Abstract
BackgroundCare guidelines for people with chronic obstructive pulmonary disease (COPD) recommend an integrated approach for holistic, flexible, and tailored interventions. Continuity of care is also emphasised. However, many patients with COPD experience fragmented care. Discontinuities in healthcare and related social services are likely to result in disjointed rather than integrated care which can negatively affect patient health outcomes. The purpose of this qualitative study was to improve our understanding of, and how, contextual features pertaining to structures and processes of COPD integrated care influence delivery of care within patients’ healthcare networks.MethodsWe conducted individual interviews with 28 participants (9 patients, 16 healthcare professionals, and 3 spousal caregivers). Participants were recruited through the lung clinic at a city hospital in western Canada. We employed a social network paradigm to analyse and interpret the data.ResultsThe analysis revealed an overarching theme of fragmented COPD care with two sub-themes: (1) Funding shortfalls and availability of resources, and (2) Dis(mis)connected communication pathways. The overarching theme depicts variations, delays, and discontinuities in patient care. The sub-themes describe how macro level influences and meso level shortfalls were perceived to influence the availability of respiratory care resources that contributed to fragmented COPD care.ConclusionsEmploying a social network lens drew particular attention to family physicians’ pivotal role in delivering community-based COPD care. While an integrated approach to care is recommended by care guidelines, institutional and organizational structures and processes, such as financial and communication structures, may inhibit delivery of integrated care. Thus, macro and meso level structures and processes have the potential to shape patient care by constraining family physicians’ purposive and communication actions necessary for facilitating an integrated distributed approach to care. We propose a context of care which fosters a context for family physicians’ delivery of patient-centered care. Integrated care delivery may improve patients’ wellbeing and alleviate financial constraints on the healthcare system.
Highlights
Care guidelines for people with chronic obstructive pulmonary disease (COPD) recommend an integrated approach for holistic, flexible, and tailored interventions
The analysis revealed an overarching theme of fragmented COPD care, with two interwoven subthemes: (1) Funding shortfalls and availability of resources, and (2) Dis(mis)connected communication pathways
We explored the experiences of people with COPD and their community healthcare networks to gain a broader and deeper understanding of the healthcare network structures and processes which contribute to distributed integrated COPD care
Summary
Care guidelines for people with chronic obstructive pulmonary disease (COPD) recommend an integrated approach for holistic, flexible, and tailored interventions. In relation to patient care, integrated care more often relates to collaboration between various healthcare practices, such as family physician, respiratory specialist, therapist, pharmaceutical, and pulmonary rehabilitation services, that are necessary to treat and manage COPD [7, 9]. Integrated care with these collaborative characteristics has been shown to improve patient health outcomes, with respect to decreased exacerbations and hospitalization [11, 12]. At the organizational level, integrated care refers to the organizations and services that deliver healthcare, such as health authorities and private service providers, and is thought to reduce healthcare costs [9,10,11]
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