The downward referral experiences of stroke caregivers in the regional medical alliance in China: A phenomenological study

Abstract

The downward referral platform in the regional medical alliance has provided more possibilities to follow-up rehabilitation and transitional care for increasing stroke survivors, which also has the most contributions in the rational use of resources and health promotion of stroke survivors. However the downward referral rate is low compared to upward referral. At present, no scholars have explored the downward referral experiences of medical demanders from the perspective of qualitative study, and these experiences may also most truly reflect the influencing factors of their unwillingness to downward referral. Therefore, this study explored the subjective experiences of stroke caregivers who had experienced the downward referral, because stroke attacks often lead to lack of autonomy of patients themselves, making it difficult to complete interviews with them. A descriptive phenomenological study was adopted. A purposive sampling strategy was used to recruit 13 stroke caregivers. Interviews were guided by a semi-structured interview-guide encouraging interviewees to reflect on their experiences with downward referral. Coliazzi’s data analysis process was applied. The analysis of the data revealed 4 themes: coping challenges; disrupted information; gaps in medical and nursing transition, and potential enabling factors. The results of this study showed that the lack of knowledge of medical alliance, non-sharing of medical information and non-homogeneousness of medical quality were identified to be impeding positive attitude towards downward referral and be factors of bad experiences. Of course, the interviewees had positive experiences such as smooth referral and comfortable environment. These may be potential enabling factors to their attitude towards downward referral. The challenges and needs of medical demanders after downward referral are worthy of attention, and these should be solved by corresponding measures to improve the downward referral rate and referral experiences.

Transition experiences of patients with post stroke dysphagia and family caregivers: A longitudinal, qualitative study

“…The transitional experience of PSD patients and their caregivers showed that the transfer of referral information between medical institutions at all levels needs to be improved. There was a lack of information sharing platforms between different levels of hoapitals and led to the fragmentation of patients’ health information [ 34 ], which may increase the frequency of swallowing function evaluation and the risk of aspiration. Discontinuous information transmission would also lead to a decline in patient satisfaction [ 35 ] and influencing the effectiveness of swallowing rehabilitation training.…”

Associations Among Organizational Capabilities, Organizational Performance and the Medical Alliance Implementation Effect in Community Health Centers in China: A Moderated Mediation Model

“…36,37 A better effect of medical alliances implementation maybe improve the basic medical service capabilities and management capabilities of CHCs, promote the rational allocation of medical staff, improve the satisfaction of medical staff, and enhance the basic and core capabilities of CHCs, which may have a positive impact on organizational performance. [38][39][40] In contrast, a poor effect of medical alliance implementation affects the improvement of the medical service capabilities of CHCs and cannot promote its development. Therefore this study proposes hypothesis 2: H2: The medical alliance implementation effect has a moderating effect on the process by which the organizational capabilities influence organizational performance of CHCs.…”