Volume 14 Supplement 2

Health Services Research: Evidence-based practice

Open Access

The real-world problem of care coordination: a longitudinal qualitative study with patients living with advanced progressive illness and their unpaid caregivers

  • Barbara A Daveson1,
  • Richard Harding1,
  • Cathy Shipman1,
  • Bruce L Mason2,
  • Eleni Epiphaniou1,
  • Irene J Higginson1,
  • Clare Ellis-Smith1,
  • Lesley Henson1,
  • Dan Munday3,
  • Veronica Nanton3,
  • Jeremy Dale3,
  • Kirsty Boyd2,
  • Allison Worth2,
  • Stephen Barclay4,
  • Anne Donaldson2 and
  • Scott A Murray2
BMC Health Services Research201414(Suppl 2):O27

https://doi.org/10.1186/1472-6963-14-S2-O27

Published: 7 July 2014

Objectives

To develop a model of care coordination for patients living with advanced progressive illness and their unpaid caregivers, and to understand their perspective regarding care coordination.

Design

A prospective longitudinal, multi-perspective qualitative study involving a case-study approach.

Materials and methods

Serial in-depth interviews were conducted, transcribed verbatim and then analyzed through open and axial coding in order to construct categories for three cases (sites). This was followed by continued thematic analysis to identify underlying conceptual coherence across all cases in order to produce one coherent care coordination model.

Participants

Fifty-six purposively sampled patients and 27 case-linked unpaid caregivers.

Settings

Three cases from contrasting primary, secondary and tertiary settings within Britain.

Results

Coordination is a deliberate cross-cutting action that involves high-quality, caring and well-informed staff, patients and unpaid caregivers who must work in partnership together across health and social care settings. For coordination to occur, it must be adequately resourced with efficient systems and services that communicate. Patients and unpaid caregivers contribute substantially to the coordination of their care, which is sometimes volunteered at a personal cost to them. Coordination is facilitated through flexible and patient-centered care, characterized by accurate and timely information communicated in a way that considers patients’ and caregivers’ needs, preferences, circumstances and abilities.

Conclusions

In the midst of advanced progressive illness, coordination is a shared and complex intervention involving relational, structural and information components. Our study is one of the first to extensively examine patients’ and caregivers’ views about coordination, thus aiding conceptual fidelity. These findings can be used to help avoid oversimplifying a real-world problem, such as care coordination. Avoiding oversimplification can help with the development, evaluation and implementation of real-world coordination interventions for patients and their unpaid caregivers in the future.

Authors’ Affiliations

(1)
Cicely Saunders Institute, King’s College London
(2)
Centre for Population Health Sciences, Medical School, University of Edinburgh
(3)
Health Sciences, University of Warwick
(4)
The Primary Care Unit, Institute of Public Health

Copyright

© Daveson et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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