Elsevier

Health Policy

Volume 121, Issue 1, January 2017, Pages 58-65
Health Policy

Primary care managers’ perceptions of their capability in providing care planning to patients with complex needs

https://doi.org/10.1016/j.healthpol.2016.11.010Get rights and content

Highlights

  • Care planning is a process where patient’s needs and interventions are determined.

  • Managers’ perception of care planning was dominated by non-cooperation and separation.

  • Care planning was not a priority for actors in primary care.

Abstract

Objectives

The aim of this study was to investigate primary care managers’ perceptions of their capability in providing care planning to patients with complex needs. Care planning is defined as a process where the patient, family and health professionals engage in dialogue about the patient’s care needs and plan care interventions together.

Methods

Semi-structured interviews with 18 primary care managers in western Sweden were conducted using Westrin’s theoretical cooperation model. Data were analysed using a qualitative deductive method.

Main findings

Results reveal that the managers’ approach to care planning was dominated by non-cooperation and separation. The managers were permeated by uncertainty about the meaning of the task of care planning as such. They did not seem to be familiar with the national legislation stipulating that every healthcare provider must meet patients’ need for care interventions and participate in the care planning.

Implications for practice

To accomplish care planning, the process needs to cross – and overcome – both professional and organisational boundaries. There is also a need for incentives to develop working methods that promote local cooperation in order to facilitate optimal care for patients with complex needs.

Introduction

Patients with complex care needs who require long-term contact with healthcare services are in danger of ‘falling through the cracks’ when transferring from one healthcare provider to another [1], [2], [3], [4], [5]. Therefore, in many countries, primary care units are responsible for coordinating care efforts so that they function optimally. Primary care has, however, been criticised for lacking the ability to manage these patients’ acute and unplanned care interventions [6], [7]. This study aims to investigate primary care managers’ perceptions of their capability in providing care planning to patients with complex needs. The reason for studying primary care managers was because the rules governing care planning are included in legislation on primary care.

Section snippets

Patients with complex care needs

Patients with complex care needs often suffer from multi-morbidity, that is, having two or more chronic medical conditions [5], [8], [9]. What is common in this group is the need for regular contact with, and treatment from, various healthcare providers, which means that the need for coordinating care measures is crucial [10], [11], [12], [13], [14]. Moreover, care coordination has proven to be particularly important before, during and after hospitalisation [15], [16], [17].

Care planning

To optimise care

Design

Primary care managers situated at primary care centres in different municipalities were interviewed about how care planning was accomplished. The managers were asked to describe not only their own role but also their employee’s role in relation to care planning. The interviews were conducted individually using a semi-structured interview guide and analysed utilising a qualitative deductive method [42].

The study was conducted according to the ethical principles of the Declaration of Helsinki [43]

Approach to coordinated care planning in primary care

All managers perceived the task of care planning for patients with complex needs as being ambiguous. Just over half claimed that no policy document existed. Furthermore, they expressed that unclear rules led to conflicts in individual patient cases between primary care staff and their colleagues in the municipal health services. These conflicts came into play during handover reporting, care needs assessments, when assessing the care interventions required and during negotiations on who should

Discussion

The purpose of this study was to examine primary care managers’ perceptions of the capability of primary care organisations to accomplish care planning for patients with complex needs.

The analysis highlights a number of problems such as managers’ approach to the task itself as well as their view of primary care responsibilities, care planning practice and its future role in order to meet the needs of patients with complex care, in cooperation with other healthcare providers and across

Conclusion

This study reveals that primary care managers’ approach to care planning for patients with complex needs was dominated by non-cooperation and separation. The managers were permeated by uncertainty about the meaning of the task of care planning as such. They were not familiar with the national legislation stipulating that every healthcare provider must participate in the care planning. The study highlights the need to overcome both professional and organisational boundaries. It also emphasises

Conflicts of interest

The authors have no conflicts of interest.

Acknowledgements

We are grateful to the study participants who shared their experiences with us. We wish to acknowledge Jonny Melander, Närhälsan Kungshamn Health Centre, Region Västra Götaland, for financial support, and are grateful for the funding from the Fyrbodal Research and Development Council, Region Västra Götaland, and the Fyrbodal Health Academy, Trollhättan, Sweden.

