Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil

Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes ...

Continuity of clinical management and information across care levels: perceptions of users of different healthcare areas in the Catalan national health system

The integration of health care has become a priority in most health systems, as patients increasingly receive care from several professionals in various different settings and institutions, particularly those with chronic conditions and multi-morbidities. Continuity of care is defined as one patient experiencing care over time as connected and coherent with his or her health needs and personal circumstances. The objective is to analyse perceptions of continuity of clinical management and information across care levels and the factors influencing it, from the viewpoint of users of the Catalan national health system.

The Development, Description and Appraisal of an Emergent Multimethod Research Design to Study Workforce Changes in Integrated Care Interventions

In this paper, they provide a detailed and explicit description of the processes and decisions underlying and shaping the emergent multimethod research design of their study on workforce changes in integrated chronic care. They argue that the terminology developed for the description of mixed methods designs should also be used for multimethod designs such as the one presented here. 

Identification of influencing factors and strategies to improve communication between general practitioners and community nurses: a qualitative focus group study

As the number of patients with complex healthcare needs grows, inter-professionaal collaboration between primary care professionals must be constantly optimized. General practitioners (GPs) and community nurses (CNs) are key professions in primary care; however, poor GP-CN communication is common, and research into the factors influencing its quality is limited. 

Barriers and Facilitators to Workforce Changes in Integrated Care

Health systems are faced with an ageing population and an increase in chronic conditions. These challenges require more appropriate approaches than the current largely single-disease and acute-care focussed health care systems. Integrated care is seen as one of the most promising of these approaches by targeting the health system, patient-provider relationships, care process design, communication infrastructures, community resources, and how care is delivered by health professionals. The aim of the study is to investigate the barriers and facilitators to the implementation of workforce changes implemented as part of integrated chronic care interventions.

Implementation of patient-centred care: which organisational determinants matter from decision maker’s perspective? Results from a qualitative interview study across various health and social care organisations

Health and social care systems, organisations and providers are under pressure to organise care around patients’ needs with constrained resources. To implement patient-centred care (PCC) successfully, barriers must be addressed. Up to now, there has been a lack of comprehensive investigations on possible determinants of PCC across various health and social care organisations (HSCOs). Our qualitative study examines determinants of PCC implementation from decision makers’ perspectives across diverse HSCOs.

What do older people want from integrated care? Experiences from a South Australian co-design case study

The challenges of improving the integration of care for older people with complex care needs are well recognised. Evidence suggests that solutions should be co-designed with older people to ensure they are contextually relevant and person-centred.

Becoming part of an upwards spiral: Meanings of being person-centred in nursing homes

Previous research suggests that person- centred care is positive for people living in nursing homes, but less is known on what motivates people working in nursing homes to be person- centred. Previous research has focused on person-centred care in relation to people in need of care, which may lead to a risk of viewing person- centred care as a means to achieve quality of care, and not as a means in itself. This study highlights health aspects of being person- centred from the perspective of people working in nursing homes, and complements previous research that describes the impact of person- centred care on people in need of care.

Codesigning person-centred quality indicators with diverse communities: A qualitative patient engagement study

Effective engagement of underrepresented communities in health research and policy remains a challenge due to barriers that hinder participation. Our study had two objectives: (1) identify themes of person-centred care (PCC) from perspectives of diverse patients/caregivers that would inform the development of person-centred quality indicators (PC-QIs) for evaluating the quality of PCC and initiatives to improve PCC and (2) explore innovative participatory approaches to engage ethnocultural communities in qualitative research. Incorporating patient and community voices requires addressing issues related to equity and understanding barriers to effective and meaningful engagement.

Short Communication: Opportunities and Challenges for Early Person-Centered Care for Older Patients in Emergency Settings

The provision of person-centered care (PCC) for older adults in emergency settings is important. This short communication explores the complexity of providing comprehensive PCC for older adults in emergency settings, based on a synthesis of existing literature and empirical data from a small-scale case study on the potential of improving patient engagement in a Danish emergency department (ED). Our findings highlight overall positive attitudes towards PCC, as patient engagement is perceived as important and feasible during the waiting hours that older patients experience. 

