Smith-Carrier Tracy, Sinha Samir K, Nowaczynski Mark, Akhtar Sabrina, Seddon Gayle, Pham Thuy-Nga Tia
School of Social Work, King's University College at Western University, London, Ontario, Canada.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Health Soc Care Community. 2017 Mar;25(2):723-733. doi: 10.1111/hsc.12362. Epub 2016 Jun 10.
The lack of effective systems to appropriately manage the health and social care of frail older adults - especially among those who become homebound - is becoming all the more apparent. Home-based primary care (HBPC) is increasingly being promoted as a promising model that takes into account the accessibility needs of frail older adults, ensuring that they receive more appropriate primary and community care. There remains a paucity of literature exploring patients' experiences with HBPC programmes. The purpose of this study was to explore the experiences of patients accessing HBPC delivered by interprofessional teams, and their perspectives on the facilitators and barriers to this model of care in Ontario, Canada. Using certain grounded theory principles, we conducted an inductive qualitative content analysis of in-depth patient interviews (n = 26) undertaken in the winter of 2013 across seven programme sites exploring the lived experiences and perspectives of participants receiving HBPC. Themes emerged in relation to patients' perceptions regarding the preference for and necessity of HBPC, the promotion of better patient care afforded by the model in comparison to office-based care, and the benefits of and barriers to HBPC service provision. Underlying patterns also surfaced related to patients' feelings and emotions about their quality of life and satisfaction with HBPC services. We argue that HBPC is well positioned to serve frail homebound older adults, ensuring that patients receive appropriate primary and community care - which the office-based alternative provides little guarantee - and that they will be cared for, pointing to a model that may not only lead to greater patient satisfaction but also likely contributes to bettering the quality of life of a highly vulnerable population.
缺乏有效的系统来妥善管理体弱老年人的健康和社会护理——尤其是那些居家不出的老年人——这一问题正日益凸显。基于家庭的初级保健(HBPC)作为一种有前景的模式越来越受到推广,该模式考虑到了体弱老年人的可及性需求,确保他们能获得更合适的初级和社区护理。目前探索患者参与HBPC项目经历的文献仍然匮乏。本研究的目的是探讨患者接受跨专业团队提供的HBPC的经历,以及他们对加拿大安大略省这种护理模式的促进因素和障碍的看法。我们运用某些扎根理论原则,对2013年冬季在七个项目点进行的深入患者访谈(n = 26)进行了归纳性定性内容分析,以探究接受HBPC的参与者的生活经历和观点。出现了与患者对HBPC的偏好和必要性的认知、该模式相较于门诊护理在提供更好患者护理方面的促进作用,以及HBPC服务提供的益处和障碍相关的主题。还浮现出了与患者对其生活质量的感受和情绪以及对HBPC服务满意度相关的潜在模式。我们认为,HBPC非常适合为居家不出的体弱老年人服务,确保患者获得合适的初级和社区护理——而门诊护理几乎无法保证这一点——并且他们会得到照料,这表明该模式不仅可能提高患者满意度,还有助于改善这一高度脆弱人群的生活质量。