Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study

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Abstract

Background

Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs.

Methods

Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through “Embrace,” an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach.

Results

Responses of participants concerned two focus areas: 1) Experiences with aging, with the themes “Struggling with health,” “Increasing dependency,” “Decreasing social interaction,” “Loss of control,” and “Fears;” and 2) Experiences with Embrace, with the themes “Relationship with the case manager,” “Interactions,” and “Feeling in control, safe, and secure”. The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants’ ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system.

Conclusion

The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging.

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Most cited references 32

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Multimorbidity in older adults.

M Salive (2013)

Multimorbidity, the coexistence of 2 or more chronic conditions, has become prevalent among older adults as mortality rates have declined and the population has aged. We examined population-based administrative claims data indicating specific health service delivery to nearly 31 million Medicare fee-for-service beneficiaries for 15 prevalent chronic conditions. A total of 67% had multimorbidity, which increased with age, from 50% for persons under age 65 years to 62% for those aged 65-74 years and 81.5% for those aged ≥85 years. A systematic review identified 16 other prevalence studies conducted in community samples that included older adults, with median prevalence of 63% and a mode of 67%. Prevalence differences between studies are probably due to methodological biases; no studies were comparable. Key methodological issues arise from elements of the case definition, including type and number of chronic conditions included, ascertainment methods, and source population. Standardized methods for measuring multimorbidity are needed to enable public health surveillance and prevention. Multimorbidity is associated with elevated risk of death, disability, poor functional status, poor quality of life, and adverse drug events. Additional research is needed to develop an understanding of causal pathways and to further develop and test potential clinical and population interventions targeting multimorbidity. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2013.

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Development and validation of the Patient Assessment of Chronic Illness Care (PACIC).

Russell E. Glasgow, Edward H Wagner, Judith Schaefer … (2005)

There is a need for a brief, validated patient self-report instrument to assess the extent to which patients with chronic illness receive care that aligns with the Chronic Care Model-measuring care that is patient-centered, proactive, planned and includes collaborative goal setting; problem-solving and follow-up support. A total of 283 adults reporting one or more chronic illness from a large integrated health care delivery system were studied. Participants completed the 20-item Patient Assessment of Chronic Illness Care (PACIC) as well as measures of demographic factors, a patient activation scale, and subscales from a primary care assessment instrument so that we could evaluate measurement performance, construct, and concurrent validity of the PACIC. The PACIC consists of 5 scales and an overall summary score, each having good internal consistency for brief scales. As predicted, the PACIC was only slightly correlated with age and gender, and unrelated to education. Contrary to prediction, it was only slightly correlated (r = 0.13) with number of chronic conditions. The PACIC demonstrated moderate test-retest reliability (r = 0.58 during the course of 3 months) and was correlated moderately, as predicted (r = 0.32-0.60, median = 0.50, P < 0.001) to measures of primary care and patient activation. The PACIC appears to be a practical instrument that is reliable and has face, construct, and concurrent validity. The resulting questionnaire is in the public domain, and recommendations for its use in research and quality improvement are outlined.

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Is Open Access

Use of qualitative methods alongside randomised controlled trials of complex healthcare interventions: methodological study

Simon Lewin, Claire Glenton, Andrew D Oxman (2009)

Objective To examine the use of qualitative approaches alongside randomised trials of complex healthcare interventions. Design Review of randomised controlled trials of interventions to change professional practice or the organisation of care. Data sources Systematic sample of 100 trials published in English from the register of the Cochrane Effective Practice and Organisation of Care Review Group. Methods Published and unpublished qualitative studies linked to the randomised controlled trials were identified through database searches and contact with authors. Data were extracted from each study by two reviewers using a standard form. We extracted data describing the randomised controlled trials and qualitative studies, the quality of these studies, and how, if at all, the qualitative and quantitative findings were combined. A narrative synthesis of the findings was done. Results 30 of the 100 trials had associated qualitative work and 19 of these were published studies. 14 qualitative studies were done before the trial, nine during the trial, and four after the trial. 13 studies reported an explicit theoretical basis and 11 specified their methodological approach. Approaches to sampling and data analysis were poorly described. For most cases (n=20) we found no indication of integration of qualitative and quantitative findings at the level of either analysis or interpretation. The quality of the qualitative studies was highly variable. Conclusions Qualitative studies alongside randomised controlled trials remain uncommon, even where relatively complex interventions are being evaluated. Most of the qualitative studies were carried out before or during the trials with few studies used to explain trial results. The findings of the qualitative studies seemed to be poorly integrated with those of the trials and often had major methodological shortcomings.

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Author and article information

Contributors

Fiona Harris: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 21 October 2015

Publication date Collection: 2015

Volume: 10

Issue: 10

Electronic Location Identifier: e0137803

Affiliations

[1 ]Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

[2 ]Department of Applied Research in Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

[3 ]Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

University of Stirling, UNITED KINGDOM

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: ASF KS SLWS KW. Performed the experiments: ASF KS. Analyzed the data: KS SLWS KW. Wrote the paper: ASF HPHK SAR KS SLWS KW.

* E-mail: s.l.w.spoorenberg@ 123456umcg.nl

Article

Publisher ID: PONE-D-15-11803

DOI: 10.1371/journal.pone.0137803

PMC ID: 4619446

PubMed ID: 26489096

SO-VID: 2323b64a-52c4-4ade-b6b2-bd4c4d2c44b6

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

History

Date received : 18 March 2015

Date accepted : 21 August 2015

Page count

Figures: 3, Tables: 2, Pages: 21

Funding

The Embrace study was funded by the Netherlands Organisation for Health Research and Development (ZonMw: grant number 314010201; http://www.zonmw.nl). The healthcare professionals involved were funded by the Dutch Healthcare Authority (NZa: file number 300-1021; http://www.nza.nl). Financial sponsors played no role in any contribution of these authors. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Data Availability Relevant interview excerpts will be provided upon acceptance of the manuscript and should be published alongside the paper as Supporting Information files. Full, anonymized transcripts are available upon request (Sophie Spoorenberg, s.l.w.spoorenberg@ 123456umcg.nl ).

Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study

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Most cited references 32

Multimorbidity in older adults.

Development and validation of the Patient Assessment of Chronic Illness Care (PACIC).

Use of qualitative methods alongside randomised controlled trials of complex healthcare interventions: methodological study

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