scholarly journals Key stakeholder experiences of an integrated healthcare pilot in Australia: a thematic analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Steven A. Trankle ◽  
Tim Usherwood ◽  
Penelope Abbott ◽  
Mary Roberts ◽  
Michael Crampton ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Illness ◽  
Integrated Care ◽  
Thematic Analysis ◽  
Hospital Admissions ◽  
Developed Countries ◽  
Added Value ◽  
Self Management ◽  
Health Providers ◽  
Allied Health Professionals

Abstract Background In Australia and other developed countries, chronic illness prevalence is increasing, as are costs of healthcare, particularly hospital-based care. Integrating healthcare and supporting illness management in the community can be a means of preventing illness, improving outcomes and reducing unnecessary hospitalisation. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health funded a range of key strategies through the Western Sydney Integrated Care Program (WSICP) to integrate care across hospital and community settings for patients with these illnesses. Complementing our previously reported analysis related to specific WSICP strategies, this research provided information concerning overall experiences and perspectives of WSICP implementation and integrated care generally. Methods We administered 125 in-depth interviews in two rounds over 12 months with 83 participants including patients and their carers, care facilitators, hospital specialists and nurses, allied health professionals, general practitioners and primary care nurses, and program managers. Half of the participants (n = 42) were interviewed twice. We conducted an inductive, thematic analysis on the interview transcripts. Results Key themes related to the set-up and operationalising of WSICP; challenges encountered; and the added value of the program. Implementing WSICP was a large and time consuming undertaking but challenges including those with staffing and information technology were being addressed. The WSICP was considered valuable in reducing hospital admissions due to improved patient self-management and a focus on prevention, greater communication and collaboration between healthcare providers across health sectors and an increased capacity to manage chronic illness in the primary care setting. Conclusions Patients, carers and health providers experienced the WSICP as an innovative integrated care model and valued its patient-centred approach which was perceived to improve access to care, increase patient self-management and illness prevention, and reduce hospital admissions. Long-term sustainability of the WSICP will depend on retaining key staff, more effectively sharing information including across health sectors to support enhanced collaboration, and expanding the suite of activities into other illness areas and locations. Enhanced support for general practices to manage chronic illness in the community, in collaboration with hospital specialists is critical. Timely evaluation informs ongoing program implementation.

scholarly journals Key stakeholder experiences of an integrated healthcare pilot in Australia: A thematic analysis

2020 ◽  
Author(s):  
STEVEN TRANKLE ◽  
TIM USHERWOOD ◽  
PENELOPE ABBOTT ◽  
MARY ROBERTS ◽  
MICHAEL CRAMPTON ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Illness ◽  
Integrated Care ◽  
Thematic Analysis ◽  
Hospital Admissions ◽  
Developed Countries ◽  
Added Value ◽  
Self Management ◽  
Health Providers ◽  
Allied Health Professionals

Abstract BackgroundIn Australia and other developed countries, chronic illness prevalence is increasing, as are costs of healthcare, particularly hospital-based care. Integrating healthcare and supporting illness management in the community can be a means of preventing illness, improving outcomes and reducing unnecessary hospitalisation. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health funded a range of key strategies through the Western Sydney Integrated Care Program (WSICP) to integrate care across hospital and community settings for patients with these illnesses. Complementing our previously reported analysis related to specific WSICP strategies, this research provided information concerning overall experiences and perspectives of WSICP implementation and integrated care generally.MethodsWe administered 125 in-depth interviews in two rounds over 12 months with 83 participants including patients and their carers, care facilitators, hospital specialists and nurses, allied health professionals, general practitioners and primary care nurses, and program managers. Half of the participants (n=42) were interviewed twice. We conducted an inductive, thematic analysis on the interview transcripts.ResultsKey themes related to the set-up and operationalising of WSICP; challenges encountered; and the added value of the program. Implementing WSICP was a large and time consuming undertaking but challenges including those with staffing and information technology were being addressed. The WSICP was considered valuable in reducing hospital admissions due to improved patient self-management and a focus on prevention, greater communication and collaboration between healthcare providers across health sectors and an increased capacity to manage chronic illness in the primary care setting.Conclusions Patients, carers and health providers experienced the WSICP as an innovative integrated care model and valued its patient-centred approach which was perceived to improve access to care, increase patient self-management and illness prevention, and reduce hospital admissions. Long-term sustainability of the WSICP will depend on retaining key staff, more effectively sharing information including across health sectors to support enhanced collaboration, and expanding the suite of activities into other illness areas and locations. Enhanced support for general practices to manage chronic illness in the community, in collaboration with hospital specialists is critical. Timely evaluation informs ongoing program implementation.

