We examined the telephone response rates in a 2-year study of patients with COPD to identify factors associated with non-response. A total of 381 patients received monthly telephone calls to assess symptoms and treatment in 2007 and 2008. A total of 9019 calls were made over 24 months, of which 73% were answered. The highest response rate was obtained in February 2007 (81%), and the lowest in July 2008 (48%). The monthly response rate was lower in the second year of follow up. There were 39 patients (10%) who were less frequent responders, with 10 or fewer responses. Less frequent responders were more likely to be current smokers and have hypoxaemia. The median number of answered calls was 18 (interquartile range 16-20). In bivariate models the median number of responses was significantly lower in subjects with chronic cough. In multivariate models neither demographic nor disease characteristics were significantly associated with non-response. We found less frequent responders to monthly telephone calls to be similar in characteristics to frequent responders. This suggests that non-response does not necessarily introduce bias in telephone surveys of patients with COPD.
Background Distributed Leadership (DL) has been suggested as being helpful when different health care professionals and patients need to work together across professional and organizational boundaries to provide integrated care (IC). This study explores whether General Practitioners (GPs) adopt leadership actions that transcend organizational boundaries to provide IC for patients and discusses whether the GPs’ leadership actions in collaboration with patients and health care professionals contribute to DL. Methods We interviewed GPs (n = 20) of elderly multimorbid patients in a municipality in Norway. A qualitative interpretive case design and Gioia methodology was applied to the collection and analysis of data from semi-structured interviews. Results GPs are involved in three processes when contributing to IC for elderly multimorbidity patients; the process of creating an integrated patient experience, the workflow process and the process of maneuvering organizational structures and medical culture. GPs take part in processes comparable to configurations of DL described in the literature. Patient micro-context and health care macro-context are related to observed configurations of DL. Conclusion Initiating or moving between different configurations of DL in IC requires awareness of patient context and the health care macro-context, of ways of working, capacity of digital tools and use of health care personnel.
BACKGROUND Due to the demographic changes in the elderly population worldwide, delivering coordinated care at home to multimorbid older adults is of great importance. Older adults living with multiple chronic conditions need information to manage and coordinate their care. eHealth can be effective for gaining sufficient information, communication, and self-management of chronic conditions for the elderly. There is a need for more knowledge on how multimorbid older adults participate in coordinating their care and for a better understanding of how eHealth supports their participation. OBJECTIVE This study aims to 1) gain knowledge on multimorbid older adults’ experiences with participation in care coordination with the general practitioner (GP) and district nurses (DNs), and 2) explore how eHealth supports their participation in care coordination. METHODS The study has a qualitative explorative approach. Data collection included semi-structured interviews with 20 older adults with multimorbidity receiving primary care services from their GPs and DNs. The participants were included by their GP or a nurse at a local inter-municipal acute inpatient care (AIC) unit. The data analysis was guided by systematic text condensations (STC). RESULTS We identified two categories: 1) Older adults in charge of and using eHealth to coordinate their care, 2) older adults with a loss of control to coordinate their care. The first category describes how communication with the GP and DNs can facilitate participation, the importance of managing own medication, and how eHealth can support older adults' information needs. The second category focuses on older adults who depend on guidance from their GP and DNs to manage their health, describing how lack of the capacity to be involved in information sharing makes these adults lose control of their care coordination. CONCLUSIONS Being in charge of care coordination is important for the elderly. Future research should lead to understanding of electronic information sharing among healthcare providers, as older adults experience a lack of involvement in the information sharing, which hampers participation. The results show that older adults are willing to use eHealth to be informed and seek information, which enables participation in care coordination.
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