A Mixed-Methods Study of the Experiences and Beliefs of Older People With Complex Health Care Needs About Medication Adherence

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Sacha Purvis ◽  
Elizabeth Manias ◽  
Bernice Redley
Keyword(s):  
Health Care ◽  
Mixed Methods ◽  
Medication Adherence ◽  
Older People ◽  
Mixed Methods Study ◽  
Health Care Needs ◽  
Care Needs

Health care Needs of Women Immediately Post-Incarceration: A Mixed Methods Study

2013 ◽  
Vol 30 (5) ◽  
pp. 409-419 ◽  
Author(s):  
Alison M. Colbert ◽  
L. Kathleen Sekula ◽  
Rick Zoucha ◽  
Susan M. Cohen
Keyword(s):  
Health Care ◽  
Mixed Methods ◽  
Mixed Methods Study ◽  
Health Care Needs ◽  
Care Needs

Evaluating a Model of Service Integration for Older People with Complex Health Needs

2005 ◽  
Vol 4 (1-2) ◽  
pp. 34-41 ◽  
Author(s):  
Steve Bird ◽  
William Kurowski ◽  
Gillian Dickman
Keyword(s):  
Health Care ◽  
Older People ◽  
Service Integration ◽  
Evaluation Process ◽  
Target Population ◽  
Multiple Chronic Conditions ◽  
Health Care Needs ◽  
Care Needs ◽  
Community Based ◽  
Quantitative And Qualitative Methods

Background Older people with multiple chronic conditions and complex health care needs require a comprehensive, accessible and well-coordinated system of services. To address this growing problem, a consortium of acute and community-based health care organisations implemented a ‘Patients First’ model of service integration for the target population. The project evaluation utilised a combination of quantitative and qualitative methods in an action research framework. Findings The evaluation process not only demonstrated the benefits of the project to patients and the health care system, but also contributed to the identification of pivotal components in the model, aspects requiring attention and consequently their refinement. It was also a vehicle for the development of a sense of ownership amongst staff and has evolved into an integral part of the model.

Assessment of older people in the community: lessons from Britain’s ‘75-and-over checks’

1999 ◽  
Vol 9 (4) ◽  
pp. 305-316 ◽  
Author(s):  
Steve Iliffe ◽  
Mari Gould ◽  
Paul Wallace
Keyword(s):  
Health Care ◽  
Older People ◽  
General Practitioners ◽  
Unmet Need ◽  
Health Assessment ◽  
Health Care Needs ◽  
Care Needs ◽  
Contractual Obligation ◽  
Assessment Programme ◽  
The World

Research carried out in the 1950s and early 1960s indicated that there was considerable unmet need amongst older people in Britain. This work prompted research into ways of meeting the health care needs of older people, a task made more important by the aging of the population at the end of this century. This focus resulted in the introduction in 1990 of a nationwide health assessment programme for older people, as a contractual obligation for general practitioners. The programme, the first in the world, remains in force but is widely ignored. This paper describes:

Piloting a structured developmental tool to assess transition readiness for youth with special health-care needs: A mixed-methods exploration of health-care provider experiences

2019 ◽  
Vol 24 (1) ◽  
pp. 92-105
Author(s):  
Judy Bond ◽  
Susan Shanske ◽  
Roberta Hoffman ◽  
Abigail M Ross
Keyword(s):  
Health Care ◽  
Mixed Methods ◽  
Patient Care ◽  
Special Health Care Needs ◽  
Health Care Needs ◽  
Care Providers ◽  
Care Needs ◽  
Special Health Care ◽  
Transition Readiness ◽  
Special Health

This mixed-methods study examined providers’ experiences using a structured developmentally sensitive tool to assess transition readiness for youth with special health-care needs moving from pediatric to adult care. Twenty-eight health-care providers from three pediatric specialty clinics reported their experiences using the tool by surveys and semistructured telephone interviews. Qualitative data were analyzed using thematic analysis. Most (96%) believed routine practice should include a structured tool; 65.7% incorporated information from the tool into patient care plans. Salient themes pertained to practice behavior changes and implementation barriers. Integrating structured tools into standard clinical practice has the potential to optimize transition and improve patient care.

scholarly journals Integrated care facilitation for older patients with complex health care needs reduces hospital demand

2007 ◽  
Vol 31 (3) ◽  
pp. 451 ◽  
Author(s):  
Stephen R Bird ◽  
William Kurowski ◽  
Gillian K Dickman ◽  
Ian Kronborg
Keyword(s):  
Health Care ◽  
Older People ◽  
Community Health ◽  
Hospital Admissions ◽  
Acute Hospital ◽  
Health Care Needs ◽  
Hospital Services ◽  
Model Of Care ◽  
Care Needs ◽  
Bed Days

Objective: The evaluation of a new model of care for older people with complex health care needs that aimed to reduce their use of acute hospital services. Method: Older people (over 55 years) with complex health care needs, who had made three or more presentations to a hospital emergency department (ED) in the previous 12 months, or who were identified by community health care agencies as being at risk of making frequent ED presentations, were recruited to the project. The participants were allocated a ?care facilitator? who provided assistance in identifying and accessing required health care services, as well as education in aspects of self management. Data for the patients who had been participants on the project for a minimum of 90 days (n = 231) were analysed for their use of acute hospital services (ED presentations, admissions and hospital bed-days) for the period 12-months pre-recruitment and postrecruitment. A similar analysis on the use of hospital services was conducted on the data of patients who were eligible and who had been offered participation, but who had declined (comparator group; n=85). Results: Post recruitment, the recruited patients displayed a 20.8% reduction in ED presentations, a 27.9% reduction in hospital admissions, and a 19.2% reduction in bed-days. By comparison, the patients who declined recruitment displayed a 5.2% increase in ED presentations, a 4.4 % reduction in hospital admissions, and a 15.3% increase in inpatient bed-days over a similar timeframe. Conclusion: A model of care that facilitates access to community health services and provides coordination between existing services reduces hospital demand.

