The care delivery experience of hospitalized patients with complex chronic disease

Abstract

ObjectiveThis study investigated what is important in care delivery from the perspective of hospital inpatients with complex chronic disease, a currently understudied population.Participants and SettingOne‐on‐one semi‐structured interviews were conducted with inpatients at a continuing care/rehabilitation hospital (n = 116) in Canada between February and July 2011.DesignThe study design was mixed methods and reports on patient characteristics and care delivery experiences. Basic descriptive statistics were run using SPSS version 17, and thematic analysis on the transcripts was conducted using NVivo9 software.ResultsPatients had an average of 5 morbidities and several illness symptoms including activity of daily living impairments, physical pain and emotional disturbance. Three broad themes (each with one or more subthemes) were generated from the data representing important components of care delivery: components of the care plan (a comprehensive assessment, supported transitions and a bio‐psycho‐social care package); care capacity and quality (optimal staff to patient ratios, quicker response times, better patient–provider communication and consistency between providers) and the patient–provider relationships (characterized by respect and dignity).ConclusionsAs health systems throughout the industrialized world move to sustain health budgets while optimizing quality of care, it is critical to better understand this population, so that appropriate metrics, services and policies can be developed. The study has generated a body of evidence on the important components of care delivery from the perspectives of a diverse group of chronically ill individuals who have spent a considerable amount of time in the health‐care system. Moving forward, exploration around the appropriate funding models and skill mix is needed to move the evidence into changed practice.

Results from 10 Years of a CBT Pain Self-Management Outpatient Program for Complex Chronic Conditions

“…Health-related QOL describes the physical, mental, social, psychological, and functional aspects of wellbeing from the patient's perspective [3]. Chronic pain afflicts 20–30% of the adult population in western countries [4, 5] and often accompanies other complex chronic conditions [6]. Notably, a recent survey by Kuluski et al [6] conducted at the same centre at which the present research was conducted, Bridgepoint Health, found that pain was the most commonly reported illness symptom by inpatients in a continuing care/rehabilitation hospital.…”

“It's a fight to get anything you need” — Accessing care in the community from the perspectives of people with multimorbidity

“…The patients in this study had an average of five health conditions and several illness symptoms including problems with daily activities, pain management and mental health issues. The qualitative results of the primary study revealed three broad themes that represent the important components of care delivery: components of the care plan, care capacity and quality and the patient–provider relationship …”

Evaluation of a Specialized Yoga Program for Persons Admitted to a Complex Continuing Care Hospital: A Pilot Study

“…Individuals with complex health conditions have been identified as unique in terms of their specific health care needs and health-related experiences [36]. Although the disease combinations reported in multimorbidity are diverse, the most common diagnoses are diabetes, stroke, hypertension, cancer, arthritis, asthma, fractures, the presence of an artificial knee or hip, fatigue, multiple sclerosis, demyelinating diseases of the central nervous system, gonarthrosis, ataxia, COPD, dependence on renal dialysis, malignant neoplasm of breast/prostate, depressive episodes, and pure hypercholesterolemia [39, 40]. Consistent across studies of this population is the severity of the impact of having multiple conditions [41].…”

“…Consistent across studies of this population is the severity of the impact of having multiple conditions [41]. Patients with CCDD have an average of five health conditions (comorbidities) [40] and frequently reported pain, weakness, illness-related symptoms, functional challenges (mobility, activities of daily living, equipment devices, etc. ), symptoms of anxiety and depression, and disruptions in independence, recreational activities, occupation, social roles, and self-identity.…”

“…Given the evidence supporting the use of yoga for many of the common primary and secondary diagnoses of patients with CCDD (e.g., musculoskeletal conditions, multiple sclerosis, hypertension, arthritis, renal disease, depression, diabetes, COPD, cholesterol levels, and breast and prostate cancer), it is possible that yoga may be able to address many of the multiple health needs these individuals report as being important [40]. Other frequently reported symptoms (e.g., pain, fatigue, emotional upset, nausea, and difficulty breathing) and facets of living that are disrupted (e.g., mobility, activities of living, and social well-being) have also been shown to improve with yoga practice [2, 19, 21, 55, 56].…”