What is needed for continuity of care and how can we achieve it? - Perceptions among multiprofessionals on the chronic care trajectory

Conditions for and potential solutions associated with continuity of care for patients with complex care needs across Swedish regions with differing population densities

BACKGROUND

This study, conducted across three distinct geographical regions in Sweden, highlights the diverse conditions and challenges in healthcare provision. The study focuses on the sparsely populated northern regions of Sweden, the capital city of Stockholm, and the southeast rural area of Sweden. Each location presents unique obstacles to continuity of care, influenced by factors such as population density and geographical disparities. By examining the experiences of patients with complex care needs, their family carers, and healthcare personnel, this study aims to describe the conditions for and identify potential solutions associated with the delivery of continuity in care in different geographical regions of Sweden, with differing population densities.

METHOD

Secondary analysis was conducted using qualitative content analysis on interview data from two studies, consisting of 53 transcripts from individual, pair, and focus group interviews held between August 2018 and November 2019. The potential solutions identified from participants' experiences were categorized into region-specific and common themes. Three personas-Vera, Bo, and Inga-were developed, each representing a scenario based on the region-specific analyses.

RESULTS

Despite regional differences, universal solutions to common challenges were identified focusing on relational, management, and informational aspects. Common key obstacles to continuity of care included resource shortages, insufficient information transfer, and privacy regulations. Possible solutions for overcoming these challenges include prioritizing relational continuity, streamlining processes, and advocating for a unified communication system. By collaborating, building trust, understanding patient preferences, and ensuring clear communication, healthcare personnel can effectively promote continuity of care.

CONCLUSIONS

Building a stable workforce while prioritizing relational continuity, along with patients' preferences and needs, is essential for ensuring continuity of care from multiple providers. Digital solutions can enhance collaboration across distances, while coordinating responsibilities within smaller geographical areas can strengthen partnerships among healthcare organizations. Direct dialogue, along with ensuring that everyone has access to relevant information through a unified communication system, is vital for management continuity. By integrating these universal and transferable solutions to the obstacles associated with continuity of care, we can create a cohesive care experience for patients, regardless of geographical and demographic conditions.

Understanding young persons' experiences through healthcare transition. A qualitative study

PURPOSE

During adolescence, the care for adolescents and young adults (AYAs) with chronic conditions is expected to transfer from a pediatric to adult setting. Up to 40 % of AYAs experience a disruption in medical care access after their transfer. To mitigate this, a gradual implementation of interventions focusing on positive health behaviors is desirable. Currently, the majority of such interventions are designed for complex disease-specific chronic conditions, focusing primarily on pre-transfer intervention strategies. This study aims to provide an in-depth understanding of AYAs with mild chronic conditions' experiences throughout the stages of healthcare transition.

METHODS

A qualitative study was conducted using semi-structured interviews, complemented by photovoice. Study participants were AYAs, 15-21 years old, diagnosed with asthma, type 1 diabetes, and/or obesity, and were either facing the upcoming transfer or had already experienced the transfer to adult care. Interview and image data were thematically analyzed using NVivo.

RESULTS

A total of 18 AYAs (Mage=18 years) participated and a total of 39 photographs were acquired. Five themes were identified, with transition being an individual process as the overarching theme. Additional themes were: setting the expectations, wanting a voice in transition, trust is key and the importance of a support system.

CONCLUSION

Healthcare transition experiences are overarching across different chronic conditions. The current study highlights the need for continuity of care in healthcare transition, by providing an overview of insights pre-, peri- and post-transfer. Complementary, photovoice was applied as a participatory method. Overall, healthcare transition cannot be approached as a one size fits all, with AYAs advocating for an individualized transition program, tailored to their needs.

Continuity of care during long-term care transitions: a scoping review of the Canadian literature

BACKGROUND

Patients who maintain longitudinal provider-patient relationships experience better overall health outcomes. However, most older adults in Canada lose contact with their family physician when they enter long-term care (LTC) as new providers assume responsibility for their care. There is relatively little known about the contextual factors, processes, knowledge, and health professions education antecedents that promote the benefits of relational, management, and informational care continuity during LTC transitions.