scholarly journals Home Alone or Not? A Mixed Methods Study of Different Perceptions of Social Isolation between Care Managers and Older Housebound Adults

2016 ◽  
Vol 1 (1) ◽  
Keyword(s):  
Mixed Methods ◽  
Older People ◽  
Social Isolation ◽  
Well Being ◽  
Mixed Methods Study ◽  
Assessment Process ◽  
Older Person ◽  
Care Needs ◽  
Care Manager ◽  
Care Managers

Purpose: This paper aims to discuss whether the level of social isolation and loneliness as assessed by care managers corresponds to the level of social isolation and loneliness as perceived by the older persons whose care needs are being assessed. Design/methodology/approach: This mixed methods study followed up the assessment of 40 older people by 20 care managers with a focus on the accuracy of the care manager’s assessment on the level of social isolation experienced by the service user. In order for this to be achieved structured interviews were conducted with both the older person and the care manager assessing their needs, with a specific focus on the assessment of loneliness and social isolation. Following these initial interviews two focus groups were then undertaken with the care manager to discuss the findings and unpack the assessment process. Findings: The key issues were that the true level of social isolation and loneliness was under assessed by the care manager completing the assessment. That the care manager’s assessment was predominantly focused on the physical well-being of the older person and heavily influenced by the assessment paperwork. Originality/value: This provides lessons for professionals about the lack of effectiveness of their assessment of social isolation and loneliness in older people, and the potential impact this has on the older person’s quality of life.

scholarly journals Respite care and short breaks for young adults aged 18–40 with complex health-care needs: mixed-methods systematic review and conceptual framework development

2021 ◽  
Vol 9 (6) ◽  
pp. 1-268
Author(s):  
Katherine Knighting ◽  
Gerlinde Pilkington ◽  
Jane Noyes ◽  
Brenda Roe ◽  
Michelle Maden ◽  
...  
Keyword(s):  
Health Care ◽  
Young Adults ◽  
Mixed Methods ◽  
Cost Effectiveness ◽  
Conceptual Framework ◽  
Respite Care ◽  
Knowledge Map ◽  
Health Care Needs ◽  
Care Needs ◽  
Adult Services

Background The number of young adults with complex health-care needs due to life-limiting conditions/complex physical disability has risen significantly over the last 15 years, as more children now survive into adulthood. The transition from children to adult services may disrupt provision of essential respite/short break care for this vulnerable population, but the impact on young adults, families and providers is unclear. Aim To review the evidence on respite care provision for young adults (aged 18–40 years) with complex health-care needs, provide an evidence gap analysis and develop a conceptual framework for respite care. Design A two-stage mixed-methods systematic review, including a knowledge map of respite care and an evidence review of policy, effectiveness, cost-effectiveness and experience. Data sources Electronic databases and grey/unpublished literature were searched from 2002 to September 2019. The databases searched included Cumulative Index to Nursing and Allied Health Literature, MEDLINE, EMBASE, PsycINFO, Applied Social Sciences Index and Abstracts, Health Management Information Consortium, PROSPERO, Turning Research into Practice, COnNECT+, British Nursing Index, Web of Science, Social Care Online, the National Institute for Health Research Journals Library, Cochrane Effective Practice and Organisation of Care specialist register, databases on The Cochrane Library and international clinical trials registers. Additional sources were searched using the CLUSTER (Citations, Lead authors, Unpublished materials, Scholar search, Theories, Early examples, Related projects) approach and an international ‘call for evidence’. Methods and analysis Multiple independent reviewers used the SPICE (Setting, Perspective, Intervention/phenomenon of interest, Comparison, Evaluation) framework to select and extract evidence for each stage, verified by a third reviewer. Study/source characteristics and outcomes were extracted. Study quality was assessed using relevant tools. Qualitative evidence was synthesised using a framework approach and UK policy was synthesised using documentary content analysis. GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research) was used to assess confidence in the evidence. Logic models developed for each type of respite care constituted the conceptual framework. Results We identified 69 sources (78 records) from 126,267 records. The knowledge map comprised the following types of respite care: residential, home based, day care, community, leisure/social provision, funded holidays and emergency. Seven policy intentions included early transition planning and prioritising respite care according to need. No evidence was found on effectiveness and cost-effectiveness. Qualitative evidence focused largely on residential respite care. Facilitators of accessible/acceptable services included trusted and valued relationships, independence and empowerment of young adults, peer social interaction, developmental/age-appropriate services and high standards of care. Barriers included transition to adult services, paperwork, referral/provision delay and travelling distance. Young adults from black, Asian and minority ethnic populations were under-represented. Poor transition, such as loss of or inappropriate services, was contrary to statutory expectations. Potential harms included stress and anxiety related to safe care, frustration and distress arising from unmet needs, parental exhaustion, and a lack of opportunities to socialise and develop independence. Limitations No quantitative or mixed-methods evidence was found on effectiveness or cost-effectiveness of respite care. There was limited evidence on planned and emergency respite care except residential. Conclusions Policy intentions are more comprehensively met for young people aged < 18 years who are accessing children’s services. Young adults with complex needs often ‘fall off a cliff’ following service withdrawal and this imbalance needs addressing. Future work Research to quantify the effectiveness and cost-effectiveness of respite care to support service development and commissioning. Development of a core set of outcomes measures to support future collation of evidence. Study registration This study is registered as PROSPERO CRD42018088780. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 6. See the NIHR Journals Library website for further project information.

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