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A bridge over troubled water? A qualitative study of primary care patients' experiences of a rehabilitation program.

ABSTRACT: PurposeThe aim of this study was to explore how patients on sick leave experienced and perceived the early collaboration work model (ECM) for rehabilitation.Patients and methodsData were collected via focus group discussions and individual interviews with 15 patients on sick leave, at nine primary health care centers. The systematic text condensation method described by Malterud was used for thematic analysis of meaning and content of data across cases.ResultsThe participants perceived that sharing experiences with others in a similar situation was restorative. They described the importance of coordination in the program as well as the efforts of the rehabilitation coordinator, who helped with daily structure and support in the beginning as well as encouragement throughout the sick leave period. Some participants felt ashamed of being on sick leave and of being outside the community.ConclusionECM with a rehabilitation coordinator who could share responsibility with the patient during the entire sick leave period was perceived to be of support during rehabilitation.

SUBMITTER: Skoglund I

PROVIDER: S-EPMC6141123 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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A bridge over troubled water? A qualitative study of primary care patients' experiences of a rehabilitation program.

Skoglund Ingmarie I Petersson Eva-Lisa EL Hange Dominique D

Journal of multidisciplinary healthcare 20180911

<h4>Purpose</h4>The aim of this study was to explore how patients on sick leave experienced and perceived the early collaboration work model (ECM) for rehabilitation.<h4>Patients and methods</h4>Data were collected via focus group discussions and individual interviews with 15 patients on sick leave, at nine primary health care centers. The systematic text condensation method described by Malterud was used for thematic analysis of meaning and content of data across cases.<h4>Results</h4>The parti ...[more]

PMID: 30254453

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Project description:BACKGROUND:The Veterans Access, Choice and Accountability Act (hereafter, Choice Program) seeks to improve access to care by enabling eligible Veterans to receive care from community providers. Veterans Affairs (VA) primary care providers (PCPs) play a key role in making referrals to community specialists, but their frontline experiences with referrals are not well understood. OBJECTIVE:To understand VA PCPs' experiences referring patients to community specialists while VA works to expand and refine the implementation of the Choice Program. DESIGN:Qualitative study using interview methods. PARTICIPANTS:Semi-structured telephone interviews were conducted with VA primary care providers (N = 72 out of 599 contacted) recruited nationally. APPROACH:Open-ended interview questions elicited PCP perceptions and experiences with referrals to community specialists via the Choice Program. Keywords were identified using automated coding features in ATLAS.ti and evaluated using conventional content analysis to inductively describe the qualitative data. KEY RESULTS:VA PCPs emphasized problems with care coordination and continuity between the VA and community specialists (e.g., "It is extremely difficult for us to obtain and continue continuity of care because there's not much communication with the community specialist"). They described difficulties with tracking the initial referral, coordinating care after receiving community specialty care, accessing community medical records, and aligning community specialists' prescriptions with the VA formulary. CONCLUSIONS:The VA Choice Program provides access to community specialists for VA patients; however, VA primary care providers face challenges tracking referrals to community specialists and in coordinating care. Strategies to improve care coordination between the VA and community providers should focus on providing PCPs with information to follow Veterans throughout the Choice referral process and follow-up.

Project description:BackgroundElectronic consultation (eConsult), which involves primary care provider (PCP)-to-specialist asynchronous consultation, is increasingly used in health care systems to streamline care and to improve patient access. The Association of American Medical Colleges (AAMC) formed a collaborative to support the implementation of an electronic medical record (EMR)-based, opt-in eConsult program across multiple academic medical centers (AMCs). In this model, PCPs can elect to send either an eConsult or a traditional referral.ObjectiveWe sought to understand the PCP experience with eConsult to identify facilitators of and barriers to the successful adoption of the model.Design and participantsWe conducted 35 semi-structured interviews and 6 focus groups with a range of primary care providers at 7 AMCs participating in the AAMC collaborative.ApproachInterviews were recorded and transcribed or detailed field notes were taken. We used the constant comparative method to identify recurring themes within and across sites, and resolve interpretive discrepancies.Key resultsWe identified three major themes related to the eConsult program: (1) eConsult increases the comprehensiveness of primary care and fills PCPs' knowledge gaps through case-based learning. (2) Factors that influence PCPs to order an eConsult rather than a traditional referral include patient preference, case complexity, and need for expert guidance. (3) Implementation challenges included increasing PCPs' awareness of the program, addressing PCPs' concerns about increased workload, recruiting engaged specialist consultants, and ensuring high quality eConsult responses. Implementation success relied on PCP ownership of the consultation process, mitigating unintended consequences, ongoing education about the program, and mechanisms for providing feedback to clinicians.ConclusionsOur findings demonstrate that an opt-in eConsult program at AMCs has the potential to increase PCP knowledge and enhance the comprehensiveness of primary care. For these benefits to be realized, program implementation requires sustained efforts to overcome barriers to use and establish norms guiding eConsult communication.

Project description:Background In an earlier study, PRIM-CARE RCT, a care manager implementation at the primary care centre showed improved return to work and reduced sick leave for patients with CMD. To further improve return to work, the project Co-Work-Care added a person-centered dialogue meeting between the patient, the employer and the rehabilitation coordinator, preceded by an increased collaboration between care manager, rehabilitation coordinator and GP. In this first qualitative study of the Co-Work-Care project, we explored how care managers and rehabilitation coordinators experienced the Co-Work-Care model. The purpose of this study was to explore care managers’ and rehabilitation coordinators’ perceptions and experiences of a close collaboration and the use of the person-centred dialogue meeting. Methods From an ongoing RCT with 20 primary care centres, care managers (CMs) (n?=?13) and rehabilitation coordinators (RCs) (n?=?12) participated in a qualitative study with focus groups. The study was conducted in the primary health care in a Swedish region. The data was analysed with Systematic Text Condensation by Malterud. Results Seven codes describing the participants’ experiences of the Co-Work-Care model were identified: 1) The importance of collaboration at the primary care centre, 2) Collaboration and division of roles between the RC and the CM, 3) Collaboration with the General practitioner (GP), 4) The person-centred dialogue meeting, 5) Initiating the person-centred dialogue meeting, 6) The person-centred dialogue meeting to improve collaboration with the employer, and 7) The person-centred dialogue meeting to teach about the return to work process. Conclusion The increased collaboration within the Co-Work-Care model created a common picture and understanding of the patient’s situation. The person-centred dialogue meeting in the rehabilitation process became a bridge between the employer and the patient. Trial registration NCT03250026 (registered August 15, 2017). Supplementary Information The online version contains supplementary material available at 10.1186/s12875-020-01348-x.

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A bridge over troubled water? A qualitative study of primary care patients' experiences of a rehabilitation program.

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A bridge over troubled water? A qualitative study of primary care patients' experiences of a rehabilitation program.

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