Caring, chronicity and community: an emergent model of community health services provision for people living with chronic illness

PURPOSE: An evaluation of an Integrated Care approach with the aim of exploring the components of the service which contributed to its functioning. THEORY: There is growing recognition internationally that conventional approaches to the management of chronic illness are not adequately meeting the needs of people with such conditions. This concern is also shared in Ireland and a pilot programme to provide an alternative community based approach was established in Callan, Co. Kilkennny, Ireland for such service users in 2003. METHODS: The study was based on a pluralistic design. A mixed methods approach was adopted, relying primarily on focus groups and semi-structured interviews. All key stakeholders were included in the data collection, including members of the multidisciplinary team; members of the ‘governance group’ of the service; ‘service users’, ‘concerned persons’ as well as referring agents. Data analysis was informed by Burnard's Framework RESULTS AND CONCLUSIONS: An emergent model of service provision for people with chronic illness is presented. The model suggests that all stakeholders base their perceptions of services on prior experiences. These comparative experiences contribute to the generation and maintenance of their own expectancies. In terms of new services these expectancies are met, exceeded or indeed not met, but are always a point of reference for stakeholders. These expectancies form an underpinning context for the therapeutic experiences encountered within the service. Likewise, the ethos of a service underpins the therapeutic approach and outcomes of a service. Both of these pre-requisites contribute to the therapeutic milieu. All in combination contribute to the effectiveness of the service. The service users are central to the model, within the context of a partnership approach cognisant of community needs, the contribution of service providers and the policy context.