Primary care managers’ perceptions of their capability in providing care planning to 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.
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