Experiencing integration: a qualitative pilot study of consumer and provider experiences of integrated primary health care in Australia

Michelle Banfield,Paresh Dawda,Kirsty A Douglas,Anne Parkinson,Tanisha Jowsey

doi:10.1186/s12875-016-0575-z

Abstract

BackgroundThe terms integration and integrated care describe the complex, patient-centred strategies to improve coordination of healthcare services. Frameworks exist to conceptualise these terms, but these have been developed from a professional viewpoint.The objective of this study was to explore consumers’ and providers’ concepts, expectations and experience of integrated care. A key focus was whether frameworks developed from a professional perspective are effective models to explore people’s experiences.MethodsA qualitative pilot study was undertaken at one Australian multidisciplinary primary health care centre. Semi-structured interviews were conducted with consumers (N = 19) and staff (N = 10). Data were analysed using a framework analysis approach.ResultsConsumers’ experience of integrated care tended to be implicit in their descriptions of primary healthcare experiences more broadly. Experiences related to the typologies involved clinical and functional integration, such as continuity of providers and the usefulness of shared information. Staff focused on clinical level integration, but also talked about a cultural shift that demonstrated normative, professional and functional integration.ConclusionsExisting frameworks for integration have been heavily influenced by the provider and organisational perspectives. They are useful for conceptualising integration from a professional perspective, but are less relevant for consumers’ experiences. Consumers of integrated primary health care may be more focussed on relational aspects of care and outcomes of care.

Highlights

The terms integration and integrated care describe the complex, patient-centred strategies to improve coordination of healthcare services
Staff had a strong focus on clinical level integration, and talked about a cultural shift that demonstrated normative, professional and functional integration
The current study provides evidence that work is still needed on the key concepts of quality integrated primary health care from the consumer perspective

Summary

Introduction

The terms integration and integrated care describe the complex, patient-centred strategies to improve coordination of healthcare services. A key focus was whether frameworks developed from a professional perspective are effective models to explore people’s experiences. Kodner and colleagues have pointed out that ‘integration’ refers to structures and processes, while ‘integrated care’ is more concerned with the patient experiences and outcomes of such processes [1]. Despite this distinction, confusion [a] multi-level, multi-modal, demand driven and patient-centred strategy designed to address complex and costly health needs by achieving better coordination of services across the entire care continuum. As Goodwin recently argued, we lack the means to effectively measure and monitor outcomes in integrated care, ‘ in terms of understanding improvements in the user experience’[11]

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