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Patients’ and next of kin’s expectations and experiences of a mobile integrated care model with a home health care physician – a qualitative thematic study
University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health and Welfare, Jönköping University, Sweden. (Wellbeing in Long-term Health Problems (WeLHP))ORCID iD: 0000-0001-6484-9239
University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). College of Nursing, University of Rhode Island, Kingston, RI, USA. (Wellbeing in Long-term Health Problems (WeLHP))ORCID iD: 0000-0003-3970-1288
University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). (Wellbeing in Long-term Health Problems (WeLHP))ORCID iD: 0000-0002-6305-8993
University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). (Wellbeing in Long-term Health Problems (WeLHP))ORCID iD: 0000-0003-1819-0896
2023 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 921Article in journal (Refereed) Published
Abstract [en]

Background

The organizational principle of remaining at home has offset care from the hospital to the home of the older person where care from formal and informal caregivers is needed. Globally, formal care is often organized to handle singular and sporadic health problems, leading to the need for several health care providers. The need for an integrated care model was therefore recognized by health care authorities in one county in Sweden, who created a cross-organisational integrated care model to meet these challenges. The Mobile integrated care model with a home health care physician (MICM) is a collaboration between regional and municipal health care. Descriptions of patients’ and next of kin’s experiences of integrated care is however lacking, motivating exploration.

Method

A qualitative thematic study. Data collection was done before the patients met the MICM physician, and again six months later.

Results

The participants expected a sense of relief when admitted to MICM, and hoped for shared responsibility, building a personal contact and continuity but experienced lack of information about what MICM was. At the follow-up interview, participants described having an easier daily life. The increased access to the health care personnel (HCP) allowed participants to let go of responsibility, and created a sense of safety through the personalised contact and continuity. However, some felt ignored and that the personnel teamed up against the patient. The MICM structure was experienced as hierarchical, which influenced the possibility to participate. However, the home visits opened up the possibility for shared decision making.

Conclusion

Participants had an expectation of receiving safe and coherent health care, to share responsibility, personal contact and continuity. After six months, the participants expressed that MICM had provided an easier daily life. The direct access to HCP reduced their responsibility and they had created a personalised contact with the HCP and that the individual HCP mattered to them, which could be perceived as in line with the goals in the shift to local health care. The MICM was experienced as a hierarchic structure with impact on participation, indicating that all dimensions of person-centred care were not fulfilled.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023. Vol. 23, no 1, article id 921
Keywords [en]
Patient, Next of kin, Home health care, Home health care physician, Nursing, Municipal care, Thematic analysis, Qualitative
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy Geriatrics Gerontology, specialising in Medical and Health Sciences
Research subject
Wellbeing in long-term health problems (WeLHP)
Identifiers
URN: urn:nbn:se:his:diva-23151DOI: 10.1186/s12913-023-09932-4ISI: 001057696200008PubMedID: 37644455Scopus ID: 2-s2.0-85168928826OAI: oai:DiVA.org:his-23151DiVA, id: diva2:1792912
Funder
University of SkövdeThe Kamprad Family Foundation
Note

CC BY 4.0

Correspondence: Lina Emmesjö lina.hovlin@his.se

BMC part of Springer Nature

Open access funding provided by University of Skövde. This study was supported by a grant from the Kamprad Family Foundation for Entrepreneurship, Research, & Charity in Sweden (20190175). It was also supported by the School of Health Sciences, University of Skövde, Sweden, Agneta Prytz-Folkes and Gösta Folke’s Foundation, Gösta Svenssons Foundation and The Foundation of Ragnhild and Einar Lundström’s Memory.

Available from: 2023-08-30 Created: 2023-08-30 Last updated: 2023-10-10Bibliographically approved

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Emmesjö, LinaGillsjö, CatharinaDahl Aslan, Anna K.Hallgren, Jenny

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