How does an intensive care coordination program for people with chronic conditions and complex needs incorporate person-centred care? A multi-methods qualitative study

Problem

In Australia, Hospital Admission Risk Programs (HARP) aim to decrease hospital demand through comprehensive assessment, care coordination, and timely, responsive, specialist care in the community for people with complex needs, who present frequently or are at imminent risk of presenting to hospital. The HARPs focus on people with complex needs, particularly those with multiple chronic conditions who require intensive support to help manage their health. One key principle of these HARPs is person-centred care, a core element of high-quality healthcare. Numerous frameworks of person-centred care exist, and commonly comprise an informed and involved patient or client, receptive and responsive health professionals, and a coordinated, supportive, healthcare environment. How, and to what extent, person-centred care is incorporated in HARPs, is not known. To date, studies of person-centred care have focussed on the perceptions of providers. The perspectives of clients about approaches to care, their experiences, and what is important to them in the care they receive, has not been studied. This qualitative study aims to explore how a HARP for people with multiple chronic conditions and complex needs incorporates principles of person-centred care.

Approach

The study is set in a large metropolitan health service in Melbourne, Australia, in an area of social disadvantage. Seventeen staff, predominantly clinical nurse consultants as care coordinators, and 23 clients, with a variety of chronic conditions and complexities, were interviewed to understand their experiences of the program. For six of the clients interviewed, their carer participated in the interview. Interviews were supplemented with analysis of the health records of interviewed clients, as well as observation of chronic disease outpatient clinics providing specialist medical, nursing, and allied health support. Data were analysed using Braun & Clarke's thematic analysis.

Findings

This study is in progress: interviews are completed while analysis of the health records and observation field notes continue. Interview findings will be presented as themes based on key elements of patient-centred care: in particular, the experiences of clients planning their care, using information provided to make decisions, and having their needs identified and met. Staff interview data will also outline barriers and enablers to providing person-centred care in the HARP. The characteristics of care that matter most to clients with multiple chronic conditions will be presented.

Consequences

The findings of this study will provide core person-centred elements of care for people with multiple chronic conditions in the community, as described by the clients themselves. Similar programs aiming to reduce potentially preventable hospitalisations, and improve chronic disease management strategies can use these elements. The findings will also give voice to people with multiple chronic conditions and complex needs, to understand what is most important to them in their care.