Abstract
BackgroundIt is well known that older adults are high users of the health care system. Older adults with chronic conditions receive care from multiple providers, across multiple settings, and this care is often unorganized and confusing. In 2005, Ontario established a model of inter-professional primary care (family health teams) with the aim of providing enhanced interdisciplinary primary care to patients. Primary care requires an in-depth understanding of the operations of primary care teams and their relationships with other community services. The aim of this study was to develop a deeper understanding of the current operations of two family health teams in Ontario, including their current processes for referrals, information sharing, and engagement of patients in decision-making.MethodsFocus group and individual semi-structured interviews with health care providers were conducted. Purposeful sampling was used to ensure information was obtained from different professional perspectives. Interviews were audio-recorded and transcribed verbatim. Using NVivo 10, data were analyzed using line by line thematic analysis techniques. A cluster technique was then applied to group similar codes into themes.ResultsThree focus group interviews (involving 4–6 health care providers/focus group) and six individual interviews were conducted with health care providers from two primary care teams and surrounding community care organizations. Six key themes were identified: 1) challenges engaging older adults in decisions about their care; 2) who is responsible for coordinating the care? 3) fragmented information sharing between health care providers; 4) lack of standardized referral processes and follow-up; 5) identifying services in the community for older adults; and 6) caring for older adults in rural communities.ConclusionsThe results of this study provide an in-depth understanding of the current context in which the primary care teams are currently operating. Improved primary care will require stronger processes of coordination, greater knowledge of and connections with other community services, and enhanced patient engagement processes. This information provides a helpful basis for implementing interventions in primary care.
Highlights
IntroductionOlder adults with chronic conditions receive care from multiple providers, across multiple settings, and this care is often unorganized and confusing
It is well known that older adults are high users of the health care system
Many of the findings identified through this project were not entirely unfamiliar in health care system research, these results provide greater awareness of the current issues faced by the primary health care sector [2, 16,17,18,19]
Summary
Older adults with chronic conditions receive care from multiple providers, across multiple settings, and this care is often unorganized and confusing. Through the development of both structural and funding-based barriers between primary and community care, the delivery of healthcare has become fragmented in many countries [4, 5]. Many patients, those individuals who are older and who experience one or more chronic conditions, may require long-term, often complex care from multiple providers working in a variety of settings [6, 7]. Health care providers are acknowledging the need to work together with patients, their families, and informal caregivers, and to collaborate with other health care providers to tailor healthcare to better fit the individual patient context [8]
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