scholarly journals Key stakeholder experiences of an integrated healthcare pilot in Australia: A thematic analysis

2020 ◽  
Author(s):  
Steven Trankle ◽  
Tim Usherwood ◽  
Penelope Abbott ◽  
Mary Roberts ◽  
Michael Crampton ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Illness ◽  
Integrated Care ◽  
Thematic Analysis ◽  
Hospital Admissions ◽  
Developed Countries ◽  
Added Value ◽  
Self Management ◽  
Health Providers ◽  
Allied Health Professionals

Abstract Background In Australia and other developed countries, chronic illness prevalence is increasing, as are costs of healthcare, particularly hospital-based care. Integrating healthcare and supporting illness management in the community can be a means of preventing illness, improving outcomes and reducing unnecessary hospitalisation. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health funded a range of key strategies through the Western Sydney Integrated Care Program (WSICP) to integrate care across hospital and community settings for patients with these illnesses. Complementing our previously reported analysis related to specific WSICP strategies, this research provided information concerning overall experiences and perspectives of WSICP implementation and integrated care generally.Methods We administered 125 in-depth interviews in two rounds over 12 months with 83 participants including patients and their carers, care facilitators, hospital specialists and nurses, allied health professionals, general practitioners and primary care nurses, and program managers. Half of the participants (n=42) were interviewed twice. We conducted an inductive, thematic analysis on the interview transcripts.Results Key themes related to the set-up and operationalising of WSICP; challenges encountered; and the added value of the program. Implementing WSICP was a large and time consuming undertaking but challenges including those with staffing and information technology were being addressed. The WSICP was considered valuable in reducing hospital admissions due to improved patient self-management and a focus on prevention, greater communication and collaboration between healthcare providers across health sectors and an increased capacity to manage chronic illness in the primary care setting.Conclusions Patients, carers and health providers experienced the WSICP as an innovative integrated care model and valued its patient-centred approach which was perceived to improve access to care, increase patient self-management and illness prevention, and reduce hospital admissions. Long-term sustainability of the WSICP will depend on retaining key staff, more effectively sharing information including across health sectors to support enhanced collaboration, and expanding the suite of activities into other illness areas and locations. Enhanced support for general practices to manage chronic illness in the community, in collaboration with hospital specialists is critical. Timely evaluation informs ongoing program implementation.

scholarly journals Key stakeholder experiences of an integrated healthcare pilot in Australia: A thematic analysis

2020 ◽  
Author(s):  
STEVEN TRANKLE ◽  
TIM USHERWOOD ◽  
PENELOPE ABBOTT ◽  
MARY ROBERTS ◽  
MICHAEL CRAMPTON ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Illness ◽  
Integrated Care ◽  
Thematic Analysis ◽  
Hospital Admissions ◽  
Developed Countries ◽  
Added Value ◽  
Fee For Service ◽  
Health Providers ◽  
Allied Health Professionals

