School of Health Sciences, University of Skövde, P.O. Box 408, SE-541 28, Skövde, Sweden.
School of Health and Welfare, Jönköping University, Jönköping, Sweden.
BMC Health Serv Res. 2023 Aug 29;23(1):921. doi: 10.1186/s12913-023-09932-4.
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.
A qualitative thematic study. Data collection was done before the patients met the MICM physician, and again six months later.
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.
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.
居家养老原则将医院的护理转移到老年人的家中，需要正式和非正式护理人员的护理。在全球范围内，正式护理通常是为了处理单一和偶发的健康问题而组织的，这导致需要多个医疗保健提供者。因此，瑞典一个县的医疗保健当局认识到需要一种综合护理模式，他们创建了一种跨组织的综合护理模式来应对这些挑战。移动综合护理模式与家庭保健医生（MICM）是区域和市政医疗保健之间的合作。然而，缺乏对患者和家属对综合护理体验的描述，这促使我们进行探索。
一项定性主题研究。数据收集是在患者与 MICM 医生见面之前进行的，然后在六个月后再次进行。
参与者在被 MICM 收治时期望得到缓解，并希望分担责任，建立个人联系和连续性，但对 MICM 是什么缺乏了解。在随访访谈中，参与者描述说日常生活变得更加轻松。增加了对医疗保健人员（HCP）的访问，使参与者能够放弃责任，并通过个性化的联系和连续性获得安全感。然而，一些人感到被忽视，并且工作人员联合起来对抗患者。MICM 结构被体验为等级制度，这影响了参与的可能性。然而，家访为共同决策提供了可能性。
参与者期望获得安全和连贯的医疗保健，分担责任，建立个人联系和连续性。六个月后，参与者表示 MICM 提供了更轻松的日常生活。直接访问 HCP 减轻了他们的责任，他们与 HCP 建立了个性化的联系，并且 HCP 对他们很重要，这可以被视为符合向当地医疗保健转变的目标。MICM 被体验为一个等级制度结构，对参与产生影响，表明以人为本的护理的所有方面都没有得到满足。
