Abstract
Background:Integrated care pathways (ICPs) could improve the organisation and delivery of care for community dwelling older adults. An ICP was developed and implemented in Québec to support home care processes. This study explores the perspectives of home care staff on the use of an ICP to support the organisation and delivery of health and social care to community-dwelling older adults with complex needs.Theory and Methods:A case study based on eleven semi-structured interviews and analysis of documents was carried out in an urban home care unit. The Normalization Process Theory was used for mixed thematic analysis.Results:While its capacity to store data and enhance interprofessional information exchange was appreciated by home care staff, the broad scope, and automated features of the ICP tool were often problematic. Concerns about increased provider workloads, disruption to provider-client relationships during clinical encounters, and difficulties engaging clients in decision-making were main obstacles in the use of the ICP.Conclusion:Given the importance of ICPs in advancing clinical integration, it is critical to continuously adjust their design to align with providers’ realities in order to optimize their potential in real life contexts.
Highlights
Demographic and epidemiological trends of industrialised countries over the last few decades reveal increasing proportions of community-dwelling older adults living with complex health and social needs [1]
While its capacity to store data and enhance interprofessional information exchange was appreciated by home care staff, the broad scope, and automated features of the Integrated care pathways (ICPs) tool were often problematic
Despite overall improvements in the organisation of home care services, several studies have reported wide variations in the type and quality of services offered in home care programs, with potential negative impacts on people living with complex needs [3, 7, 8]
Summary
Demographic and epidemiological trends of industrialised countries over the last few decades reveal increasing proportions of community-dwelling older adults living with complex health and social needs [1]. Despite overall improvements in the organisation of home care services, several studies have reported wide variations in the type and quality of services offered in home care programs, with potential negative impacts on people living with complex needs [3, 7, 8]. To address these variations, Integrated Clinical Pathways (ICPs) have emerged in many countries as organisational strategies to standardize and improve the effectiveness of home care services [9,10,11]. The Normalization Process Theory was used for mixed thematic analysis
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