Abstract Background In Australia and other developed countries, the prevalence of chronic illness is increasing, as are costs of healthcare, particularly hospital-based care. Integrating healthcare and supporting illness management in the community are seen as a means of preventing illness, improving outcomes and reducing unnecessary hospitalisation. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health funded a range of key strategies through the Western Sydney Integrated Care Program (WSICP) to integrate care across hospital and community settings for patients with these illnesses. Methods We aimed to explore how different stakeholders experienced the WSICP and investigate their broader perspectives on the care delivered. We administered 125 in-depth interviews in two rounds over 12 months with 83 participants including patients and their carers, care facilitators, hospital specialists and nurses, allied health professionals, general practitioners and primary care nurses, and program managers. Half of the participants (n=42) were interviewed twice. We conducted a thematic analysis on the interview transcripts. Results The key themes related to the set-up and operationalising of WSICP; challenges encountered; and the added value of the program. Implementing the WSICP was a large and time consuming undertaking but challenges including those with staffing and information technology were being addressed. The WSICP was considered to have value in reducing hospital admissions due to improved patient self-management and a focus on prevention, greater communication and collaboration between healthcare providers across health sectors and an increased capacity to manage chronic illness in the primary care setting. Conclusions Patients, carers and health providers experienced the WSICP as an innovative integrated care model and valued its patient centred approach. Long term sustainability of the WSICP will depend on more effectively sharing information including across health sectors to support enhanced collaboration, continuing its suite of strategies and expanding them into other illness areas and locations, and ongoing capacity building of primary health care. Funding reform of the current fee-for-service payment system was recommended to facilitate high quality management of chronic illness in the community.

scholarly journals Reducing unscheduled hospital care for adults with diabetes following a hypoglycaemic event: which community-based interventions are most effective? A systematic review

2021 ◽  
Author(s):  
Aoife Watson ◽  
Donna McConnell ◽  
Vivien Coates
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Integrated Care ◽  
Hospital Care ◽  
Hospital Admissions ◽  
Community Based Interventions ◽  
Community Based ◽  
Integrated Care Pathways ◽  
Effective Community ◽  
Balance Of Care

Abstract Aim To determine which community-based interventions are most effective at reducing unscheduled hospital care for hypoglycaemic events in adults with diabetes. Methods Medline Ovid, CINAHL Plus and ProQuest Health and Medical Collection were searched using both key search terms and medical subject heading terms (MeSH) to identify potentially relevant studies. Eligible studies were those that involved a community-based intervention to reduce unscheduled admissions in adults with diabetes. Papers were initially screened by the primary researcher and then a secondary reviewer. Relevant data were then extracted from papers that met the inclusion criteria. Results The search produced 2226 results, with 1360 duplicates. Of the remaining 866 papers, 198 were deemed appropriate based on titles, 90 were excluded following abstract review. A total of 108 full papers were screened with 19 full papers included in the review. The sample size of the 19 papers ranged from n = 25 to n = 104,000. The average ages within the studies ranged from 41 to 74 years with females comprising 57% of the participants. The following community-based interventions were identified that explored reducing unscheduled hospital care in people with diabetes; telemedicine, education, integrated care pathways, enhanced primary care and care management teams. Conclusions This systematic review shows that a range of community-based interventions, requiring different levels of infrastructure, are effective in reducing unscheduled hospital care for hypoglycaemia in people with diabetes. Investment in effective community-based interventions such as integrated care and patient education must be a priority to shift the balance of care from secondary to primary care, thereby reducing hospital admissions.

scholarly journals Identifying priorities for primary care investment in Ireland through a population-based analysis of avoidable hospital admissions for ambulatory care sensitive conditions (ACSC)

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e028744 ◽  
Author(s):  
Geraldine McDarby ◽  
Breda Smyth
Keyword(s):  
Primary Care ◽  
Ambulatory Care ◽  
Integrated Care ◽  
Hospital Admissions ◽  
Acute Hospital ◽  
Ambulatory Care Sensitive Conditions ◽  
Hospital System ◽  
Bed Days ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

