A qualitative study of health care providers\u2019 perceptions and experiences of working together to care for children with medical complexity (CMC)

Lisa Altman,Yvonne Zurynski,Tim Hoffmann,Susan Woolfenden,Christie Breen

doi:10.1186/s12913-018-2857-8

Abstract

BackgroundChildren with medical complexity (CMC) have a wide range of long term health problems and disabilities that have an adverse impact on their quality of life. They have high levels of family identified health care needs and health care utilisation. There is no Australian literature on the experiences of health care providers working in the Australian tertiary, secondary and primary health care system, whilst managing CMC. This information is essential to inform the design of integrated health care systems for these children. We address this knowledge gap by exploring the perceptions and experiences of health care providers on the provision of health care for CMC aged 0 to 18 years.MethodA qualitative research study was undertaken. Stakeholder forums, group and individual in depth interviews were undertaken using a semi-structured interview guide. The stakeholder forums were audio recorded and transcribed verbatim. Field notes of the stakeholder forums, group and individual interviews were taken. Inductive thematic analysis was undertaken to identify key themes.ResultsOne hundred and three providers took part in the stakeholder forums and interviews across 3 local health districts, a tertiary paediatric hospital network, and primary health care organisations. Providers expressed concern regarding family capacity to negotiate the system, which was impacted by the medical complexity of the children and psychosocial complexity of their families. Lack of health care provider capacity in terms of their skills, time and availability to manage CMC was also a key problem. These issues occurred within a health system that had impaired capacity in terms of fragmentation of care and limited communication among health care providers.ConclusionWhen designing integrated care models for CMC, it is essential to understand and address the challenges experienced by their health care providers. This requires adequate training of providers, additional resources and time for coordination of care, improved systems of communication among services, with timely access to key information for parents and providers.

Highlights

Children with medical complexity (CMC) have a wide range of long term health problems and disabilities that have an adverse impact on their quality of life
Providers expressed concern regarding family capacity to negotiate the system, which was impacted by the medical complexity of the children and psychosocial complexity of their families
Setting The project was undertaken across Sydney Children’s Hospitals Network (SCHN), which provides over 90% of tertiary paediatric care in New South Wales (NSW) with three local health district (LHD) and three primary health network (PHN) partners

Summary

Introduction

Children with medical complexity (CMC) have a wide range of long term health problems and disabilities that have an adverse impact on their quality of life They have high levels of family identified health care needs and health care utilisation. There is no Australian literature on the experiences of health care providers working in the Australian tertiary, secondary and primary health care system, whilst managing CMC This information is essential to inform the design of integrated health care systems for these children. Families are impacted by time demands, distance travelled, stress, sleep deprivation, comorbid behaviour problems and out of pocket costs [7, 8] These children are at greater risk of falling through the gaps of a fragmented and inequitable health care service [9]. Fragmented health care is costly, with uncoordinated care in the USA costing 35% more in health care costs than coordinated care [12]

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Results

Discussion

Conclusion