Care Planning Meetings: Issues for Policy, Multi-disciplinary Practice and Patient Participation

Donnelly, Sarah; Cahill, Suzanne; O’Neill, Desmond

doi:10.1080/09503153.2017.1385758

Cited by 4 publications

(3 citation statements)

References 65 publications

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“…One of the major reasons for non-involvement is the lack of opportunity to be involved or that there are few or no choices made available to them (Smebye, Kirkevold, & Engedal, 2012). In addition, it’s been found that the physical involvement of older people in care planning and decision-making does not necessarily guarantee genuine involvement (Donnelly, Cahill, & O’Neill, 2017; Donnelly et al., 2013; Hedberg, Cederborg, & Johanson, 2007). Organisational pressures such as discharge deadlines, limited resources and time pressures can make for hurried decision-making practices which can contribute to the older person feeling coerced into processes and plans that are not sensitive to their needs or wishes (Drystad, Laugaland, & Storm, 2015).…”

Section: Introductionmentioning

confidence: 99%

How are people with dementia involved in care-planning and decision-making? An Irish social work perspective

Donnelly

Begley

O’Brien³

2018

Dementia

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In recent years, there have been national and international policy advances around capacity and decision-making and an apparent burgeoning rights-based approach to the issue, all of which have the potential to impact on the experience for people with dementia in Ireland. There is little evidence however on whether these policies and principles are being translated into practice and whether traditional paternalistic approaches to decision-making are being challenged. To gain insight into current practice, research was undertaken with social workers working with older people in Ireland; reporting on the involvement of people living with dementia in care-planning processes. Data collection included a mixed method approach; an on-line survey of social workers from across the country who reported on their open caseload during the month of June 2015 (N = 38 social workers reporting on the experiences of 788 older people, of which 39% of older people had a formal diagnosis of dementia). In addition, semi-structured telephone interviews were conducted with social workers working in the nine Community Health Organisation areas (N = 21). Findings show that people with dementia were high users of social work services, accounting for 44.5% of the client group. Social workers reported that there were no standardised approaches to how Health and Social Care Professionals involved people with dementia in care planning and decision-making. Overall, people with dementia were more likely to be excluded from decision-making processes due to (i) assumptions that they lacked capacity, (ii) family members preferences that the person was not involved, (iii) communication difficulties, (iv) time constraints, (v) little or no opportunity given or (vi) the person delegated decision-making to others. Good practices were identified through multidisciplinary team approaches and formal care planning meetings. This research highlights variability in how people with dementia participate in decision-making around their care. It sheds light on existing barriers which challenge the full implementation of the Irish Assisted Decision-Making legislation; highlighting the need for appropriate guidance and education for Health and Social Care Professionals. The findings also show that family dynamics and existing relationships can play a role in how people with dementia participate and are involved. To ensure consistent opportunities for participation, effective practices and approaches to supporting the participation of people living with dementia in care planning needs to be developed and rolled out in all care settings through increased training and adoption of standardised approaches.

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Section: Introductionmentioning

confidence: 99%

How are people with dementia involved in care-planning and decision-making? An Irish social work perspective

Donnelly

Begley

O’Brien³

2018

Dementia

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“…A number of models have been proposed to identify successful approaches to improving care integration [1]. Common interventions to improve collaboration and integration of care at the patient level are the use of case managers, multi-disciplinary teams, geriatric risk assessments, and care planning meetings [18][19][20]. At the organizational level, integration can be achieved through financial incentive networks (e.g.…”

Section: Models Of Integrated Carementioning

confidence: 99%

The Impact of the Swedish Care Coordination Act on Hospital Readmission and Length-of-Stay among Multi-Morbid Elderly Patients: A Controlled Interrupted Time Series Analysis

Spangler¹,

Linder²,

Winblad

2023

International Journal of Integrated Care

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Coordinating follow-up care after discharge from hospital is critical to ensuring good outcomes for patients, but is difficult when multiple care providers are involved. In 2018, Sweden adopted the Care Coordination Act, which modified economic incentives to reduce discharge delays and mandated a discharge planning process for patients requiring post-discharge social-or primary care services. This study evaluates the impact of this reform on hospital length-of-stay and unplanned readmissions among multi-morbid elderly patients.Interrupted time series analysis of all in-patient care episodes involving multi-morbid elderly patients in Sweden from 2015 -2019 (n = 2 386 039) was performed. Secondary analyses using case-mix adjustment and controlled interrupted time series analysis were employed to assess for bias.Average length of stay decreased during the post-reform period, corresponding to 248 521 saved care days. Unplanned readmissions meanwhile increased, corresponding to 7 572 excess unplanned readmissions. While reductions in length-of-stay were concentrated among patients targeted by the reform, increases in readmission rates were similar in patients not targeted by the reform, indicating potential confounding. The reform thus appears to have achieved its goal of decreasing in-patient length of stay, but a robust effect on readmissions, outpatient visits, or mortality was not found. This may be due to lackluster implementation or an ineffective mandated intervention.

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“…Moreover, according to Donnelly et al (2018) who conducted a study on patient participation and care-planning meetings, the results can conclude that nowadays there is a considerable attention on new models and plans for healthcare management and organization, as CPM and communication between operators, due to an increased participation and empowerment in the patients, with a noticeable effects in elder people, mainly if affected from a chronical disease.…”

mentioning

confidence: 99%

Exploring patient empowerment

Ippolito

Smaldone

Ruberto

2019

TQM

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Purpose The purpose of this paper is to develop a research framework for exploring and improving patient empowerment through the analysis of the effects produced by a satisfying physician relationship on patient involvement in the healthcare process. Design/methodology/approach The authors begin with a literature review of patient empowerment in healthcare, useful to highlight the importance of relational aspects. Then, the authors tested the hypotheses of the research through the analysis of 450 questionnaires. The results are analyzed through covariance-based structural equation modeling. Findings This paper highlights how empowerment is a more complex phenomenon, needing many dimensions to be investigated. The hypotheses were tested, and correlations computed, highlighting a medium-strong positive correlation between physician relationship and patient involvement determining satisfying patient empowerment. Research limitations/implications The considerations conducted in the paper are restricted to physician relationship and needs further research aimed to analyze and evaluate the changes in the patient behaviors influenced by empowerment. Practical implications The research points offer new insight into patient empowerment and allow the healthcare provider to create new opportunities for promoting patient empowerment through the development of quality relationship for effective patient involvement. Originality/value The study developed contributes new insight about patient empowerment in the healthcare management literature, proving the key role of satisfying physician relationship useful for future researches.

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Care Planning Meetings: Issues for Policy, Multi-disciplinary Practice and Patient Participation

Cited by 4 publications

References 65 publications

How are people with dementia involved in care-planning and decision-making? An Irish social work perspective

How are people with dementia involved in care-planning and decision-making? An Irish social work perspective

The Impact of the Swedish Care Coordination Act on Hospital Readmission and Length-of-Stay among Multi-Morbid Elderly Patients: A Controlled Interrupted Time Series Analysis

Exploring patient empowerment

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