Patient-centred access to health care: a framework analysis of the care interface for frail older adults
Tóm tắt
The objective of this study was to explore the issues surrounding access to health and social care services for frail older adults with Polish stakeholders, including healthy and frail/pre-frail older adults, health care providers, social care providers, and caregivers, in order to determine their views and perspectives on the current system and to present suggestions for the future development of a more accessible and person-centred health and social care system. Focus groups were used to gather qualitative data from stakeholders. Data were analysed using framework analysis according to five dimensions of accessibility to care: approachability, acceptability, availability and accommodation, affordability and appropriateness. Generally services were approachable and acceptable, but unavailable. Poor availability related to high staff turnover, staff shortages and a lack of trained personnel. There were problems of long waiting times for specialist care and rehabilitation services, and geographically remote clinics. Critically, there were shortages of long-term inpatient care places, social care workers and caregivers. The cost of treatments created barriers to care and inequities in the system. Participants described a lack of integration between health and social care systems with differing priorities and disconnected budgets. They described an acute medical system that was inappropriate for patients with complex needs, alongside a low functioning social care system, where bureaucratisation caused delays in providing services to the vulnerable. An integrated system with a care coordinator to improve connections between services and patients was suggested. There is an immediate need to improve access to health and social care systems for pre-frail and frail patients, as well as their caregivers. Health and social care services need to be integrated to reduce bureaucracy and increase the timeliness of treatment and care.
Tài liệu tham khảo
Marmot M. Health inequalities in the European Union — final report of a consortium: European Commission Directorate General for Health and Consumers; 2003. https://doi.org/10.2772/34426.
European Commission. Reducing health inequalities in the European Union: Directorate General for Employment, Social Affairs and Equal Opportunities; 2003. http://docplayer.net/13894583-Reducing-health-inequalities-in-the-european-union.html. Accessed 17 Jan 2018
Dahlgren G, Whitehead M. European strategies for tackling social inequities in health: Levelling up Part 2. Copenhagen: Health October 24 WHO Regional Office for Europe (Studies on social and economic determinants of population health, No. 3); 2007. http://www.euro.who.int/__data/assets/pdf_file/0018/103824/E89384.pdf?ua=1 Accessed 17 Jan 2018
Whitehead M. The concepts and principles of equity and health. Int J Health Serv. 1992;22(3):429–45.
Fabbricotti IN, Janse B, Looman WM, de Kuijper R, van Wijngaarden JDH, Reiffers A. Integrated care for frail elderly compared to usual care: a study protocol of a quasi-experiment on the effects on the frail elderly, their caregivers, health professionals and health care costs. BMC Geriatr. 2013;13(1):31.
Supreme Audit Office. Raport Najwyższej Izby Kontroli (NIK) Opieka medyczna nad osobami w wieku podeszłym. KZD-4101-003/2014 Nr ewid.2/2015/P/14/062/KZD. 2014. https://www.nik.gov.pl/plik/id,8319,vp,10379.pdf. Accessed 14 Apr 2017.
Dixon-Woods M, Kirk MD, Agarwal MS, Annandale E, Arthur T, Harvey J, Hsu R, Katbamna S, Olsen R, Smith L and Riley L. Vulnerable groups and access to health care: a critical interpretive review. National Coordinating Centre NHS Service Delivery Organ RD (NCCSDO) 2005: http://www.netscc.ac.uk/hsdr/files/project/SDO_FR_08-1210-025_V01.pdf. Accessed 17 Jan 2018.
Fried LP, Tangen C, Walston J, Newman A, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop W, Burke G, McBurnie M. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–57.
Bergman H, Ferrucci L, Guralnik J, Hogan DB, Hummel S, Karunananthan S, Wolfson C. Frailty: an emerging research and clinical paradigm–issues and controversies. J Gerontol A Biol Sci Med Sci. 2007;62(7):731–7.
Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95.
Hussey PS, Schneider EC, Rudin RS, Fox D, Lai J, Pollack C. Continuity and the costs of care for chronic disease. JAMA Intern Med. 2014;174(5):742–8.
Shaw R, Gwyther H, Holland C, Bujinowska-Fedak M, Kurpas D, Cano A, Marcucci M, Riva S, D'Avanzo B. Understanding frailty: meanings and beliefs about screening and prevention across key stakeholder groups in Europe. Ageing Soc. 2017:1–30. https://doi.org/10.1017/S0144686X17000745.
D'Avanzo B, Shaw R, Riva S, Apostolo J, Bobrowicz-Campos E, Kurpas D, Bujinowska M, Holland C. Stakeholders’ views and experiences of care and interventions for addressing frailty and pre-frailty: a meta-synthesis of qualitative evidence. PLoS One. 2017;12(7):e0180127.
