Beyond multimorbidity: primary care and the older person with complex needs

2021 ◽  
Author(s):  
Jennifer Mann ◽  
Fintan Thompson ◽  
Rachel Quigley ◽  
Robyn McDermott ◽  
Susan Devine ◽  
...  
Keyword(s):  
Primary Care ◽  
Older Person ◽  
Complex Needs

scholarly journals OPEN ARCH: integrated care at the primary–secondary interface for the community-dwelling older person with complex needs

2020 ◽  
Vol 26 (2) ◽  
pp. 104
Author(s):  
Jennifer Mann ◽  
Rachel Quigley ◽  
Desley Harvey ◽  
Megan Tait ◽  
Gillian Williams ◽  
...  
Keyword(s):  
Primary Care ◽  
Integrated Care ◽  
Older Persons ◽  
Healthcare Delivery ◽  
Community Dwelling ◽  
Ageing Population ◽  
Preventative Care ◽  
Older Person ◽  
Complex Needs ◽  
Open Arch

Optimal care of community-dwelling older Australians with complex needs is a national imperative. Suboptimal care that is reactive, episodic and fragmented, is costly to the health system, can be life threatening to the older person and produces unsustainable carer demands. Health outcomes would be improved if services (health and social) are aligned towards community-based, comprehensive and preventative care. Integrated care is person-focussed in outlook and defies a condition-centric approach to healthcare delivery. Integration is a means to support primary care, with the volume and complexity of patient needs arising from an ageing population. Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) is a targeted model of care that improves access to specialist assessment and comprehensive care for older persons at risk of functional decline, hospitalisation or institutionalised care. OPEN ARCH was developed with primary care as the central integrating function and is built on four values of quality care: preventative health care provided closer to home; alignment of specialist and generalist care; care coordination and enablement; and primary care capacity building. Through vertical integration at the primary–secondary interface, OPEN ARCH cannot only improve the quality of care for clients, but improves the capacity of primary care to meet the needs of this population.

scholarly journals Experience of primary care for people with HIV: a mixed-method analysis

BJGP Open ◽  
2019 ◽  
Vol 3 (4) ◽  
pp. bjgpopen19X101665
Author(s):  
Tanvi Rai ◽  
Jane Bruton ◽  
Meaghan Kall ◽  
Richard Ma ◽  
Erica Pufall ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Mixed Method ◽  
Care Staff ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Framework Analysis ◽  
Complex Needs ◽  
Hiv Status Disclosure ◽  
Method Analysis

BackgroundAdvances in treatment have transformed HIV into a long-term condition (LTC), presenting fresh challenges for health services, HIV specialists, and GPs.AimTo explore the experience of people living with HIV (PLHIV) regarding consulting their GPs.Design & settingA mixed-method analysis using data from two sources: a nationally-representative survey of PLHIV and a qualitative study with London-based PLHIV.MethodUnivariate logistic regression was used for quantitative data and framework analysis for qualitative data.ResultsThe survey had 4422 participants; the qualitative study included 52 participants. In both studies, registration with a GP and HIV status disclosure were high. Similar to general population trends, recent GP use was associated with poor self-rated health status, comorbidities, older age, and lower socioeconomic status. Two-thirds reported a good experience with GPs; a lower proportion felt comfortable asking HIV-related questions. Actual or perceived HIV stigma were consistently associated with poor satisfaction. In the interviews, participants with additional LTCs valued sensitive and consistent support from GPs. Some anticipated, and sometimes experienced, problems relating to HIV status, as well as GPs’ limited experience and time to manage their complex needs. Sometimes they took their own initiative to facilitate coordination and communication. For PLHIV, a ‘good’ GP offered continuity and took time to know and accept them without judgment.ConclusionThe authors suggest clarification of roles and provision of relevant support to build the confidence of PLHIV in GPs and primary care staff to care for them. As the PLHIV population ages, there is a strong need to develop trusting patient–GP relationships and HIV-friendly GP practices.

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

Health Policy ◽  
2017 ◽  
Vol 121 (1) ◽  
pp. 58-65 ◽  
Author(s):  
Lena Gunvor Larsson ◽  
Siv Bäck-Pettersson ◽  
Sven Kylén ◽  
Bertil Marklund ◽  
Eric Carlström
Keyword(s):  
Primary Care ◽  
Care Planning ◽  
Complex Needs ◽  
Care Managers

Medical Home: Is there a place for recreational therapy?

2010 ◽  
Vol 9 (2) ◽  
pp. 13-20
Author(s):  
Mary Ann Keogh Hoss, PhD, CTRS, FACHE, FDRT ◽  
Kari Kensinger, PhD, CTRS
Keyword(s):  
Primary Care ◽  
Medical Home ◽  
Clinical Skills ◽  
Primary Care Providers ◽  
Care Physician ◽  
Recreational Therapy ◽  
Care Providers ◽  
Complex Needs ◽  
Community Skills ◽  
Medical Home Model

The purpose of this article is to explore the role of recreational therapy within a medical home model. Medical home is a movement to manage the care of individuals with complex and chronic health needs through their primary care physician and the physician’s team. The concepts of medical home are discussed. These concepts are the same as those on which recreational therapists have been trained. This article demonstrates the various ways in which recreational therapists can meet the challenges posed by serving individuals with chronic disease.The medical home model provides a rare opportunity for recreational therapists to combine clinical skills with community skills to meet the needs of those individuals in the community with chronic and complex needs. This article demonstrates that recreational therapists are already engaged and invested in this model. What is lacking is the promotion of skills and services of the recreational therapists to market and communicate this to primary care providers.

