Search results

This study aims to describe survivors of stroke circumstances, issues with providing care for survivors of stroke and services expected by caregivers and survivors of stroke.

A qualitative research design was conducted in Singburi Province. Data collection methods included in-depth interviews, focus groups and participatory observations. Semi-structured in-depth interview guides, quality-of-life scale and depression scale were used to collect data from survivors of stroke, their caregivers, health personnel, local governors and village health volunteers. Naturalistic research tradition was used for qualitative data analysis and descriptive statistics for quantitative data analysis.

The majority of survivors of stroke had hemiplegic limb and severe deficits in their activities of daily living. Caregivers were family members, and they often developed depression. Issues with providing care to stroke survivors included lack of knowledge about stroke and home care, inadequacy and discontinuity of care and the shortage of stroke care personnel in the community. A stakeholder's expected stroke services included the provision of effective continuing care, community participation in care and enhancing the village health volunteer's capacity.

This study illustrated the stroke service systems in rural Thai communities. The study's findings could be applied when planning future research using community participation to test a model of care for stroke survivors to promote better outcomes and be responsive to the needs of stroke survivors, especially those who are disabled.

For over 40 years, Canadian and international bodies have endorsed comprehensive primary health care (PHC), yet very little work has been done to describe how services and programs are delivered within these organizations. Because health equity is now of greater interest to policy makers and the public, it is important to describe an evidence-informed framework for the delivery of integrated and equitable PHC. The purpose of this paper is to describe the development of a “Model of Health and Well-being” (MHWB) that provides a roadmap to the delivery of PHC in a successful network of community-governed PHC organizations in Ontario, Canada.

The MHWB was developed through an iterative process that involved members of community-governed PHC organizations in Ontario and key stakeholders. This included literature review and consultation to ensure that the model was evidence informed and reflected actual practice.

The MHWB has three guiding principles: highest quality health and well-being for people and communities; health equity and social justice; and community vitality and belonging. In addition, there are eight attributes that describe how services are provided. There is a reasonable evidence base underpinning the all principles and attributes.

As comprehensive, equitable PHC organizations become increasingly recognized as critical parts of the health care system, it is important to have a means to describe their approach to care and the values that drive their care. The MHWB provides a blueprint for comprehensive PHC as delivered by over 100 Community Governed Primary Health Care (CGPHC) organizations in Ontario. All CGPHC organizations have endorsed, adopted and operationalized this model as a guide for optimum care delivery.

The purpose of this paper was to develop deeper insights into the practices enacted by entrepreneurial healthcare managers to enhance the implementation of a partnership logic in integrated care models for older adults.

A multiple case study design in two urban centres in two jurisdictions in Canada, Ontario and Quebec. Data collection included 65 semi-structured interviews with policymakers, managers and providers and analysis of key policy documents. The institutional entrepreneur theory provided the theoretical lens and informed a reflexive iterative data analysis.

While each case faced unique challenges, there were similarities and differences in how managers enhanced a partnership’s institutional logic. In both cases, entrepreneurial healthcare managers created new roles, negotiated mutually beneficial agreements and co-located staff to foster inter-organisational partnerships between public, private and community organisations in the continuum of care for older adults. In addition, managers in Ontario secured additional funding, while managers in Quebec organised biannual meetings and joint training to enhance inter-organisational partnerships.

This study has two main implications. First, efforts to enhance inter-organisational partnerships should strategically include institutional entrepreneurs. Second, successful institutional changes may be supported by investing in integrated implementation strategies that target roles of staff, co-location and inter-organisational agreements.

Despite many calls to strengthen connections between health systems and communities as a way to improve primary healthcare, little is known about how new collaborations can effectively alter service provision. The purpose of this paper is to explore how a health authority, municipal leaders and physicians worked together in the process of transforming primary healthcare.

A longitudinal qualitative case study was conducted to explore the processes of change at the regional level and within seven communities across Northern British Columbia (BC), Canada. Over three years, 239 interviews were conducted with physicians, municipal leaders, health authority clinicians and leaders and other health and social service providers. Interviews and contextual documents were analyzed and interpreted to articulate how ongoing transformation has occurred.

