Entete 3

Care coordination for people living with multimorbidity: An Australian perspective

By Annette Peart

Two recent papers highlight the importance of person-centred care in working with people living with multimorbidity. In Melbourne, Australia, we explored the experiences of care from the perspective of people living with multimorbidity, and the health care professionals who work with them.
Hospital Admission Risk Program (HARP) services are centred on a period of intensive care coordination, comprising comprehensive assessment and care planning, specialist medical and GP management, and a self-management approach. Care coordinators support clients to navigate the health care system and services, act as a point of contact as clients complete their care plan, link them to specialised assessment and services, and support self-management.

The first paper [1] reports on a study examining the care experience of people living with multimorbidity enrolled in the HARP. We wanted to understand their experience of planning and enacting their care, using information to make care decisions, as well as identify characteristics of care of importance to them.

The participants were HARP clients who recently received a program of care coordination. They were diverse in age, gender, country of birth, number of health conditions, and length of time on the program. Of the 23 clients we interviewed, 10 were from the heart failure stream, nine from the complex psychosocial stream, and four from the chronic respiratory condition stream.

We used phenomenology as a framework for this study. Our interpretative phenomenological analysis of the experiences of care identified three master themes. Firstly, clients perceived the benefits of expert guidance and knowledge gained from their care coordinators on their health management, including navigating the health system and changing some health behaviours. Secondly, following a period to get to know the care coordinators, who provided knowledge, helped with practical tasks, and understood the clients’ needs, a relationship of trust was formed alongside a sense of a protective circle of care. Finally, clients felt it was important for them to be treated like a person, not a patient, and described experiencing their care as personalised – tailored – to them and their needs.

The second paper [2] reports on a study exploring the experience of the HARP health care professionals providing care coordination and related services to the clients. They were employed by the health service to deliver care coordination, nursing, allied health, or medical services. We interviewed those with considerable experience in HARP.
Participants were diverse in professional backgrounds and years of experience. Of the 18 participants, 11 had qualifications in nursing, four in allied health or medicine, and three were in nonclinical leadership or management roles. Of those with a clinical background, they worked across one or a combination of the streams: chronic heart failure (six participants), complex psychosocial (four), chronic respiratory (one), and across two or three streams (four). Their experience working as a health care professional ranged from 5–35 years, and working in the HARP ranged from 6 months to 13 years.

We used interpretative phenomenological analysis to identify four themes from descriptions of providing care, identifying and responding to a person’s needs, and the barriers and facilitators to providing person-centred care. First, participants spoke about providing care focusing on the client. This was not without its challenges, including perceptions of limitations in the care provided, especially if prioritising clients’ immediate needs and preferences. Second, they described having the time to listen and hear clients’ stories, perceived as helpful to understand client values and clients feeling they are heard. Third, participants spoke of techniques to engage clients in the service, including helping clients navigate the system. The fourth master theme involved participants describing how they viewed the client beyond the clinical features of a disease and as a whole person.

The models of care for programs such as the HARP espouse person-centred care as a key principle. However, these papers highlight the value of a new conceptualisation from the perspective of relationship-centred care. Both participant groups, clients, and health care professionals, noted the fundamental importance of developing a relationship as the basis for providing care.

Qualitative approaches to understanding the care experience are emerging, yet often provide superficial descriptions of “what” care was provided, rather than the “how”. These papers offer a rich, experiential account of care for a sample of people living with multimorbidity, and the impact of care coordination on their ability to manage their health conditions. The development of trusting relationships between clients and their health care professionals was the fundamental basis for the care experience and, for many, an improvement in their health and wellbeing.

1) Peart, A., Barton, C., Lewis, V., & Russell, G. (2020): The experience of care coordination for people living with multimorbidity at risk of hospitalisation: an interpretative phenomenological analysis, Psychology & Health, DOI: 10.1080/08870446.2020.1743293.

2) Peart, A., Lewis, V., Barton, C., & Russell, G. (2020). Healthcare professionals providing care coordination to people living with multimorbidity: An interpretative phenomenological analysis. J Clin Nurs. 00:1–12. https://doi.org/10.1111/jocn.15243

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