METHODS

Using a rigorous scoping review method, we searched multiple databases systematically to identify and scrutinize peer-reviewed articles pertaining to continuity of care during LTC transitions in Canada. Guided by Transitions Theory, two independent reviewers screened citations and extracted data. A descriptive analytical method was employed to categorize content into themes.

RESULTS

Eight articles met the inclusion criteria. Our findings confirm that instances of relational continuity are very few during LTC transitions, suggesting barriers associated with practice models and the influence of physician characteristics. Notably, the review also highlights that the involvement of interprofessional team members, patients, and their partners-in-care in transition planning could improve informational and management care continuity for patients as they move into LTC.

CONCLUSION

Patient and family involvement, provider training, and practice and funding arrangements are all critical to improving relational, management, and informational care continuity during LTC transition. We recommend more studies to understand processes and policies to optimize informational continuity as a panacea for the often-disrupted relational continuity.

The power of empathy: Enhancing healing outcomes in chronic wound care

AIM

This study explores the impact of healthcare providers' empathy on patients' healing outcomes and satisfaction in chronic wound care.

MATERIALS AND METHODS

A qualitative descriptive approach was used. Ten adults with chronic wounds were recruited through purposive sampling. Semi-structured interviews were conducted in January 2025, lasting an average of 37.1 min. Data were transcribed verbatim and analyzed thematically using Braun and Clarke's six-phase framework. Rigor was ensured through systematic coding, researcher triangulation, and adherence to COREQ guidelines.

RESULTS

The analysis identified three central themes: (1) The need for person-centered and consistent care, emphasizing the importance of continuity in healthcare providers to reduce emotional exhaustion and improve adherence; (2) The emotional impact of empathy in wound care, demonstrating that empathetic communication raises trust, decreases pain perception, and enhances psychological resilience; and (3) The role of communication, trust, and cultural awareness, highlighting that clear explanations and cultural competence improve patient satisfaction and engagement. Participants who felt listened to and involved in decision-making reported better motivation and adherence to treatment.

CONCLUSION

Empathy is an important component of effective wound care, influencing healing outcomes, psychological well-being, and treatment adherence. Integrating empathy into clinical practice through continuity of care, shared decision-making, and cultural competence can improve patient satisfaction and overall wound management. Healthcare systems should prioritize training and policies that support empathy-driven, person-centered care.

Experiences with hospital-to-home transitions: perspectives from patients, family members and healthcare professionals. A systematic review and meta-synthesis of qualitative studies

PURPOSE

Multiple studies have explored the needs and experiences of patients, family members, and healthcare professionals regarding hospital-to-home transitions. Our study aimed to identify, critically appraise, and summarize these studies in a qualitative meta-synthesis.

MATERIALS AND METHODS

Medline, CINAHL and Embase were systematically searched to identify eligible articles from inception to June 2024. Qualitative studies were included and critically appraised using the Critical Appraisal Skills Program. Insufficient-quality papers were excluded. We performed a meta-synthesis following (1) open coding by two independent researchers and (2) discussing codes during reflexivity meetings.

RESULTS

Ninety-eight studies were appraised, of which 53 were included. We reached thematic saturation, four themes were constructed: (1) care coordination and continuity, (2) communication, (3) patient and family involvement, and (4) individualized support and information exchange. For patients and families, tailored information and support are prerequisites for a seamless transition and an optimal recovery trajectory after hospital discharge. It is imperative that healthcare professionals communicate effectively within and across care settings to ensure multidisciplinary collaboration and care continuity.

CONCLUSIONS

This study identifies essential elements of optimal transitional care. These findings could be supportive to researchers and healthcare professionals when (re)designing transitional care interventions to ensure care continuity after hospital discharge.