Four overall strategies with nine approaches were apparent. The strategies were partnering for innovation, keeping the focus on people in communities, taking advantage of opportunities for change and encouraging experimentation while managing risk. The strategies have bumped the existing system out of the status quo and are achieving transformation. Key components have been a commitment to a clear end-in-view, a focus on patients, families, and communities, and acting together over time.

This study illuminates how partnering for primary healthcare transformation is messy and complicated but can create a foundation for whole system change.

In 2011, community nursing services were reorganised in England in response to a national policy initiative, but little is known about the impact of these changes. A total of three dominant approaches emerged: (1) integration of community nursing services with an acute hospital provider, (2) integration with a mental health provider and (3) the establishment of a stand-alone organisation, i.e. without structural integration. The authors explored how these approaches influenced the trends in emergency hospital admissions and bed day use for older people.

The methodology was a longitudinal ecological study using panel data over a ten-year period from April 2006 to March 2016. This study’s outcome measures were (1) emergency hospital admissions and (2) emergency hospital bed use, for people aged 65+ years in 140 primary care trusts (PCTs) in England.

The authors found no statistically significant difference in the post-intervention trend in emergency hospital admissions between those PCTS that integrated community nursing services with an acute care provider and those integrated with a mental health provider (IRR 0.999, 95% CI 0.986–1.013) or those that did not structurally integrate services (IRR 0.996, 95% CI 0.982–1.010). The authors similarly found no difference in the trends for emergency hospital bed use.

PCTs were abolished in 2011 and replaced by clinical commissioning groups in 2013, but the functions remain.

The authors found no evidence that any one structural approach to the integration of community nursing services was superior in terms of reducing emergency hospital use in older people.

As far as the authors are aware, previous studies have not examined the impact of alternative approaches to integrating community nursing services on healthcare use.

The Health Service Executive in Ireland seeks to further develop healthcare in the community. It has identified that this reform requires developing leadership amongst the staff. This study aims to identify what kind of leadership staff in community healthcare observe in practice and their leadership preferences. The core objective has been to identify the readiness of the organisation to implement the adopted national policy of integrated community care reform in terms of leadership development.

An online cross-sectional survey was conducted using the Organisational Cultural Assessment Instrument, based on the Competing Values Framework. This tool identifies four overarching leadership types: Clan (Collaborative), Adhocracy (Creative), Market (Competitive) and Hierarchy (Controlling). Participants (n = 445) were a representative sample of regional community health care employees. They were asked to identify presently observed leadership and preferred leadership in practice. The statistical analysis emphasised a comparison of observed and preferred leadership types.

Participants reported the current prevailing leadership type as Market (M = 34.38, SD = 6.22) and Hierarchical (M = 34.38, SD = 22.62), whilst the preferred or future style was overwhelmingly Clan (M = 40.38, SD = 18.08). Differences were significant (all p’s < 0.001). The overall outcome indicates a predominance of controlling and competitive leadership and a lack of collaborative leadership to implement the planned reform.

During reform in healthcare, leadership in practice must be aligned to the reform strategy, demonstrating collaboration, flexibility and support for innovation. This unique study demonstrates the importance of examining leadership type and competencies to indicate readiness to deliver national community health care reform.

The purpose of this study is to examine the effectiveness of the Thai nursing student competency enhancement program applied through project-based learning (PjBL) in caring for the elderly in the community.

This quasi-experimental one-group pre-post-test design was used to compare mean scores on gerontological nursing competency scales comprising four dimensions including holistic health promotion, empirical evidence, empowerment and quality care and ethical and moral competencies. A total of 95 participants were randomly selected from a list of registered attendees. A five-week PjBL approach for a community nursing practicum was designed and comprised of an introduction to the project, components of research methodology, group projects and group presentations. A gerontological nursing competencies questionnaire was used with participants, and data were analyzed using descriptive statistics. Two-way ANOVA and a paired t-test were used to compare pre-post mean scores of competencies.

A total of 95 students participated in the PjBL and the majority of participants were female (92.6%). The results revealed post–PjBL mean scores of gerontological nursing competencies were higher than the premean score (p value < 0.05) except the empirical evidence competencies which showed no statistical difference.

Since the results show the effectiveness of the student nursing competency enhancement program through PjBL when caring for the elderly in the community, it is important for health care instructors to apply PjBL, especially in community nursing. Improving empirical competency evidence among nursing students is still required and necessary.

