Residents’ perspectives of mobile X-ray services in support of healthcare-in-place in residential aged care facilities: a qualitative study

Abstract

Background Mobile X-ray services (MXS) could be used to investigate clinical issues in aged care residents within familiar surroundings, reducing transfers to and from emergency departments and enabling healthcare to be delivered in residential aged care facilities. There is however little research exploring consumer perspectives about such services. The objective of this research was to explore the perspectives and preferences of residents about the provision of MXS in residential aged care facilities, including their knowledge about the service, perceived benefits, and factors that require consideration for effective implementation. Methods A qualitative study design was used. The setting for the study included four residential aged care facilities of different sizes from different parts of a South Australian city. Purposive sampling was used to recruit participants. 16 residents participated in semi-structured interviews that were audio-recorded and transcribed verbatim. Data were inductively derived using thematic analysis. Results Participants had a mean age of 85 years, 56% were female, 25% had dementia and 25% had had a mobile X-ray in the last 12 months. Four themes were developed. Participants preferred mobile X-rays, provided as healthcare-in-place, to improve accessibility to them and minimize physical and psychological discomfort. Participants had expectations about the processes for receiving mobile X-rays. Costs of X-rays to people, family and society were a consideration. Decision making required residents be informed about mobile X-rays. Conclusions Residents have positive views of MXS as they can receive healthcare-in-place, with familiar people and surroundings. They emphasised that MXS delivered in residential aged care facilities need to be of equivalent quality to those found in other settings. Increased awareness of mobile X-ray services is required.

Economic and cost considerations of delivering and using mobile X‐ray services in residential aged care facilities: A qualitative study

“…A 2015 evaluation of MXS delivered by one Australian hospital to residents in RACFs demonstrated a 12% reduction in emergency department (ED) presentations 5 . Our recent qualitative research from the perspective of residents 6 and informal carers of residents (IC) 7 revealed strong support for using MXS in RACFs to achieve healthcare‐in‐place, concurring with the perspectives of health and aged care clinicians and managers (stakeholders) 8,9 …”

“…Stakeholders also observed this. This negates the policy aim of the Medicare call‐out rebate of promoting healthcare‐in‐place and reducing avoidable ED presentations, 19 and is counter to the preferences of many residents and IC to avoid transfer if possible 6,7 . Substituting ‘free’ services in response to avoiding an upfront cost with an out‐of‐pocket cost remaining to the resident after they receive their Medicare rebate has also been noted in other settings, 21 and are unlikely to be utilised equitably among residents, 21 many of whom have limited income with little money for ‘extras’.…”

“…paying for taxi) and non‐monetary (e.g. forfeiting other obligations) cost implications for residents and ICs, 7,14 which are not usually accounted for in health costing 23 . Without using MXS, the system relies on ICs' hidden input and opportunity costs, which residents prefer to avoid using 6 .…”

“…Therefore, one‐off semistructured interviews were conducted, in two phases. Phase 1 research protocol has been described previously but is briefly reported here 6–8 …”

“…Our qualitative research found that some residents 6 and ICs 7 of residents were willing to pay for a ‘call‐out’ fee because of the perceived benefits to residents and ICs, though this raised equity concerns. Furthermore, one IC highlighted that the fee paid upfront was a potential barrier to residents accessing MXS 7 . Our published research had limitations, however, in that we had not analysed data with stakeholders for economic and cost considerations.…”