ObjectivePatient navigators are a promising mechanism to link patients with primary care. While navigators have been used in population health promotion and prevention programmes, their impact on access to primary care is not clear. The aim of this scoping review was to examine the use of patient navigators to facilitate access to primary care and how they were defined and described, their components and the extent to which they were patient centred.Setting and participantsWe used the Arksey and O’Malley scoping review method. Searches were conducted in MEDLINE, Embase, ProQuest Medical, other key databases and grey literature for studies reported in English from January 2000 to April 2016. We defined a patient navigator as a person or process creating a connection or link between a person needing primary care and a primary care provider. Our target population was people without a regular source of, affiliation or connection with primary care. Studies were included if they reported on participants who were connected to primary care by patient navigation and attended or made an appointment with a primary care provider. Data analysis involved descriptive numerical summaries and content analysis.ResultsTwenty studies were included in the final scoping review. Most studies referred to ‘patient navigator’ or ‘navigation’ as the mechanism of connection to primary care. As such, we grouped the components according to Freeman’s nine-principle framework of patient navigation. Seventeen studies included elements of patient-centred care: informed and involved patient, receptive and responsive health professionals and a coordinated, supportive healthcare environment.ConclusionsPatient navigators may assist to connect people requiring primary care to appropriate providers and extend the concept of patient-centred care across different healthcare settings. Navigation requires further study to determine impact and cost-effectiveness and explore the experience of patients and their families.

Aims and objectives To explore the healthcare professionals (HCP) experience of providing care coordination to people living with multimorbidity. Background There is increasing interest in improving care of people living with multimorbidity who need care coordination to help manage their health. Little is known about the experiences of HCP working with people living with multimorbidity. Design Phenomenological approach to understanding the experiences of HCP. Methods We interviewed 18 HCP, including 11 registered nurses, working in care coordination in Melbourne, Australia. We used interpretative phenomenological analysis to identify themes from descriptions of providing care, identifying and responding to a person’s needs, and the barriers and facilitators to providing person‐centred care. Results We identified four themes as follows: (a) Challenge of focusing on the person; (b) “Hear their story,” listening to and giving time to clients to tell their story; (c) Strategies for engagement in the programme; and, (d) “See the bigger picture,” looking beyond the disease to the needs of a person. Our results are reported using COREQ. Conclusions The HCP experienced challenges to a traditional approach to care when focusing on the person. They described providing care that was person‐centred, and acknowledged that optimal, guideline‐oriented care might not be achieved. They took the necessary time to hear the story and see the context of the person’s life, to help the person manage their health. Relevance to clinical practice For registered nurses in care coordination programmes, focusing on the client may challenge traditional approaches to care. Providing care involves developing a relationship with the client to optimise health outcomes. Experienced registered nurses appear to use skills in reflective practice and accept the parameters of care to improve the client’s health and well‐being.

Purpose To investigate if first-year occupational therapy students who have had no on-campus, face-to-face learning experiences differed from second-, third- and fourth-year students in their perceptions and experiences of online learning during the Covid-19 pandemic. Methods One hundred and fifty-one occupational therapy undergraduate students (80.8% female; 66.2% 20–24 old) completed the Student Engagement in the e-Learning Environment Scale (SELES) and the Distance Education Learning Environment Scale (DELES). Analysis of variance (ANOVA) with bootstrapping was completed to examine the differences between first-year and senior students’ perceptions and experiences of online learning. Results Significant differences were observed across several SELES and DELES scales: peer collaboration (SELES) (p = .001), interactions with instructors (SELES) (p = .026), student interaction and collaboration (DELES) (p = .003), authentic learning (DELES) (p = .026) and active learning (DELES) (p = .013). Conclusion The findings demonstrate significant differences in first-year and senior students’ perceptions and experiences of online learning during the Covid-19 pandemic. The outcomes highlight the importance of facilitating collaborative and active engagement for all students by implementing academic, technological and social support measures within occupational therapy curricula.

Introduction The rapid shift to digital platforms during the COVID‐19 pandemic enabled occupational therapy practice education to continue while creating unique learning opportunities for students in an environment of high demand for practice education providers. How occupational therapy practice educators experienced fieldwork supervision during this rapid redesign of service delivery is not widely understood. This study aimed to explore the experiences of practice educators who supervised occupational therapy students during the COVID‐19 pandemic in Australia. Methods Fifteen occupational therapy practice educators participated in focus groups and individual semi‐structured interviews. Reflexive thematic analysis was used to understand the experiences of the participants and explore the barriers and facilitators to providing practice education in this context. Findings The experiences of the occupational therapy practice educators were interpreted into three themes: (1) Opportunities lost and then created (as two subthemes); (2) The relationship between the student and practice educator (comprising subthemes of practicing self‐care and connection and support); and (3) Signing‐off of students' competencies . While digital platforms were initially viewed as limiting, they also were used to create new opportunities for student learning. Participants spoke of being mindful of their and students' wellbeing and finding ways to provide connection and support. Participants were challenged by the need to adapt how they evaluated students in the context of a pandemic. Conclusion The findings of this study highlight the complexities of occupational therapy practice education in the rapidly shifting context of the COVID‐19 pandemic in Australia. The outcomes highlight the importance of creating new ways of using digital platforms during practice education while focussing on the relationships with students.