Preserving Continuity and Trust in Primary Care: Strategies for Implementing Team-Based Models in South Tyrol, Italy

Continuity of care is fundamental to the efficacy of primary healthcare, fostering trust, enhancing patient satisfaction, and improving health outcomes. However, the implementation of Ministerial Decree 77/2022, which advocates for team-based care in multidisciplinary Community Health Centers, presents challenges to these established principles. This article proposes strategies to maintain continuity and trust whilst supporting the reform objectives, specifically tailored to the unique linguistic and cultural context of the Autonomous Province of Bolzano-South Tyrol. A synthesis of regional healthcare reports, academic literature, and practical insights from implementing Ministerial Decree 77/2022 was performed to develop strategies addressing challenges such as ensuring continuity, minimizing administrative burdens, and promoting patient and general practitioner engagement. Strategies include establishing Community Health Centers as integration hubs, assigning primary providers within teams, formalizing personalized care contracts, leveraging digital tools for collaboration, and expanding the roles of nurses and care coordinators. Additional measures focus on building infrastructure for telemedicine and home-based care, engaging patients through transparent communication and feedback loops, and preserving GP autonomy through flexible participation models and incentives. Strategies adapted to accommodate South Tyrol's demographic, cultural, and systemic characteristics can maintain continuity and trust during the transition to team-based care. By addressing key risks and fostering collaboration among stakeholders, these reforms can enhance healthcare delivery without compromising the principles of personalized, patient-centered care.

Continuity of care as central theme in perinatal care: A systematic review

PROBLEM

The global shortage of nurses is straining perinatal care, disrupting continuity of care and negatively affecting patient outcomes.

BACKGROUND

Continuity of care is essential in perinatal care, where the complexity of maternal and infant needs requires coordinated care across the antenatal, intrapartum, and postpartum periods.

AIM

To provide an overview of the current literature on continuity of care in the interprofessional perinatal care from the perspective of nursing.

METHODS

Guided by the Joanna Briggs Institute, a search in seven academic databases was conducted in March 2023. A thematic synthesis was carried out to structure and integrate the findings.

FINDINGS

A total of 23 articles were identified. Studies explored the impact of continuity of care, served as determinant or outcome, categorised into relational, management, and informational continuity. Notably, continuity as a determinant was the most commonly investigated aspect. Five determinants were identified related to three outcome categories: patient-reported experience measures, patient-reported outcomes, and the prevention or reduction of complications.

DISCUSSION

Continuity of care is mainly manifested in relational and management continuity, with known healthcare professionals, whether or not involved in a care program, being key determinants. The most positive outcomes related to continuity of care were found in the patient-reported experience measures.

CONCLUSION

The personal relationship between patient, parents and healthcare professionals is crucial. Informational continuity is underrepresented in perinatal care research, and there is a lack of research on the relationship between continuity of care and patient-reported outcomes.

The role of continuity of care in high-risk pregnant women in Indonesia

INTRODUCTION

High-risk pregnancies require special attention in maternal and child health services, given the high potential for complications that can affect maternal and fetal health. The continuity of care (COC) approach is expected to increase family independence and prevent pregnancy complications. This study aims to analyze the effectiveness of COC in improving the family independence of high-risk pregnant women in preventing pregnancy complications.

METHODS

This study used a quasi-experimental design with a pretest-posttest approach without a control group, involving 134 high-risk pregnant women, in the target area at the Wonoayu Community Health Centre, Sidoarjo, Indonesia from February to May 2024, who were selected through purposive sampling. Data were collected through structured questionnaires before and after the COC intervention, which included assessing knowledge and family roles in supporting pregnant women's health. The COC mentoring program was implemented for three months, with a focus on family education and involvement in maternal healthcare. A validated questionnaire measured family self-reliance before and after the intervention.

RESULTS

The study showed a significant increase in family self-reliance, with a p<0.001 in all aspects measured, including fulfilment of physiological and psychological needs, preparation for labor, the postpartum period, and preparation after the baby is born. This increase suggests that the COC intervention is effective in empowering families to support high-risk pregnant women. Before the intervention, the mean score for physiological and psychological needs fulfilment was 17.45, which increased to 36.42 after the intervention (p<0.001). In addition, labor preparation also showed a significant increase from 11.40 to 24.38, as well as postpartum preparation from 13.00 to 28.79, and preparation after the baby is born from 13.25 to 28.75 (all p<0.001).

