Elderly patients with complex health problems in the care trajectory: a qualitative case study

Marianne Kumlin,Geir Vegar Berg,Kari Kvigne,Ragnhild Hellesø

doi:10.1186/s12913-020-05437-6

Abstract

BackgroundElderly patients with multiple health problems often experience disease complications and functional failure, resulting in a need for health care across different health care systems during care trajectory. The patients’ perspective of the care trajectory has been insufficiently described, and thus there is a need for new insights and understanding. The study aims to explore how elderly patients with complex health problems engage in and interact with their care trajectory across different health care systems where several health care personnel are involved.MethodsThe study had an explorative design with a qualitative multi-case approach. Eleven patients (n = 11) aged 65–91 years participated. Patients were recruited from two hospitals in Norway. Observations and repeated interviews were conducted during patients’ hospital stays, discharge and after they returned to their homes. A thematic analysis method was undertaken.ResultsPatients engaged and positioned themselves in the care trajectory according to three identified themes: 1) the patients constantly considered opportunities and alternatives for handling the different challenges and situations they faced; 2) patients searched for appropriate alliance partners to support them and 3) patients sometimes circumvented the health care initiation of planned steps and took different directions in their care trajectory.ConclusionsThe patients’ considerations of their health care needs and adjustments to living arrangements are constant throughout care trajectories. These considerations are often long term, and the patient engagement in and management of their care trajectory is not associated with particular times or situations. Achieving consistency between the health care system and the patient’s pace in the decision-making process may lead to a more appropriate level of health care in line with the patient’s preferences and goals.

Highlights

Patients with multiple health problems often experience disease complications and functional failure, resulting in a need for health care across different health care systems during care trajectory
They chose a variety of strategies to participate in their care management, driving the care trajectory forward and handling barriers
The patients were engaged and positioned themselves according to three identified themes: continuous consideration of opportunities and alternatives, consideration for appropriate alliances and circumvention of the health care initiation of planned steps

Summary

Introduction

Patients with multiple health problems often experience disease complications and functional failure, resulting in a need for health care across different health care systems during care trajectory. The study aims to explore how elderly patients with complex health problems engage in and interact with their care trajectory across different health care systems where several health care personnel are involved. Persons with multiple health problems often experience. Several terms have been used to describe patients’ needs that span levels of health care system, including care pathways, clinical pathways, critical pathways, care trajectories, standardised patient pathways and care bundles. The term care pathway can be defined as the Kumlin et al BMC Health Services Research (2020) 20:595 management of care and chronological activities of a health care process for a well-defined group of patients during a well-defined period of time [4]. Questions have been asked if these pathways are a risk to patient preferences and if individual needs will receive less attention [8, 9]

Objectives

Methods

Results

Discussion

Conclusion