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The role of the home health care physician in mobile integrated care: a qualitative phenomenograpic study
University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health and Welfare, Jönköping University, Sweden. (Välbefinnande vid långvariga hälsoproblem (WeLHP), Wellbeing in Long-term Health Problems)ORCID iD: 0000-0001-6484-9239
University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). (Välbefinnande vid långvariga hälsoproblem (WeLHP), Wellbeing in Long-term Health Problems)ORCID iD: 0000-0003-1819-0896
University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. (Välbefinnande vid långvariga hälsoproblem (WeLHP), Wellbeing in Long-term Health Problems)ORCID iD: 0000-0002-6305-8993
University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). College of Nursing, University of Rhode Island, Kingston, RI, USA. (Välbefinnande vid långvariga hälsoproblem (WeLHP), Wellbeing in Long-term Health Problems)ORCID iD: 0000-0003-3970-1288
2022 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 22, no 1, article id 554Article in journal (Refereed) Published
Abstract [en]

Background: An increasing older population, along with the organizational principle of remaining at home, has moved health care from institutions into the older person’s home, where several health care providers facilitate care. The Mobile Integrated Care Model strives to provide cost-efficient, coherent, person-centered health care in the home. In the integrated care team, where the home health care physician is the medical authority, several health care professions work across organizational borders. Therefore, the aim of this study was to describe Home Health Care Physicians perceptions of working and providing health care in the Mobile Integrated Care Model, as well as perceptions of participating in and forming health care.

Methods: A phenomenographic qualitative study design, with semi-structured interviews using an interview guide.

Results: Working within Mobile Integrated Care Model was a different way of working as a physician. The physicians’ role was to support the patient by making safe medical decisions. Physicians described themselves as a piece in the team puzzle, where the professional knowledge of others was crucial to give quality health care. Being in the patients’ homes was expressed as adding a unique dimension in the provision of health care, and the physicians learned more about the patients by meeting them in their homes than at an institution. This aided the physicians in respecting patient autonomy in medical decision making, even though the physicians sometimes disregarded patient autonomy in favor of their own medical experience. There was a divided view on next of kin participation among the home health care physicians, ranging from always including to total absence of involving next of kin in decision making.

Conclusions: The home health care physicians described the Mobile Integrated Care Model as the best way to work, but there was still a need for additional resources and structure when working in different organizations. The need for full-time employment, additional time or hours, more equipment, access to each other’s medical records, and additional collaboration with other health care providers were expressed, which could contribute to increased work satisfaction and facilitate further development of person-centered care in the Mobile Integrated Care Model. 

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022. Vol. 22, no 1, article id 554
Keywords [en]
aged, article, controlled study, decision making, full time employment, health care personnel, health care quality, home care, human, job satisfaction, medical decision making, medical record, organization, patient autonomy, perception, physician, professional knowledge, qualitative research, semi structured interview, Home health care, Home health care physician, Integrated care, Municipality care, Person-centered care, Phenomenography, Qualitative
National Category
Nursing Geriatrics Health Care Service and Management, Health Policy and Services and Health Economy Other Health Sciences Gerontology, specialising in Medical and Health Sciences
Research subject
Wellbeing in long-term health problems (WeLHP)
Identifiers
URN: urn:nbn:se:his:diva-21625DOI: 10.1186/s12877-022-03211-3ISI: 000820628000002PubMedID: 35787260Scopus ID: 2-s2.0-85133286268OAI: oai:DiVA.org:his-21625DiVA, id: diva2:1683176
Note

CC BY 4.0

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

© 2022 BioMed Central Ltd unless otherwise stated. Part of Springer Nature. 

Correspondence: lina.hovlin@his.se

The project was approved by the Swedish Ethical Review Authority (Dnr 1020-17; 2019–02563; 2020–04324), and conducted according to the ethical guidelines of the Declaration of Helsinki. All participants received written and oral information about what the data would be used for and gave informed consent.

Available from: 2022-07-14 Created: 2022-07-14 Last updated: 2022-10-17Bibliographically approved

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Hovlin, LinaHallgren, JennyDahl Aslan, Anna K.Gillsjö, Catharina

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