Bragstad LK, Kirkevold M, Foss C. The indispensable intermediaries: a qualitative study of informal caregivers’ struggle to achieve influence at and after hospital discharge. BMC Health Serv Res. 2014;14(1):331.
Sussman T. The influence of service factors on spousal caregivers' perceptions of community services. J Gerontol Soc Work. 2009;52(4):406–22.
Vasileiou K, Barnett J, Barreto M, Vines J, Atkinson M, Lawson S, Wilson M. Experiences of loneliness associated with being an informal caregiver: a qualitative investigation. Front Psychol. 2017;8:585. https://doi.org/10.3389/fpsyg.2017.00585.
Cameron ID, Fairhall N, Langron C, Lockwood K, Monaghan N, Aggar C, Sherrington C, Lord SR, Kurrle SE. A multifactorial interdisciplinary intervention reduces frailty in older people: randomized trial. BMC Med 2013;11(1):1–10.
Boyd CM, McNabney MK, Brandt N, Correa-de-Araujuo R, Daniel M, Epplin J, Fried TR, Goldstein MK, Holmes HM, Ritchie CS, Shega JW. Guiding principles for the care of older adults with multimorbidity: an approach for clinicians: American geriatrics society expert panel on the care of older adults with multimorbidity. J Am Geriatr Soc. 2012;60(10):E1–E25.
Freiberger E, Kemmler W, Siegrist M, Sieber C. Frailty and exercise interventions. Z Gerontol Geriatr. 2016;49(7):606–11.
Gill TM, Gahbauer EA, Allore HG, Han L. Transitions between frailty states among community-living older persons. Arch Intern Med. 2006;166(4):418–23.
The World Bank. The present and future of long-term care in ageing Poland. 2015 https://das.mpips.gov.pl/source/opiekasenioralna/Long%20term%20care%20in%20ageing%20Poland_ENG_FINAL.pdf. Accessed 17 Jan 2018.
Kujawska J. Organisation and management of care for the elderly, University in Szczecin no 855, Finance, Financial Markets, Insurance vol 1, 2015 pp709–722 (Original in Polish: Organizacja i zarządzanie opieką nad osobami starszymi. Zeszyty Naukowe Uniwersytetu Szczecińskiego nr 855 Finanse, Rynki Finansowe, Ubezpieczenia nr 74, t. 1. 2015), http://www.wneiz.pl/nauka_wneiz/frfu/74-2015/FRFU-74-t1-709.pdf. Accessed 17 Jan 2018. doi: https://doi.org/10.18276/frfu.2015.74/1-62%20s.709%2D722.
OECD/European Observatory on Health Systems and Policies. Poland: country health profile 2017. State of Health in the EU. Brussels: OECD Publishing, Paris/European Observatory on Health Systems and Policies; 2017.
Napolitano F, Napolitano P, Garofalo L, Recupito M, Angelillo IF. Assessment of continuity of care among patients with multiple chronic conditions in Italy. PLoS One. 2016;11(5):e0154940 https://doi.org/10.1371/journal.pone.0154940.
Rich E, Lipson D, Libersky J, Parchman M. Coordinating care for adults with complex care needs in the patient-centered medical home: challenges and solutions. In: White paper prepared by Mathematica Policy Research under Contract No. HHSA290200900019I/HHSA29032005T. AHRQ Publication No. 12–0010-EF. Rockville: Agency for Healthcare Research and Quality; 2012.
Janse B, Huijsman R, Fabbricotti IN. A quasi-experimental study of the effects of an integrated care intervention for the frail elderly on informal caregivers’ satisfaction with care and support. BMC Health Serv Res. 2014;14:140.
Smith ML, Bergeron CD, Adler CH, Patel A, Ahn SN, Towne SD, Bien M, Ory MG. Factors associated with healthcare-related frustrations among adults with chronic conditions. Patient Educ Couns. 2017;100(6):1185–93.
Stein KV. Integrated care around the world. Examples to help improve (primary) health care in Poland. 2016; http://akademia.nfz.gov.pl/wp-content/uploads/2016/12/Raport_Opieka_koordynowana_ENG.pdf. Accessed 16 Jan 2018.
Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff. 2008;27(3):759–69.
Looman WM, Fabbricotti IN, de Kuyper R, Huijsman R. The effects of a pro-active integrated care intervention for frail community-dwelling older people: a quasi-experimental study with the GP-practice as single entry point. BMC Geriatr. 2016;16(1):43.