ObjectivesWe aimed to identify the core elements of centredness in healthcare literature. Our overall research question is: How has centredness been represented within the health literature published between 1990 and 2019?MethodsA scoping review across five databases (Medline (Ovid), PsycINFO, CINAHL, Embase (Ovid) and Scopus; August 2019) to identify all peer-reviewed literature published since 1990 that focused on the concept of centredness in any healthcare discipline or setting. Screening occurred in duplicate by a multidisciplinary, multinational team. The team met regularly to iteratively develop and refine a coding template that was used in analysis and discuss the interpretations of centredness reported in the literature.ResultsA total of 23 006 title and abstracts, and 499 full-text articles were screened. A total of 159 articles were included in the review. Most articles were from the USA, and nursing was the disciplinary perspective most represented. We identified nine elements of centredness: Sharing power; Sharing responsibility; Therapeutic relationship/bond/alliance; Patient as a person; Biopsychosocial; Provider as a person; Co-ordinated care; Access; Continuity of care. There was little variation in the concept of centredness no matter the preceding word (eg, patient-/person-/client-), healthcare setting or disciplinary lens. Improving health outcomes was the most common justification for pursuing centredness as a concept, and respect was the predominant driving value of the research efforts. The patient perspective was rarely included in the papers (15% of papers).ConclusionsCentredness is consistently conceptualised, regardless of the preceding word, disciplinary lens or nation of origin. Further research should focus on centring the patient perspective and prioritise research that considers more diverse cultural perspectives.

This paper reports on two studies that used qualitative thematic and quantitative linguistic analysis, respectively, to assess the content and language of the largest ever sample of graded research impact case studies, from the UK Research Excellence Framework 2014 (REF). The paper provides the first empirical evidence across disciplinary main panels of statistically significant linguistic differences between high-versus low-scoring case studies, suggesting that implicit rules linked to written style may have contributed to scores alongside the published criteria on the significance, reach and attribution of impact. High-scoring case studies were more likely to provide specific and high-magnitude articulations of significance and reach than low-scoring cases. High-scoring case studies contained attributional phrases which were more likely to attribute research and/or pathways to impact, and they were written more coherently (containing more explicit causal connections between ideas and more logical connectives) than low-scoring cases. High-scoring case studies appear to have conformed to a distinctive new genre of writing, which was clear and direct, and often simplified in its representation of causality between research and impact, and less likely to contain expressions of uncertainty than typically associated with academic writing. Highscoring case studies in two Main Panels were significantly easier to read than low-scoring cases on the Flesch Reading Ease measure, although both high-scoring and low-scoring cases tended to be of "graduate" reading difficulty. The findings of our work enable impact case study authors to better understand the genre and make content and language choices that communicate their impact as effectively as possible. While directly relevant to the assessment of impact in the UK's Research Excellence Framework, the work also provides insights of relevance to institutions internationally who are designing evaluation frameworks for research impact.

Aim: To explore recent research on care coordination interventions for people living with multimorbidity, from the perspective of the person receiving care. Background: Care coordination interventions for people living with multimorbidity show some effectiveness in improving management of their health and reducing potentially preventable hospitalisations. The experience of people enrolled in care coordination interventions requires further exploration. Design: State-of-the-art review. Methods: A review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist where five databases (The Cochrane Library, PsycINFO, Scopus, CINAHL and MEDLINE) were searched for qualitative sources published from January 2008-March 2019. Two additional databases focused on multimorbidity and integrated care were included in the search. Titles, abstracts and full texts were screened using inclusion criteria. Reference lists of the included articles were hand-searched. Summary tables were developed for data extraction, and the data were mapped to the research question. Results: Eighteen primary research articles were included. Three themes of participant experience were identified: (a) relationships built on trust, (b), a sense of safety and security and (c) feeling cared for and respected. Conclusion: The contribution of qualitative approaches to evaluating the experiences of care for people living with multimorbidity is growing. Participants' describe a focus on relationships formed with healthcare professionals during care coordination. Further research incorporating lived experiences of participants could illuminate these concepts further. Relevance to clinical practice: People living with multimorbidity who require assistance via care coordination value trusting relationships with healthcare professionals, who respect their needs and provide a sense of security. Understanding participant experiences is important to shape care coordination interventions that incorporate person-centred approaches. Additional supporting information may be found online in the Supporting Information section. How to cite this article: Peart A, Barton C, Lewis V, Russell G. A state-of-the-art review of the experience of care coordination interventions for people living with multimorbidity.

IntroductionChronic conditions are associated with over one-third of potentially avoidable hospitalisations. Integrated care programmes aim to help people with chronic conditions to self-manage their health, thus avoiding hospital admissions. While founded on principles of person-centred care, the experiences of people with multiple chronic conditions in integrated care programmes are not widely known. Our study will explore how person-centred care is incorporated into an integrated care programme for people with multiple chronic conditions.Methods and analysisThis is a qualitative phenomenological study being conducted from March 2018 to June 2019, in a large metropolitan health service in Melbourne, Australia. Participants will be programme clients (and/or their carers) and staff working in the programme. We will interview staff about their experiences of the programme. Recruited staff will assist with recruitment of clients who recently completed an episode of care, to participate in a semistructured interview in their home. We will also analyse the medical records of interviewed clients, and observe outpatient clinics connected to the programme, based on the findings of the interviews. We will analyse all data using thematic analysis, with overarching themes representing staff and client perspectives of person-centred care.Ethics and disseminationEthical approval was granted by Monash Health (HREC/18/MonH/33) and Monash University (12260) Human Research Ethics Committees. Our study will provide a comprehensive exploration of person-centred care in an integrated care programme. It will add information to person-centred care literature on participants’ perceptions of what works and why, including barriers and enablers to person-centred care in a complex environment. Findings of this study will be disseminated via publications, conferences and presentations to the health service participants.