Smartphone-Based Health Technologies for Dementia Care: Opportunities, Challenges, and Current Practices

2017 ◽  
Vol 38 (1) ◽  
pp. 73-91 ◽  
Author(s):  
Ellen Leslie Brown ◽  
Nicole Ruggiano ◽  
Juanjuan Li ◽  
Peter J. Clarke ◽  
Emma S. Kay ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Caregivers ◽  
Behavioral Health Care ◽  
Research Practice ◽  
Smartphone Apps ◽  
Complex Needs ◽  
Health Technologies ◽  
Care And Support ◽  
Hispanic Populations

Most of the 5.4 million people affected by Alzheimer’s disease and other forms of dementia (AD) are noninstitutionalized, receiving care by unpaid family caregivers and medically managed by a primary care provider (PCP). Health Information Technology has been recognized for its potential in improving efficiency and quality of AD care and support for AD caregivers. Simultaneously, smartphone technologies have become an increasingly common way to deliver physical and behavioral health care. However, little is known about how smartphone technologies have been used to support AD caregiving and care. This article highlights the current need for smartphone-based interventions for AD and systematically identified and appraised current smartphone apps targeting and available for AD caregivers. Findings indicate that individual available apps have limited functions (compared with the complex needs of caregivers) and little has been done to extend AD caregiving apps to Hispanic populations. Implications for research, practice, and policy are discussed.

Treating eczema in the older person in primary care

2016 ◽  
Vol 27 (1) ◽  
pp. 34-37 ◽  
Author(s):  
Jean Watkins
Keyword(s):  
Primary Care ◽  
Older Person

scholarly journals Access to primary health care for asylum seekers and refugees: a qualitative study of service user experiences in the UK

2019 ◽  
Vol 69 (685) ◽  
pp. e537-e545 ◽  
Author(s):  
Cara Kang ◽  
Louise Tomkow ◽  
Rebecca Farrington
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Asylum Seekers ◽  
Healthcare Access ◽  
Negative Consequences ◽  
Complex Needs ◽  
Primary Health ◽  
The Uk ◽  
Asylum Seekers And Refugees

BackgroundAsylum seekers and refugees (ASR) face difficulty accessing health care in host countries. In 2017, NHS charges for overseas visitors were extended to include some community care for refused asylum seekers. There is growing concern that this will increase access difficulties, but no recent research has documented the lived experiences of ASR accessing UK primary health care.AimTo examine ASR experiences accessing primary health care in the UK in 2018.Design and settingThis was a qualitative community-based study. ASR were recruited by criterion-based sampling through voluntary community organisations.MethodA total of 18 ASR completed face-to-face semi-structured recorded interviews discussing primary care access. Transcripts underwent thematic analysis by three researchers using Penchansky and Thomas’s modified theory of access.ResultsThe qualitative data show that participants found primary care services difficult to navigate and negotiate. Dominant themes included language barriers and inadequate interpretation services; lack of awareness of the structure and function of the NHS; difficulty meeting the costs of dental care, prescription fees, and transport to appointments; and the perception of discrimination relating to race, religion, and immigration status.ConclusionBy centralising the voices of ASR and illustrating the negative consequences of poor healthcare access, this article urges consideration of how access to primary care in the UK can be enhanced for often marginalised individuals with complex needs.

scholarly journals The mismeasurement of complexity: provider narratives of patients with complex needs in primary care settings

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Fiona Webster ◽  
Kathleen Rice ◽  
Onil Bhattacharyya ◽  
Joel Katz ◽  
Eric Oosenbrug ◽  
...  
Keyword(s):  
Primary Care ◽  
Complex Needs ◽  
Primary Care Settings

scholarly journals Evaluating integrated care for people with complex needs

2020 ◽  
Vol 26 (1) ◽  
pp. 46-53
Author(s):  
Panagiotis Kasteridis ◽  
Anne Mason ◽  
Andrew Street
Keyword(s):  
Primary Care ◽  
Integrated Care ◽  
Models Of Care ◽  
Care Team ◽  
Future Research ◽  
Complex Care ◽  
Care Needs ◽  
Complex Needs ◽  
Care Models ◽  
Integrated Care Models

Objectives As part of the Vanguard programme, two integrated care models were introduced in South Somerset for people with complex care needs: the Complex Care Team and Enhanced Primary Care. We assessed their impact on a range of utilization measures and mortality. Methods We used monthly individual-level linked primary and secondary care data from April 2014 to March 2018 to assess outcomes before and after the introduction of the care models. The analysis sample included 564 Complex Care Team and 841 Enhanced Primary Care cases that met specific criteria. We employed propensity score methods to identify out-of-area control patients and difference-in-differences analysis to isolate the care models’ impact. Results We found no evidence of significantly reduced utilization in any of the Complex Care Team or Enhanced Primary Care cohorts. The death rate was significantly lower only for those in the first Enhanced Primary Care cohort. Conclusions The integrated care models did not significantly reduce utilization nor consistently reduce mortality. Future research should test longer-term outcomes associated with the new models of care and quantify their contribution in the context of broader initiatives.

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