Objectives: This study explored the care challenges experienced by older patients with multimorbidity, their informal caregivers and family physicians. Approach: Semi-structured interviews were conducted with 27 patients, their informal caregivers and family physicians. Qualitative description was used to identify key themes in the interview transcripts. Results: Participants experienced many common challenges when managing multimorbidity, including a lack of decision-making support, poor communication and uncoordinated health services. Within these themes, unique perspectives specific to the role of being a patient, caregiver or family physician emerged. Conclusion: The study adds to a limited evidence base on the experience of patients with multimorbidity. By including the perspectives of their family caregivers and physicians, we provide important insight into the management of multimorbidity and recommend the uptake of specific strategies to address them. Résumé Objectif : Cette étude explore les défis vécus par les patients aînés en situation de multimorbidité, leurs aidants naturels et leurs médecins de famille. Démarche : Des entrevues semi-dirigées ont été menées auprès de 27 patients, de leurs aidants naturels et de leurs médecins de famille. Les principaux thèmes des transcriptions des entrevues ont été dégagés à l' aide d'une description qualitative. Résultats : Les participants éprouvent plusieurs défis communs dans la gestion de la multimorbidité, notamment un manque de soutien pour la prise de décision, de mauvaises communications et des services de santé non coordonnés. Parmi ces thèmes, il y a émergence de points de vue uniques propres aux rôles du patient, de l' aidant ou du médecin. Conclusion : L' étude s' ajoute au peu de données fondées sur l' expérience des patients en situation de multimorbidité. En incluant les points de vue des aidants naturels et des médecins, nous apportons des pistes importantes pour la gestion de la multimorbidité et nous recommandons l' adoption de stratégies particulières pour aborder la question.
BackgroundGoal setting is a recommended approach in clinical care that can help individuals with multi-morbidities and their caregivers manage chronic conditions. In this paper, the types of goals that were important for older persons with multi-morbidities were explored from the perspectives of patients, their caregivers and physicians. Comparisons of goals were made across each patient, caregiver and physician triad to determine alignment.MethodsThe study was a qualitative descriptive study facilitated through semi-structured one-on-one interviews. The study took place between May and October 2012 at a Family Health Team located in Ontario, Canada. The sample included 28 family medicine patients, their informal caregivers and family physicians. Socio-demographic data were analyzed via descriptive statistics in SPSS Version 17. Open ended questions pertaining to patient goals of care were analyzed thematically using NVivo9. Themes were derived on patient care goals for each of the participant groups (patients, caregivers and family physicians). Following this, alignment of goals across each of the triads was examined. Goal alignment was defined as concurrence on at least one goal by all three parties in a particular triad (i.e., patient, caregiver and family physician).ResultsJust over half of the patients were male (56%); they had an average age of 82.3 years and 4.61 health conditions. Most of the caregivers were female (82%); and 61% were a spouse of the care recipient. At the aggregate level, common goals expressed among patients, caregivers and family physicians were the maintenance of functional independence of patients and the management of their symptoms or functional challenges. Despite these common goals at the aggregate level, little alignment of goals was found when looking across patient-caregiver and physician triads. Lack of alignment tended to occur when patients had unstable or declining functional or cognitive health; when safety threats were noted; and when enhanced care services were required.ConclusionsThe data suggest that goal divergence tends to occur when patients are less medically stable. While goal divergence may be expected due to the different roles and responsibilities of each of the players involved, these perspectives should be illuminated when building care plans. Further research is required to observe the extent to which goal setting occurs in family practice as well as how it can be embedded as a standard of practice.
This study investigated the perceived value of informal and formal supports for older adults with multi-morbidity from the perspectives of patients, care-givers and family physicians. Semi-structured interviews were conducted with patients, their informal care-givers and their family physicians in an urban academic family health team in Ontario. Analysis was conducted using a General Inductive Approach to facilitate identification of main themes and build a framework of perceived value of supports. Participant views converged on supports that facilitate patient independence and ease care-giver burden. However, important differences in participant perceptions arose regarding these priorities. Physicians and care-givers valued supports that facilitate health and safety while patients prioritised supports that enable self-efficacy and independence. While formal supports which eased care-giver burden were viewed positively by all members of the triad, many patients also rejected formal supports, citing that informal support from their care-giver was available. Such conflicts between patient, care-giver and physician-perceived value of supports may have important implications for consumer and care-giver willingness to accept formal supports when supports are available. These findings contribute to the broader literature on community-based care by incorporating the perspectives of patients, informal
HighlightsRaoultella Planticola is rarely associated with human infection and has not been described to-date in appendicitis.A novel case of R. planticola involvement in acute appendicitis is described.Bacteremia, likely secondary to micro-perforation of the appendix, was treated with amoxicillin- clavulanate.Homology to Klebsiella species and the increasing incidence of human infection warrants greater awareness of R. planticola.
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