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Enhancing integrated palliative care: what models are appropriate? A cross-case analysis
BACKGROUND: Effective integration between hospices, palliative care services and other local health care services to support patients with palliative care needs is an important international priority. A previous model suggests that integration involves a cumulative stepped process of engagement with...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5704425/ https://www.ncbi.nlm.nih.gov/pubmed/29179710 http://dx.doi.org/10.1186/s12904-017-0250-8 |
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author | Payne, Sheila Eastham, Rachael Hughes, Sean Varey, Sandra Hasselaar, Jeroen Preston, Nancy |
author_facet | Payne, Sheila Eastham, Rachael Hughes, Sean Varey, Sandra Hasselaar, Jeroen Preston, Nancy |
author_sort | Payne, Sheila |
collection | PubMed |
description | BACKGROUND: Effective integration between hospices, palliative care services and other local health care services to support patients with palliative care needs is an important international priority. A previous model suggests that integration involves a cumulative stepped process of engagement with other organisations labelled as ‘support, supplant or supplement’, but the extent to which this model currently applies in the United Kingdom is unknown. We aimed to investigate accounts of hospice integration with local health care providers, using the framework provided by the model, to determine how service users and healthcare professionals perceived palliative care services and the extent of integration experienced. METHODS: Longitudinal organisational case study methods were employed using qualitative serial interviews (interval 3 months) with patients and family carers focusing on how services responded to their needs; and group interviews with health professionals. Data were audio-recorded, transcribed verbatim, and analysed by qualitative content analysis and combined across data sources. RESULTS: The study focused on four hospices in northern England, including 34 patients (diagnosis: 17 cancer, 10 COPD, 7 heart failure), 65% female, mean age 66 (range 44–89), 13 family carers of these patients (48% partners), and 23 health care professionals. While some care fell short of expectations, all patients reported high levels of satisfaction and valued continuity of care and efficient information sharing. All hospices supported and supplemented local providers, with three hospices also supplanting local provision by providing in-patient facilities. CONCLUSION: UK hospices predominantly operate in ways that support and supplement other providers. In addition, some also supplant local services, taking over direct responsibility and funding in-patient care. They all contributed to integration with local services, with greater blurring of boundaries than defined by the original model. Integrated care offers the necessary flexibility to respond to changes in patient needs, however, constraints from funding drivers and a lack of clear responsibilities in the UK can result in shortfalls in optimal service delivery. Integrating hospice care with local healthcare services can help to address demographic changes, predominantly more frail older people, and disease factors, including the needs of those with non-malignant conditions. This model, tested in the UK, could serve as an example for other countries. |
format | Online Article Text |
id | pubmed-5704425 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-57044252017-12-05 Enhancing integrated palliative care: what models are appropriate? A cross-case analysis Payne, Sheila Eastham, Rachael Hughes, Sean Varey, Sandra Hasselaar, Jeroen Preston, Nancy BMC Palliat Care Research Article BACKGROUND: Effective integration between hospices, palliative care services and other local health care services to support patients with palliative care needs is an important international priority. A previous model suggests that integration involves a cumulative stepped process of engagement with other organisations labelled as ‘support, supplant or supplement’, but the extent to which this model currently applies in the United Kingdom is unknown. We aimed to investigate accounts of hospice integration with local health care providers, using the framework provided by the model, to determine how service users and healthcare professionals perceived palliative care services and the extent of integration experienced. METHODS: Longitudinal organisational case study methods were employed using qualitative serial interviews (interval 3 months) with patients and family carers focusing on how services responded to their needs; and group interviews with health professionals. Data were audio-recorded, transcribed verbatim, and analysed by qualitative content analysis and combined across data sources. RESULTS: The study focused on four hospices in northern England, including 34 patients (diagnosis: 17 cancer, 10 COPD, 7 heart failure), 65% female, mean age 66 (range 44–89), 13 family carers of these patients (48% partners), and 23 health care professionals. While some care fell short of expectations, all patients reported high levels of satisfaction and valued continuity of care and efficient information sharing. All hospices supported and supplemented local providers, with three hospices also supplanting local provision by providing in-patient facilities. CONCLUSION: UK hospices predominantly operate in ways that support and supplement other providers. In addition, some also supplant local services, taking over direct responsibility and funding in-patient care. They all contributed to integration with local services, with greater blurring of boundaries than defined by the original model. Integrated care offers the necessary flexibility to respond to changes in patient needs, however, constraints from funding drivers and a lack of clear responsibilities in the UK can result in shortfalls in optimal service delivery. Integrating hospice care with local healthcare services can help to address demographic changes, predominantly more frail older people, and disease factors, including the needs of those with non-malignant conditions. This model, tested in the UK, could serve as an example for other countries. BioMed Central 2017-11-28 /pmc/articles/PMC5704425/ /pubmed/29179710 http://dx.doi.org/10.1186/s12904-017-0250-8 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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. |
spellingShingle | Research Article Payne, Sheila Eastham, Rachael Hughes, Sean Varey, Sandra Hasselaar, Jeroen Preston, Nancy Enhancing integrated palliative care: what models are appropriate? A cross-case analysis |
title | Enhancing integrated palliative care: what models are appropriate? A cross-case analysis |
title_full | Enhancing integrated palliative care: what models are appropriate? A cross-case analysis |
title_fullStr | Enhancing integrated palliative care: what models are appropriate? A cross-case analysis |
title_full_unstemmed | Enhancing integrated palliative care: what models are appropriate? A cross-case analysis |
title_short | Enhancing integrated palliative care: what models are appropriate? A cross-case analysis |
title_sort | enhancing integrated palliative care: what models are appropriate? a cross-case analysis |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5704425/ https://www.ncbi.nlm.nih.gov/pubmed/29179710 http://dx.doi.org/10.1186/s12904-017-0250-8 |
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