BackgroundIn 2016, the Irish acute hospital system operated well above internationally recommended occupancy targets. Investment in primary care can prevent hospital admissions of ambulatory care sensitive conditions (ACSCs).ObjectiveTo measure the impact of ACSCs on acute hospital capacity in the Irish public system and identify specific care areas for enhanced primary care provision.DesignNational Hospital In-patient Enquiry System data were used to calculate 2011–2016 standardised bed day rates for selected ACSC conditions. A prioritisation exercise was undertaken to identify the most significant contributors to bed days within our hospital system. Poisson regression was used to determine change over time using incidence rate ratios (IRR).ResultsIn 2016 ACSCs accounted for almost 20% of acute public hospital beds (n=871 328 bed days) with adults over 65 representing 69.1% (n=602 392) of these. Vaccine preventable conditions represented 39.1% of ACSCs. Influenza and pneumonia were responsible for 99.8% of these, increasing by 8.2% (IRR: 1.02; 95% CI 1.02 to 1.03) from 2011 to 2016. Pyelonephritis represented 47.6% of acute ACSC bed days, increasing by 46.5% (IRR: 1.07; 95% CI 1.06 to 1.08) over the 5 years examined.ConclusionsPrioritisation for targeted investment in integrated care programmes is enabled through analysis of ACSC’s in terms of acute hospital bed days. This analysis demonstrates that primary care investment in integrated care programmes for respiratory ACSC’s from prevention to rehabilitation at scale could assist with bed capacity in acute hospitals in Ireland. In adults 65 years and over, including chronic obstructive pulmonary disease patients, the current analysis supports targeting community based pulmonary rehabilitation including pneumococcal and influenza vaccination programmes in order to reduce the burden of infection and hospitalisations. Further exploration of pyelonephritis is necessary in order to ascertain patient profile and appropriateness of admissions.

Integrated Pediatric Health Care in Pennsylvania: A Survey of Primary Care and Behavioral Health Providers

2018 ◽  
Vol 58 (2) ◽  
pp. 213-225 ◽  
Author(s):  
David J. Kolko ◽  
Eunice Torres ◽  
Kevin Rumbarger ◽  
Everette James ◽  
Renee Turchi ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Behavioral Health ◽  
Integrated Care ◽  
Primary Care Physicians ◽  
Empirical Literature ◽  
Health Providers ◽  
Pediatric Health ◽  
Care Experience ◽  
Pediatric Health Care

This study reports on a statewide survey of medical and behavioral health professionals to advance the knowledge base on the benefits and obstacles to delivering integrated pediatric health care. Surveys distributed in 3 statewide provider networks were completed by 110 behavioral health specialists (BHSs) and 111 primary care physicians (PCPs). Survey content documented their perceptions about key services, benefits, barriers, and needed opportunities related to integrated care. Factor analyses identified 8 factors, and other items were examined individually. We compared responses by specialty group (BHS vs PCP) and integrated care experience (no vs yes). The findings revealed differences across domains by specialty subgroup. In several cases, BHS (vs PCP) respondents, especially those with integrated care experience, reported lower benefits, higher barriers, and fewer resource requests. The implications of these results for enhancing care integration development, delivery, training, and research are discussed along with the study’s limitations and empirical literature.

Chronic illness and self-management: A patient's perspection

2003 ◽  
Vol 9 (3) ◽  
pp. 54
Author(s):  
Joanna Ng
Keyword(s):  
Primary Care ◽  
Chronic Illness ◽  
Self Management

As a person living with epilepsy, my primary care is delivered by my neurologist, my pharmacist, myself, my family and my friends. This paper will document not only the pathology of epilepsy, but also the biopsychosocial issues that affect people living with epilepsy.

scholarly journals The comorbidity of HIV, hypertension and diabetes: a qualitative study exploring the challenges faced by healthcare providers and patients in selected urban and rural health facilities where the ICDM model is implemented in South Africa

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Motlatso Godongwana ◽  
Nicole De Wet-Billings ◽  
Minja Milovanovic
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Integrated Care ◽  
Hospital Admissions ◽  
Financial Burden ◽  
Health Facilities ◽  
Health Concern ◽  
People Living With Hiv ◽  
Increased Risk ◽  
Chronic Comorbidities