Rehabilitation Workforce Challenges to Implement Person-Centered Care

There is an increasing emphasis on developing person-centered care in rehabilitation settings. However, this care practice has not been fully implemented due to several factors. This study explores rehabilitation workforce perspectives on the barriers and facilitators to implementing person-centered care (PCC). Participants described barriers such as an unsupportive organization and leadership, staff constraints, heavy workload, and resistance to change. Unique to this study, a patient’s clinical characteristics were identified as barriers to person-centered care. As facilitators, they described leadership, staff satisfaction, a positive physical environment, training and education, and shared decision-making. It is essential to understand the perceptions of the rehabilitation workforce, as they play an integral role in providing PCC. This study serves as a guide to facilitate person-centered care, as it provides an understanding of key barriers and facilitators for its implementation in rehabilitation settings.

The role of primary care in informing and supporting people with limited health literacy in the Netherlands during the COVID-19 pandemic: a qualitative interview study

During the coronavirus disease 2019 (COVID-19) pandemic, people have been confronted with a large amount of information about the virus and the governmental measures against its spreading. However, more than a quarter of individuals have limited health literacy (HL), meaning that they have difficulty finding, understanding, and applying health information. The purpose of this interview study was to investigate how individuals with limited HL acquire information about COVID-19 and governmental measures, what difficulties they experience in understanding and applying it, and what may be needed to overcome these difficulties. We also addressed other problems that they might face as a result of the pandemic. Using our findings, we aimed to make recommendations on the possible role of primary care in informing and supporting patients with limited HL during the pandemic.

Person-centred care to prevent hospitalisations – a focus group study addressing the views of healthcare providers

The primary healthcare sector comprises various health services, including disease prevention at local level. Research shows that targeted primary healthcare services can prevent the development of acute complications and ultimately reduce the risk of hospitalisations. While interdisciplinary collaboration has been suggested as a means to improve the quality and responsiveness of personal care needs in preventive services, effective implementation remains a challenge.

Transforming Primary Care in New York Through Patient-Centered Medical Homes: Findings From Qualitative Research

he patient-centered medical home (PCMH) model, an important component of healthcare transformation in the United States, is an approach to primary care delivery with the goal of improving population health and the patient care experience while reducing costs. PCMH research most often focuses on system level indicators including healthcare use and cost; descriptions of patient and provider experience with PCMH are relatively sparse and commonly limited in scope. This study, part of a mixed-methods evaluation of a multi-year New York State initiative to refine and expand the PCMH model, describes patient and provider experience with New York State PCMH and its key components.

Person-centred care in individuals with stroke: a qualitative study using in-depth interviews

Person-centred care (PCC) has considerable effects on the clinical practice of health professionals. The purpose of this study was to describe the perspectives and perceived barriers and enablers of individuals with stroke regarding the PCC model in stroke rehabilitation.

In safe hands: a qualitative study on older adults’ experiences of a tailored primary health care unit

Today’s health care system faces challenges in meeting the needs of older people with multimorbidity. To better cope with these needs, tailored primary health care with geriatric competence and person-centred care has been suggested. The aim of this study was to explore older patients’ experiences of a tailored primary health care unit.

Examining the knowledge work of person-centred care: Towards epistemic reciprocity

It is increasingly recognised that when healthcare staff fails to give adequate credence to patients' illness-related knowledge work, this epistemic injustice undermines person-centred care. Therefore, we set out to examine the experiences of people with long-term conditions with knowledge work in healthcare settings to identify changes needed to strengthen person-centred primary care.

Highlights

Nursing students' experiences and perceptions of barriers to the implementation of person-centred care in clinical settings: A qualitative study

This study explored the barriers that nurses face while delivering person-centred care,  through  the  nursing  students'  experiences  during  clinical  prac-tice. This study showed that the barriers to implement person-centred care in clinical settings were busyness, educational challenges, lack of awareness, lack of relationship building and lack of policy approaches. 

‘Sometimes you need an eye-opener’: A qualitative study on nursing assistants' experiences of developing communication skills through an educational intervention on person-centred communication

To explore nursing assistants' (NAs') experiences of developing communication skills while participating in an educational intervention on person-centred communication. The findings describe NAs' experiences concerning the communication skills needed for building relationships with older persons and handling emotionally challenging situations. The educational intervention increased their knowledge and awareness of the importance of communication skills and how such skills are developed and refined.