Managing multiple chronic conditions in the community: a Canadian qualitative study of the experiences of older adults, family caregivers and healthcare providers

Abstract

BackgroundThe prevalence of multiple chronic conditions (MCC) among older persons is increasing worldwide and is associated with poor health status and high rates of healthcare utilization and costs. Current health and social services are not addressing the complex needs of this group or their family caregivers. A better understanding of the experience of MCC from multiple perspectives is needed to improve the approach to care for this vulnerable group. However, the experience of MCC has not been explored with a broad sample of community-living older adults, family caregivers and healthcare providers. The purpose of this study was to explore the experience of managing MCC in the community from the perspectives of older adults with MCC, family caregivers and healthcare providers working in a variety of settings.MethodsUsing Thorne’s interpretive description approach, semi-structured interviews (n = 130) were conducted in two Canadian provinces with 41 community-living older adults (aged 65 years and older) with three or more chronic conditions, 47 family caregivers (aged 18 years and older), and 42 healthcare providers working in various community settings. Healthcare providers represented various disciplines and settings. Interview transcripts were analyzed using Thorne’s interpretive description approach.ResultsParticipants described the experience of managing MCC as: (a) overwhelming, draining and complicated, (b) organizing pills and appointments, (c) being split into pieces, (d) doing what the doctor says, (e) relying on family and friends, and (f) having difficulty getting outside help. These themes resonated with the emotional impact of MCC for all three groups of participants and the heavy reliance on family caregivers to support care in the home.ConclusionsThe experience of managing MCC in the community was one of high complexity, where there was a large gap between the needs of older adults and caregivers and the ability of health and social care systems to meet those needs. Healthcare for MCC was experienced as piecemeal and fragmented with little focus on the person and family as a whole. These findings provide a foundation for the design of care processes to more optimally address the needs-service gap that is integral to the experience of managing MCC.

A pharmacy carer support service: obtaining new insight into carers in the community

“…Such knowledge would enable pharmacy staff to offer more extensive carer support, such as signposting carers to external organisations. Other research has demonstrated that carers may not know which services are available to them [27][28][29] and that pharmacists can fulfil an important role as information providers and/ or care coordinators. [30] Participants emphasised that information on key support organisations such as Carers Australia was underutilised in practice and that they only became aware of these agencies following training in this study.…”

The role of ‘mediators’ of communication in health professionals' intersectoral collaboration: An ethnographically inspired study

“…International literature on intersectoral collaboration often describes intersectoral collaboration as challenging, especially when it concerns elderly people with multimorbidity (Curry & Ham, ; Goodwin, Dixon, Anderson, & Wodchis, ; Moeller, ; Ploeg et al, ; Shiner, Steel, & Howe, ). In this literature, such challenges are typically explained as related to fragmentation of health services due to medical specialization.…”

Support for Australian carers from community pharmacy: Insight into carer perspectives of a novel service

“…It is also evident that community pharmacy services need to meet the needs of the individual consumer, as well as the existing gaps in healthcare practice (Hossain et al, ). With respect to our study, there was some consensus that this individualised service was suitably placed within the pharmacy setting, with an acknowledgement that some carers may need more support than others, although they may be resistant to obtaining support for various reasons, such as pride or independence (Ploeg et al, ). An important component of equipping pharmacy staff to deliver a carer support service would be to include strategies that support staff to explore where carers are situated in their individual journey, and to be able to respond accordingly.…”