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Coordination of care for individuals with advanced progressive conditions : a multi-site ethnographic and serial interview study
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Mason, Bruce, Epiphaniou, Eleni, Nanton, Veronica, Donaldson, Anne, Shipman, Cathy, Daveson, Barbara A, Harding, Richard, Higginson, Irene, Munday, Dan, Barclay, Stephen, Boyd, Kirsty, Dale, Jeremy, Kendall, Marilyn, Worth, Allison and Murray, Scott A. (2013) Coordination of care for individuals with advanced progressive conditions : a multi-site ethnographic and serial interview study. British Journal of General Practice, 63 (613). e580-e588. doi:10.3399/bjgp13X670714 ISSN 0960-1643.
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Official URL: http://dx.doi.org/10.3399/bjgp13X670714
Abstract
Background: Coordination of care for individuals with advanced progressive conditions is frequently poor.
Aim: To identify how care is coordinated in generalist settings for individuals with advanced progressive conditions in the last year of life.
Design and setting: A mixed methods study of three UK generalist clinical settings producing three parallel case studies: an acute admissions unit in a regional hospital, a large general practice, and a respiratory outpatient service.
Method: Ethnographic observations in each setting, followed by serial interviews of patients with advanced progressive conditions and their family carers in the community. A spectrum of clinicians and healthcare workers were also interviewed.
Results: Ethnographic observations were conducted for 22 weeks. A total of 56 patients, 25 family carers and 17 clinicians yielded 198 interviews. Very few participants had been identified for a palliative approach. Rapid throughput of hospital patients and time pressures in primary care hindered identification of palliative care needs. Lack of care coordination was evident during emergency admissions and discharges. Patient, families, and professionals identified multiple problems relating to lack of information, communication, and collaboration at care transitions. Family carers or specialist nurses, where present, usually acted as the main care coordinators.
Conclusion: Care is poorly coordinated in generalist settings for patients in the last year of life, although those with cancer have better coordinated care than other patients. A model to improve coordination of care for all individuals approaching the end of life must ensure that patients are identified in a timely way, so that they can be assessed and their care planned accordingly.
Item Type: | Journal Article | ||||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Journal or Publication Title: | British Journal of General Practice | ||||||
Publisher: | Royal College of General Practitioners | ||||||
ISSN: | 0960-1643 | ||||||
Official Date: | 2013 | ||||||
Dates: |
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Volume: | 63 | ||||||
Number: | 613 | ||||||
Page Range: | e580-e588 | ||||||
DOI: | 10.3399/bjgp13X670714 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) |
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