboration, involved disciplines, professional and patient satisfaction and quality of care. On ‘patient level’ the outcome indicators are pain, fall incidence, quality of life, independence for daily life activities, depression and agitated behaviour, transitions, length of stay in hospital, mortality and period of rehabilitation. ‘Costs’ of interprofessional interventions on short- and long-term for elderly need further investigation. When organizing interprofessional collaboration or interprofessional education these outcome indicators can be considered as important topics to be addressed. Overall more research is needed to gain insight in the process of interprofessional collaboration and so to learn to work interprofessionally.

]]>