Community-based primary health care for older adults: a qualitative study of the perceptions of clients, caregivers and health care providers

Abstract

BackgroundOlder persons are often poorly served by existing models of community-based primary health care (CBPHC). We sought input from clients, informal caregivers, and health care providers on recommendations for system improvements.MethodsFocus group interviews were held with clients, informal caregivers, and health care providers in mid-sized urban and rural communities in Ontario. Data were analyzed using a combination of directed and emergent coding. Results were shared with participants during a series of feedback sessions.ResultsAn extensive list of barriers, facilitators, and recommended health system improvements was generated. Barriers included poor system integration and limited access to services. Identified facilitators were person and family-focused care, self-management resources, and successful collaborative practice. Recommended system improvements included expanding and integrating care teams, supports for system navigation, and development of standardized information systems and care pathways.ConclusionsOlder adults still experience frustrating obstacles when trying to access CBPHC. Identified barriers and facilitators of improved system integration aligned well with current literature and Wagner’s Chronic Care Model. Additional work is needed to implement the recommended improvements and to discern their impact on patient and system outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-015-0052-x) contains supplementary material, which is available to authorized users.

From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

“…The template system increased productivity and allowed physicians to focus better on patient needs during their STEP 2 FINDINGS: COMPARING IDENTIFIED EVIDENCE TO THE INITIAL PROGRAMME THEORY NIHR Journals Library www.journalslibrary.nihr.ac.uk appointment. 116 Xenakis's study 78 corroborated this, and participants in other studies 108 lamented the lack of a template system in their EHR.…”

“…Twenty-eight patients and informal caregivers and 20 health-care providers in community-based PHC in Canada described MDTs as providing a holistic care experience to their patients. 108 A virtual MDT (team members linked remotely by telephone or HIT) and hospital-at-home schemes produced better patient experience with less inconvenience and disruption for the patient and family receiving paediatric health care. 76 In 'successful' US primary care-integrated complex care management programmes, the MDTs' key role was to build trusting relationships between patients and families, and primary care providers and their staff.…”

“…116 Causal link 6.7 -lack of workflow tools Many studies 78,108,116,117 reported that health workers wanted an IT system that would track patients more effectively. A number of studies mentioned such tools as task management systems, care planning systems, standardised care pathway templates for physicians, notification systems for changes in patient status and individual patient tracking through the health-care system.…”

“…91 A qualitative study of community-based PHC in Canada found that self-management support groups and resources allowed patients to be more engaged in maintaining their own health and helped to prepare them for discharge or care transitions. 108 Neither study reported what contexts (in realist terms) favour voluntary sector involvement.…”

“…) found that PCMH doctors who used EHRs had 'greater quality improvements and changes in 108 ) found evidence that electronic health systems could function as a way to improve patient safety, reduce medical errors, improve access to data and decrease staff time spent on administrative tasks. Through semistructured interviews with physicians in PCMHs, Petersen et al 82 found that well-designed EHRs allowed them to better co-ordinate care and share information.…”