This integrated care study seeks to highlight how voluntary sector “wellbeing co-ordinators” co-located in a horizontally and vertically integrated, multidisciplinary community hub within one locality of an Integrated Care Organisation contribute to complex, person-centred, co-ordinated care.

This is a naturalistic, mixed method and mixed data study. It is complementing a before-and-after study with a sub-group analysis of people receiving input from the wider hub (including Wellbeing Co-ordination and Enhanced Intermediate Care), qualitative case studies, interviews, and observations co-produced with embedded researchers-in-residence.

The cross-case analysis uses trajectories and outcome patterns across six client groups to illustrate the bio-psycho-social complexity of each group across the life course, corresponding with the range of inputs offered by the hub.

To consider the effectiveness and mechanisms of complex system-wide interventions operating at horizontal and vertical interfaces and researching this applying co-produced, embedded, naturalistic and mixed methods approaches.

How a bio-psycho-social approach by a wellbeing co-ordinator can contribute to improved person reported outcomes from a range of preventive, rehabilitation, palliative care and bereavement services in the community.

To combine knowledge about individuals held in the community to align the respective inputs, and expectations about outcomes while considering networked pathways based on functional status, above diagnostic pathways, and along a life-continuum.

The hub as a whole seems to (1) Enhance engagement through relationship, trust and activation, (2) Exchanging knowledge to co-create a shared bio-psycho-social understanding of each individual’s situation and goals, (3) Personalising care planning by utilising the range of available resources to ensure needs are met, and (4) Enhancing co-ordination and ongoing care through multi-disciplinary working between practitioners, across teams and sectors.

Improvements in neonatal and paediatric care mean that many children with complex care needs (CCNs) now survive into adulthood. This cohort of children places great challenges on health and social care delivery in the community: they require dynamic and responsive health and social care over a long period of time; they require organisational and delivery coordination functions; and health issues such as minor illnesses, normally presented to primary care, must be addressed in the context of the complex health issues. Their clinical presentation may challenge local care management. The project explored the interface between primary care and specialised health services and found that it is not easily navigated by children with CCNs and their families across the European Union and the European Economic Area countries. We described the referral-discharge interface, the management of a child with CCNs at the acute–community interface, social care, nursing preparedness for practice and the experiences of the child and family in all Models of Child Health Appraised countries. We investigated data integration and the presence of validated standards of care, including governance and co-creation of care. A separate enquiry was conducted into how care is accessed for children with enduring mental health disorders. This included the level of parental involvement and the presence of multidisciplinary teams in their care. For all children with CCNs, we found wide variation in access to, and governance of, care. Effective communication between the child, family and health services remains challenging, often with fragmentation of care delivery across the health and social care sector and limited service availability.

The impact of population ageing is significant, multifaceted and characterised by frailty and multi-morbidity. The COVID-19 pandemic has accelerated care pathways and policies promoting self-management and home-based care. One under-researched area is how patients and family caregivers manage the complexity of end-of-life therapeutic medicine regimens. In this position paper the authors bring attention to the significant strain that patients and family caregivers experience when navigating and negotiating this aspect of palliative and end-of-life care.

Focussing on self-care and organisation of medicines in the United Kingdom (UK) context, the paper examines, builds on and extends the debate by considering the underlying policy assumptions and unintended consequences for individual patients and family care givers as they assume greater palliative and end-of-life roles and responsibilities.

Policy makers and healthcare professionals often lack awareness of the significant burden and emotional work associated with managing and administering often potent high-risk medicines (i.e. opioids) in the domiciliary setting. The recent “revolution” in professional roles associated with the COVID-19 pandemic, including remote consultations and expanding community-based care, means there are opportunities for commissioners to consider offering greater support. The prospect of enhancing the community pharmacist's medicine optimisation role to further support the wider multi-disciplinary team is considered.

The paper takes a person-focused perspective and adopts a holistic view of medicine management. The authors argue for urgent review, reform and investment to enable and support terminally ill patients and family caregivers to more effectively manage medicines in the domiciliary setting. There are clear implications for pharmacists and these are discussed in the context of public awareness, inter-professional collaboration, organisational drivers, funding and regulation and remote care delivery.