Patients’ and carers’ experience and perceptions of the pilot Integrated Care Programme for Older Persons in Cork City (ICPOP): a qualitative evaluation
University College Cork
Introduction: The older adult population is increasing dramatically. Older adults experience prolonged hospital admissions and are at a higher risk of experiencing hospital-associated decline, with frail older adults being even more vulnerable. This increases their risk of mortality, readmission, and care-dependency. The Integrated Care Programme for Older Persons (ICPOP) was introduced in Ireland in response to these demanding demographic changes, with an aim of improving quality of life for older adults by supporting them to live well in their homes. The framework for the ICPOP places an emphasis on the importance of evaluating the structural, process and patient outcomes in order to achieve the service objectives. This thesis addresses patient outcomes, with an overall aim of exploring patients’ and carers’ experiences and perceptions of the ICPOP in Cork city. The participants’ feedback will be used to further refine the service. Method: In order to approach this research question, it was necessary for the researcher to gain a more in-depth knowledge on the characteristics of similar models of care worldwide, and their effectiveness compared to usual inpatient care. Therefore, this project was divided into two phases. Phase 1 consisted of a systematic review. The main objective of this review was to determine whether hospital at home is an effective model of care for acutely unwell older adults, compared to usual inpatient care. A secondary aim was to further explore the optimal parameters (i.e. frequency, intensity, duration, and type of care provided) in the delivery of care, to improve patient outcomes. The findings of this review were also used to inform the interview schedule which was used in Phase 2. In Phase 2, the researcher addressed the main research question using qualitative research methods. Semi-structured interviews were carried out with patients and carers in their own homes. The interview guide was developed with guidance from the themes, as listed by Proctor et al (2011), exploring implementation, service, and client outcomes. Data was analysed using thematic analysis. The resulting categories were then organised using the constructs of the conceptual framework for implementation outcomes. Results: In phase 1, a total of 917 studies were screened. Among these, 23 studies were identified as highly relevant, with 16 studies ultimately fulfilling the inclusion and exclusion criteria and being included for review. The systematic review was limited by a lack of newly published randomised controlled trials and a high risk of bias across many studies. In the context of these limitations, there was evidence to support hospital at home in the areas of patient and carer satisfaction and carer burden, compared to usual inpatient care. It was not possible to determine optimal parameters in the delivery of care due to the under-reporting of interventions across many of the studies. The qualitative study revealed service users’ overwhelming satisfaction with the ICPOP. Key elements contributing to this included the accelerated discharge from hospital and home-based rehabilitation, caring personnel, the positive, therapeutic relationships developed with staff, reassurance for patients and carers and the patient’s functional recovery. Some uncertainties regarding the duration of care, end of care and rehabilitative element of the service were also highlighted. Conclusion: This study has made an important contribution to the topic of hospital at home models of care for the older adult. This study demonstrated that the patients’ and carers’ satisfaction with this service is largely due to receiving care in the home environment, the social aspect of care, reassurance for both the patient and carer, and the patients’ functional recovery. The importance of continuity of care and social relationships was also highlighted. Further high quality RCTs are necessary in order to determine the effectiveness of hospital at home care compared to usual inpatient care for the older adult, with accurate reporting of interventions in order to explore the optimal characteristics for the delivery of this model of care to improve patient outcomes.
Integrated care , Older person , Hospital avoidance , Supported discharge , Primary care , Multidisciplinary team , Qualitative
Shinkwin, C. 2020. Patients’ and carers’ experience and perceptions of the pilot Integrated Care Programme for Older Persons in Cork City (ICPOP): a qualitative evaluation. MRes Thesis, University College Cork.