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Patient Journey: Implications for Improving and Integrating Care for Older Adults with Chronic Obstructive Pulmonary Disease*

Published online by Cambridge University Press:  19 April 2012

Karen Jackson ,
Nelly D. Oelke ,
Jeanne Besner  and
Alexandra Harrison
Karen Jackson*
Affiliation:
Alberta Health Services
Nelly D. Oelke
Affiliation:
University of British Columbia
Jeanne Besner
Affiliation:
At the time of this study Dr. Besner was with Alberta Health Services
Alexandra Harrison
Affiliation:
University of Calgary
*
†Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Karen Jackson, R.N., B.Sc.N., M.Ed. Workforce Research and Evaluation Unit Alberta Health Services 10301 Southport Lane S.W. Calgary, Alberta, T2W 1S7 Canada ([email protected])
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Abstract

Many patients, particularly older patients, interact with multiple providers while accessing health care services in a variety of different settings over extended periods of time. Understanding older patients’ experiences of their journeys through the health system is critical to improving service integration and quality of care. In this study, we have summarized the experiences of four patients living with chronic obstructive pulmonary disease as they interacted with the health care system over a three-month period following hospital discharge. Guided by case study methodology, we gathered data through semi-structured interviews and patient logs. Three overarching themes – social support, system navigation, and access – emerged from the data. Attending to provider-patient and provider-provider communication, and to patient social support and self-care needs, could improve integration and care outcomes. Achieving what patients perceive as an integrated and effective system will require time and commitment.

Résumé

Beacoup de patients, surtout les patients plus âgés, interagissent avec fournisseurs multiples, tout en avant accès aux services des soins de santé dans une variété de milieux divers pendants longues périodes. Comprendre les expériences des patients plus âgés pendant leurs voyages à travers le système de santé est essentielle pour améliorer l’intégration des services et la qualité des soins. Dans cette étude, nous avons résumé les expériences de quatre patients vivant avec la maladie pulmonaire obstructive chronique en interaction avec le système des soins de santé pendant une période de trois mois après la sortie de l’hôpital. Guidé par la méthodologie d’étude de cas, on a réunis les données par le biais des entretiens semi-structurés et des journaux de patients. Trois grands thèmes - le soutien social, la navigation à travers le système, et l’accès aux soins – ont émergé à partir des données. L’attention à la communication entre fournisseur-patient et prestataire-fournisseur, ainsi que le soutien social du patient, et les besoins des soins auto-administrés, pourraient améliorer l’intégration et les résultats des soins. Pour réaliser de ce que les patients perçoivent comme une système integrée et efficace, il faudra du temps et de l’engagement.

Keywords

viellissementexpérience d’un patientvoyage d’un patientsoins centrés sur le patientintégrationagingpatient experiencepatient journeypatient-centered careintegration
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 31 , Issue 2 , June 2012 , pp. 223 - 233
Copyright
Copyright © Canadian Association on Gerontology 2012

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Footnotes

*

We sincerely appreciate the work on this study completed by Daniel Leffelaar, who at the time of the study was a Bachelor of Health Sciences student, University of Calgary.