References (56)

  • V. de Groot et al.

    How to measure comorbidity: a critical review of available methods

    Journal of Clinical Epidemiology

    (2003)
  • A. Clegg et al.

    Frailty in elderly people

    Lancet

    (2013)
  • F. Béland et al.

    Integrated models of care delivery for the frail elderly: international perspectives

    Gaceta Sanitaria

    (2011)
  • C. Hoffman et al.

    Persons with chronic conditions: their prevalence and costs

    JAMA

    (1996)
  • E. Carlström

    I skuggan av Ädel—integrering av kommunal vård och omsorg. [In the shadow of Ädel—integration in municipal home-care] [Doctoral dissertation]

    (2005)
  • M.L. Merriman

    Pre-hospital discharge planning: empowering elderly patients through choice

    Critical Care Nursing Quarterly

    (2008)
  • G. Akner

    Frail aging and multimorbidity affect more and more. Focus must be moved from isolated diseases to complex health problems

    Läkartidningen

    (2010)
  • S.W. Mercer et al.

    Multimorbidity in primary care: developing the research agenda

    Family Practice

    (2009)
  • P. Dainty et al.

    Timely discharge of older patients from hospital: improving the process

    Clinical Medicine

    (2009)
  • K. Rockwood et al.

    Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70

    Journal of the American Geriatrics Society

    (2006)
  • P. Rizza et al.

    Preventable hospitalization and access to primary health care in an area of Southern Italy

    BMC Health Services Research

    (2007)
  • C. Graf

    Functional decline in hospitalized older patients

    American Journal of Nursing

    (2008)
  • T. Lehnert et al.

    Review: health care utilization and costs of elderly persons with multiple chronic conditions

    Medical Care Research and Review

    (2011)
  • S.J. Singer et al.

    Defining and measuring integrated patient care: promoting the next frontier in health care delivery

    Medical Care Research and Review

    (2011)
  • S. Ilinca et al.

    The patterns of health care utilization by elderly Europeans: frailty and its implications for health systems

    Health Services Research

    (2015)
  • D.S. Yu et al.

    Disease management programs for older people with heart failure: crucial characteristics which improve post-discharge outcomes

    European Heart Journal

    (2006)
  • C. Batty

    Systematic review: interventions intended to reduce admission to hospital of older people

    International Journal of Therapy and Rehabilitation

    (2010)
  • I.A. Scott

    Preventing the rebound: improving care transition in hospital discharge processes

    Australian Health Review

    (2010)
  • A. Baker et al.

    Anticipatory care planning and integration: a primary care pilot study aimed at reducing unplanned hospitalization

    British Journal of General Practice

    (2012)
  • E. Kendall et al.

    Collaborative capacity building in complex community-based health partnerships: a model for translating knowledge into action

    Journal of Public Health Management and Practice

    (2012)
  • M.E. Dunnion et al.

    From the emergency department to home

    Journal of Clinical Nursing

    (2005)
  • E. Ramfelt et al.

    Parents with cancer: their approaches to participation in treatment plan decisions

    Nursing Ethics

    (2005)
  • E. Efraimsson

    Vårdplaneringsmötet: En studie av det institutionella samtalet mellan äldre kvinnor, närstående och vårdare. [Care planning meeting: a study of the institutional conversation among elderly women, families and caregivers]. [Doctoral dissertation]

    (2005)
  • F. McKeown

    The experience of older people on discharge from hospital following assessment by the public health nurse

    Journal of Clinical Nursing

    (2007)
  • S. Shepperd et al.

    Discharge planning from hospital to home

    Cochrane Database of Systematic Reviews

    (2004)
  • M. Bauer et al.

    Hospital discharge planning for frail older people and their family. Are we delivering best practice? A review of the evidence

    Journal of Clinical Nursing

    (2009)
  • S. Wadmann et al.

    Coordination between primary and secondary healthcare in Denmark and Sweden

    International Journal of Integrated Care

    (2009)
  • I. Romøren et al.

    Promoting coordination in Norwegian health care

    International Journal of Integrated Care

    (2011)
  • Cited by (10)

    View all citing articles on Scopus
    View full text