Service Users’ and Caregivers’ Perspectives on Continuity of Care in Out-of-Hours Primary Care

Abstract

Modernization policies in primary care, such as the introduction of out-of-hours general practice cooperatives, signify a marked departure from many service users' traditional experiences of continuity of care. We report on a case study of accounts of service users with chronic conditions and their caregivers of continuity of care in an out-of-hours general practice cooperative in Ireland. Using Strauss and colleagues' Chronic Illness Trajectory Framework, we explored users' and caregivers' experiences of continuity in this context. Whereas those dealing with "routine trajectories" were largely satisfied with their experiences, those dealing with "problematic trajectories" (characterized by the presence of, for example, multimorbidity and complex care regimes) had considerable concerns about continuity of experiences in this service. Results highlight that modernization policies that have given rise to out-of-hours cooperatives have had a differential impact on service users with chronic conditions and their caregivers, with serious consequences for those who have "problematic" trajectories.

Methodology or method? A critical review of qualitative case study reports

“…Possible limitations of a convenience sample were not acknowledged. Purposeful sampling was used to recruit participants within the case of one study, but not of the case itself (Gallagher et al, 2013). Random sampling was completed for case selection in two studies (Colón-Emeric et al, 2010; Jackson et al, 2012), which has limited meaning in interpretive qualitative research.…”

“…Adequate contextual description is required to understand the setting or context in which the case is revealed. In the health category, case studies were used to illustrate a clinical phenomenon or issue such as compliance and health behaviour (Colón-Emeric et al, 2010; D'Enbeau, Buzzanell, & Duckworth, 2010; Gallagher et al, 2013; Hooghe et al, 2012; Jackson et al, 2012; Roscigno et al, 2012). In these case studies, contextual boundaries, such as physical and institutional descriptions, were not sufficient to understand the case as a holistic system, for example, the general practitioner (GP) clinic in Gallagher et al (2013), or the nursing home in Colón-Emeric et al (2010).…”

“…In the health category, case studies were used to illustrate a clinical phenomenon or issue such as compliance and health behaviour (Colón-Emeric et al, 2010; D'Enbeau, Buzzanell, & Duckworth, 2010; Gallagher et al, 2013; Hooghe et al, 2012; Jackson et al, 2012; Roscigno et al, 2012). In these case studies, contextual boundaries, such as physical and institutional descriptions, were not sufficient to understand the case as a holistic system, for example, the general practitioner (GP) clinic in Gallagher et al (2013), or the nursing home in Colón-Emeric et al (2010). Similarly, in the social science and methods categories, attention was paid to some components of the case context, but not others, missing important information required to understand the case as a holistic system (Alexander, Moreira, & Kumar, 2012; Buzzanell & D'Enbeau, 2009; Nairn & Panelli, 2009; Wimpenny & Savin-Baden, 2012).…”

Patient Loyalty in a Mature IDS Market: Is Population Health Management Worth It?

“…The impact of health status on the probability of switching became meaningful for those who had high (+2.6 percent) and very high (+6.4 percent) health risk. This is counter to expectations, as the literature shows that those with a high frequency of visits place greater value on continuity of care (Nutting et al 2003;Mohammed Al-Azri and Ganguly 2009;Gallagher et al 2013). Those with diabetes, hypertension, and hyperlipidemia were less likely to switch care systems (À1.5 to À4.2 percent), but those who were frail were slightly more likely to switch (+1.8 percent).…”

How theory is used and articulated in qualitative research: Development of a new typology

“…Examples can be seen in Gibson's (2013) use of Foucault's notions of governmentality in a qualitative exploration of the enterprising nurse. Gallagher et al (2012) applied the Chronic Illness Trajectory Framework in their study on continuity of care, and Orzech's (2013) application of a bio-cultural model in adolescent sleep patterns is threaded throughout the publication. Petit et al (2013) refer to their underpinning theory throughout the paper and make an explicit statement about how it informed the analysis.…”