References

Aharony, L., & Strasser, S. (1993). Patient satisfaction: What we know and what we still need to explore. Medical Care Review, 50(1), 49–79.CrossRefGoogle ScholarPubMed
Beattie, B.L., Whitelaw, N., Mettler, M., & Turner, D. (2003). A vision for older adults and health promotion. American Journal of Health Promotion, 18(2), 200–204.Google Scholar
Bodenheimer, T. (2008). Coordinating care–a perilous journey through the health care system. The New England Journal of Medicine, 358(10), 1064–1071.CrossRefGoogle ScholarPubMed
Change Foundation. (2008). Who is the puzzle maker? Patient/caregiver perspectives on navigating health services in Ontario. Toronto, Ontario, Canada: Change Foundation.Google Scholar
Coleman, E.A., Min, S.J., Chomiak, A., & Kramer, A. (2004). Posthospital care transitions: Patterns, complications, and risk identification. Health Services Research, 39(5), 1449–1465.Google Scholar
Commission on the Future of Health Care in Canada. (2002). Building on values: The future of health care in Canada. (R.J. Romanow, Commissioner). Ottawa, Ontario, Canada: National Library of Canada.Google Scholar
Epstein, R.M., & Street, R.L. (2007). Patient-centred communication in cancer care: Promoting healing and reducing suffering. Retrieved September 13, 2011, fromhttp://outcomes.cancer.gov/areas/pcc/communication/pcc_monograph.pdf.Google Scholar
Fyke, K. (2001). Caring for Medicare: Sustaining a quality system. Saskatchewan Commission on Medicare. Regina, Saskatchewan, Canada: Government of Saskatchewan.Google Scholar
Gulliford, M., Cowie, L., & Morgan, M. (2011). Relational and management continuity survey in patients with multiple long-term conditions. Journal of Health Services & Research Policy, 16(2), 67–74.Google Scholar
Harrison, A., & Verhoef, M. (2002). Understanding coordination of care from the consumer’s perspective in a regional health system. Health Services Research, 37(4), 1031–1054.Google Scholar
Health Council of Canada. (2005). Health care renewal in Canada: Accelerating change. Retrieved October 12, 2010, fromhttp://www.healthcouncilcanada.ca/docs/rpts/2005/Accelerating_Change_HCC_2005.pdfGoogle Scholar
Hellesø, R., & Fagermoen, M.S. (2010). Cultural diversity between hospital and community nurses: Implications for continuity of care. International Journal of Integrated Care, 10, e036. Retrieved May 3, 2010, fromhttp://www.ijic.org/index.php/ijic/article/view/508.CrossRefGoogle ScholarPubMed
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.Google Scholar
International Alliance of Patients’ Organizations (IAPO). (2007). What is patient-centred healthcare: A review of definitions and principles. Retrieved September 17, 2011, fromhttp://www.patientsorganizations.org/attach.pl/547/494/IAPO%20Patient-Centred%20Healthcare%20Review%202nd%20edition.pdfGoogle Scholar
Jenkinson, C., Coulter, A., & Bruster, S. (2002). The Picker Patient Experience Questionnaire: Development and validation using data from in-patient surveys in five countries. International Journal for Quality Healthcare, 14(5), 353–358.CrossRefGoogle ScholarPubMed
Kodner, D. (2009). All together now: A conceptual exploration of integrated care. Healthcare Quarterly, 13, 8–15.Google Scholar
Leatt, P., Pink, G.H., & Guerriere, M. (2000). Towards a Canadian model of integrated healthcare. Healthcare Papers, 1, 13–35.CrossRefGoogle ScholarPubMed
Lewis, S. (2009). Patient-Centered Care: An introduction to what it is and how to achieve it A discussion paper for the Saskatchewan Ministry of Health. Retrieved September 13, 2011, fromhttp://www.changefoundation.ca/docs/patient-centred-care-intro.pdf.Google Scholar
Linenkugel, N. (2001). Integrated health networks are not created equal. Frontiers of Health Services Management, 17, 41–44.Google Scholar
McKeever, J. (2004). Mapping the patient experience: Charting patient experiences can uncover valuable information. Marketing Health Services, 24, 14–19.Google ScholarPubMed
Morse, J., & Richards, L. (2002). Readme first for a user’s guide to qualitative methods. Thousand Oaks, CA: Sage Publications.Google Scholar
Murray, M. (2009). Process improvement and supply and demand: The elements that underlie integration. Healthcare Quarterly, 13, 37–42.CrossRefGoogle ScholarPubMed
Parnaby, J., & Towill, D.R. (2008). Seamless healthcare delivery systems. International Journal of Health Care Quality Assurance, 21(3), 249–273.CrossRefGoogle ScholarPubMed
Parry, C., Coleman, E.A., Smith, J.D., Frank, J., & Kramer, A.M. (2003). The care transitions intervention: A patient-centered approach to ensuring effective transfers between sites of geriatric care. Home Healthcare Services Quarterly, 22(3), 1–17.Google Scholar
Registered Nurses Association of Ontario (RNAO). (2003). Screening for delirium, dementia and depression in older adults. Toronto, Ontario, Canada: Registered Nurses Association of Ontario.Google Scholar
Richardson, S., Casey, M., & Hider, P. (2007). Following the patient journey: Older persons’ experiences of emergency departments and discharge. Accident and Emergency Nursing, 15(3), 134–140.Google Scholar
Rogers, A., & Sheaff, R. (2000). Formal and informal systems of primary healthcare in an integrated system: Evidence from the United Kingdom. Healthcare Papers, 1, 47–58.CrossRefGoogle Scholar
Saskatchewan Ministry of Health. (2009). For patients’ sake: Patient first review commissioner’s report to the Saskatchewan Minister of Health. (T. Dagnone, Commissioner). Retrieved December 16, 2010, fromhttp://www.health.gov.sk.ca/patient-first-commissioners-report.Google Scholar
Sharp, L.K., & Lipsky, M.S. (2002). Screening for depression across the lifespan: A review of measures for use in primary care settings. American Family Physician, 66(6), 1001–1009.Google ScholarPubMed
Sidani, S. (2008). Effects of patient-centered care on patient outcomes: An evaluation. Research and Theory for Nursing Practice, 22(1), 24–37.CrossRefGoogle ScholarPubMed
Spragins, W., & Lorenzetti, D. (2008). Public expectation and patient experience of integration of health care: A literature review. Toronto, Ontario, Canada: The Change Foundation.Google Scholar
Suter, E., Oelke, N.D., Adair, C.E., & Armitage, G.D. (2009). Ten key principles for successful health systems integration. Healthcare Quarterly, 13, 16–23.CrossRefGoogle ScholarPubMed
Suter, E., Oelke, N.D., Adair, C.E., Waddell, C., Armitage, G.D., & Huebner, L.A. (2007). Health systems integration definitions, processes, & impact: A research synthesis. Calgary, Alberta, Canada: Health Systems and Workforce Research Unit, Calgary Health Region.Google Scholar
Sutherland, K., & Leatherman, L. (2010). Quality of healthcare in Canada: A chartbook. Ottawa, Ontario, Canada: Canadian Health Services Research Foundation. Retrieved April 15, 2010, fromhttp://www.chsrf.ca/documents/Chartbook/CHARTBOOK%20Eng_Feb23.pdf.Google Scholar
Wasson, J.H., & Baker, N.J. (2009). Balanced measures for patient-centered care. Journal of Ambulatory Care Management, 32(1), 44–55.Google Scholar
Yin, R.K. (2005). Appendix: Doing case studies in education. In Yin, R.K. (Ed.), Introducing the world of education a case study reader (pp. 379–398). Thousand Oaks, CA: Sage Publications, Inc.Google Scholar
Yin, R.K. (2003). Case study research: Design and methods. Thousand Oaks, CA: Sage Publications.Google Scholar