Abstract Background PLWH are living longer as a result of advancement and adherence to antiretroviral therapy. As the life expectancy of PLWH increases, they are at increased risk of hypertension and diabetes. HIV chronic co-morbidities pose a serious public health concern as they are linked to increased use and need of health services, decreased overall quality of life and increased mortality. While research shows that integrated care approaches applied within primary care settings can significantly reduce hospital admissions and mortality levels among patients with comorbidities, the primary care system in South Africa continues to be challenged with issues about the delivery of quality care. Methods This study applied a phenomenological qualitative research design. IDIs were conducted with 24 HCPs and adults living with the comorbidity of HIV and either hypertension or diabetes across two provinces in South Africa. The objective of the research was to understand the challenges faced by HCPs and patients in health facilities where the ICDM model is implemented. The health facilities were purposively sampled. However, the HCPs were recruited through snowballing and the patients through reviewing the facilities’ clinic records for participants who met the study criteria. All participants provided informed consent. The data was collected between March and May 2020. The findings were analysed inductively using thematic content analysis. Results The challenges experienced included lack of staff capacity, unclear guidelines on the delivery of integrated care for patients with HIV chronic comorbidities, pill burden, non-disclosure, financial burden, poor knowledge of treatments, relocation of patients and access to treatment. Lack of support and integrated chronic programmes including minimal information regarding the management of HIV chronic comorbidities were other concerns. Conclusion The outcomes of the ICDM model need to be strengthened and scaled up to meet the unique health needs and challenges of people living with HIV and other chronic conditions. Strengthening these outcomes includes providing capacity building and training on the delivery of chronic care treatment under the ICDM model, assisted self-management to improve patient responsibility of chronic disease management and strengthening activities for comorbidity health promotion.

scholarly journals Non-disclosure of chronic kidney disease in primary care and the limits of instrumental rationality in chronic illness self-management

2015 ◽  
Vol 131 ◽  
pp. 31-39 ◽  
Author(s):  
Gavin Daker-White ◽  
Anne Rogers ◽  
Anne Kennedy ◽  
Thomas Blakeman ◽  
Christian Blickem ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Chronic Illness ◽  
Kidney Disease ◽  
Instrumental Rationality ◽  
Self Management

scholarly journals Diabetes distress and self-management in primary care in Singapore: explorations through illness perception

2019 ◽  
Vol 6 (2) ◽  
pp. 473
Author(s):  
Janice Quek ◽  
Grace Tan ◽  
Kokkwang Lim ◽  
Chee Khong Yap ◽  
Meiyin Wong ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Education ◽  
Emotional Reactivity ◽  
Illness Perception ◽  
Developed Countries ◽  
Self Management ◽  
Diabetes Distress ◽  
Dietary Control ◽  
Cross Sectional ◽  
Interpersonal Distress

Background: Singapore was recently ranked the second highest in the percentage of diabetic individuals among developed countries’ populations. This study explored possible associations among type 2 diabetes mellitus (T2DM) patients’ perception of having this condition (illness perception), diabetes-related distress, and diabetes self-management with a view to understanding potentially useful emphases in health education and counselling for these patients in primary health care.Methods: A cross-sectional sample of 75 adults diagnosed with T2DM at five primary care clinics under National Healthcare Group Polyclinics completed three research questionnaires in English and Mandarin which assessed the participants’ perception of their own diabetic condition, experience of diabetes distress, and self-management behaviour.Results: Illness perception has specific dimensions (identity, consequence, and emotional representation) that correlated with specific aspects of diabetes distress (emotional burden, interpersonal distress, regimen distress, and overall diabetes distress). Further, overall diabetes distress correlated negatively with dietary control, physical activity, and overall self-management.Conclusions: Patients with TSDM may benefit most from health education and guidance that aim to reduce both their perception of diabetes’ impact on their lives and emotional reactivity in managing their diabetic condition.

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