Gulliford M, Figueroa-Munoz J, Morgan M, Hughes D, Gibson D, Beech R, Hudson M. What does 'access to health care’ mean? J Health Serv Res Policy. 2002;7(3):186–8.
Levesque J-F, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12(1):18.
Cano A, Kurpas D, Bujnowska-Fedak M, Santana S, Holland C, Marcucci M, Gonzalez-Segura A, Vollenbroek-Hutten M, D'avanzo B, Nobili A, Apostolo J, Bobrowicz-Campos E, Martinez-Arroyo A. FOCUS: frailty management optimisation through EIPAHA commitments and utilisation of stakeholders’ input – an innovative European project in elderly care. Fam Med Prim Care Rev. 2016;18(3):373–6.
FOCUS - Frailty management optimization through EIP-AHA commitments and utilization of stakeholders input. 2018. http://focus-aha.eu/en_GB/home. Accessed 25 Jan 2018.
Ritchie J, Spencer L, O’Connor W. Carrying out qualitative analysis. In: Qualitative research practice: a guide for social science students and researchers. London: Sage; 2003.
Espinoza S, Walston JD. Frailty in older adults: insights and interventions. Cleve Clin J Med. 2005;72.
Kowalska K, Kalbarczyk WP. Coordinated health care. International experience, proposals for Poland. Original in Polish: Koordynowana opieka zdrowotna. Doświadczenia międzynarodowe, propozycje dla Polski. 2013 Report accessed on 17 Jan 2018 http://www.ey.com/Publication/vwLUAssets/EY_Sprawne_Pa%C5%84stwo_Raport_Koordynowana_Opieka_Zdrowotna/$FILE/EY_Sprawne_Panstwo_KOZ.pdf.
Roland M, Olesen F. Can pay for performance improve the quality of primary care? BMJ. 2016;354:4058.
Beck O, Kędziora-Kornatowska K, Kornatowski M. (2014) Opieka długoterminowa domowa w Polsce – ramy, problemy, perspektywy. Long-term home care in Poland – framework, problems, prospects. Hygeia Public Health. 2014;49(2):192–6.
Golinowska S. The system of long-term care in Poland. CASE Network Studies & Analyses. Warsaw: Centre for Social and Economic Research; 2010. p. 416:s6.
Lopez-Hartmann M, Wens J, Verhoeven V, Remmen R. The effect of caregiver support interventions for informal caregivers of community-dwelling frail elderly: a systematic review. Int J of Integr Care. 2012;12:e133.
Candy B, Jones L, Drake R, Leurent B, King M. Interventions for supporting informal caregivers of patients in the terminal phase of a disease. Cochrane Database Syst Rev. 2011;15(6):CD007617.
Okamoto K, Hasebe Y, Harasawa Y. Caregiver psychological characteristics predict discontinuation of care for disabled elderly at home. Int J Geriatr Psychiatry. 2007;22(11):1110–4.
Colombo F, Llena-Nozal A, Mercier J, Tjadens F. Help wanted? Providing and paying for long-term care. OECD health policy studies, 2011:OECD Publishing, Paris. https://doi.org/10.1787/9789264097759-en. Accessed 25 Jan 2018.
Gwyther H, Shaw RL, Jaime Dauden E-A, D’Avanzo B, Kurpas D, Bujnowska-Fedak MM, Kujawa T, Marcucci M, Cano A, Holland C. Understanding frailty: a qualitative study of European healthcare policy-makers’ approaches to frailty screening and management. BMJ Open. 2018;8(1).
Hawkins K, Parker PM, Hommer CE, Bhattarai GR, Huang J, Wells TS, Ozminkowski RJ, Yeh CS. Evaluation of a high-risk case management pilot program for Medicare beneficiaries with Medigap coverage. Popul Health Manag. 2015;18(2):93–103.
Looman WM, Huijsman R, Bouwmans-Frijters CAM, Stolk EA, Fabbricotti IN. Cost-effectiveness of the ‘Walcheren integrated care model’ intervention for community-dwelling frail elderly. Fam Pract. 2016;33(2):154–60.
Sandberg M, Jakobsson U, Midlöv P, Kristensson J. Cost-utility analysis of case management for frail older people: effects of a randomised controlled trial. Health Econ Rev. 2015;5:12.
You EC, Dunt D, Doyle C, Hsueh A. Effects of case management in community aged care on client and carer outcomes: a systematic review of randomized trials and comparative observational studies. BMC Health Serv Res. 2012;12(1):395.
Berglund H, Wilhelmson K, Blomberg S, Dunér A, Kjellgren K, Hasson H. Older people's views of quality of care: a randomised controlled study of continuum of care. J Clin Nurs. 2013;22(19–20):2934–44.