CONCLUSIONS

The consistent improvement in all measured aspects, indicated that the COC intervention not only improved families' knowledge and skills, but also contributed to their preparedness in supporting pregnant women during and after pregnancy.

Assessment of older persons with multimorbidity in Norwegian primary care: a qualitative study of healthcare professionals' experiences and preferences in fostering continuity of care

BACKGROUND

As the population ages, more people live longer with multimorbidity. Older people with multimorbidity face diverse needs and medical conditions, increasing the risk of adverse health outcomes, and often experience fragmented healthcare. Research has called for better ways to reach, understand and care for this group to enhance care continuity. This study aimed to examine healthcare professionals' experiences and preferences as they relate to assessments' role in promoting care continuity for home-dwelling older patients with multimorbidity in community-based healthcare.

METHODS

This qualitative study acquired qualitative data from 17 healthcare professionals from reablement teams, interdisciplinary teams, rehabilitation teams and home nursing in three Norwegian municipalities. Representing nursing, physiotherapy, occupational therapy and social work, all participants were experienced in assessing older home-dwelling patients with multimorbidity. Semi-structured focus group and individual interviews were conducted, then the interviews were transcribed and analysed using reflexive thematic analysis.

RESULTS

The analysis elicited three themes: gaining insight beyond diagnoses to promote relational continuity, facilitating interaction to ensure informational continuity, and linking patient journeys to facilitate managerial continuity. The themes underscore the significance of evaluating patients beyond their medical conditions, emphasising assessment's collaborative nature across disciplines. Healthcare professionals use diverse assessment methods and facilitate interaction to understand patients' needs. Working together across different healthcare professions is key for care that includes the whole patient, but challenges such as underutilisation of assessments and poor documentation still exist. Furthermore, linking patient journeys remains difficult due to fragmented services and limited resources. Despite these challenges, assessments were viewed as crucial to care continuity.

CONCLUSIONS

In this qualitative study, healthcare professionals emphasised that assessment is a complex, continuous process due to the fluctuating health of individuals with multimorbidity. Effective instruments and diverse assessment methods are essential to understanding all aspects of patients' health and well-being to ensure care continuity across individual, service, and system levels. Our findings highlight the need for systematic and structured use of assessments to improve interdisciplinary collaboration and personalised care for older individuals with multimorbidity. Understanding the patient journey is crucial for achieving these goals, potentially benefiting healthcare professionals, policymakers, and primary care providers.

Telehealth use for sexual and reproductive health promotion and care during the early phase of COVID-19 pandemic: A descriptive-interpretive qualitative study of healthcare providers' perspectives and experiences in Western-Central New York State

Telehealth emerged as a key option for the provision of sexual and reproductive health (SRH) care and promotion during COVID-19 pandemic restrictions. However, there is limited research on the perspectives and experiences of healthcare providers (HCPs) in the Western-Central region of New York State. This qualitative interpretive study explored the perspectives and experiences of the HCPs' with telehealth for SRH promotion and care including counselling, testing and treatment for HIV infection and other sexually transmitted infections (STIs), in Western New York State. Ten HCPs participated in semi-structured in-depth interviews conducted between October 2019 and February 2021. Participants were predominately White, female, with 1-30 years of clinical experience. The narratives revealed three major themes: 1) HCPs' perspectives of telehealth use, 2) HCPs' experiences with telehealth use for SRH promotion and care, and 3) determinants of telehealth implementation. Though all providers reported an increase in the use of telehealth, experiences in the delivery of telehealth varied especially for SRH services. Some providers reported having more time to consult with patients because patients could just call and schedule a telehealth visit and because of a decrease in patient load which freed up time to engage with patients. Others reported technological limitations among some patients which impacted care. Strengthening telehealth-based sexual health promotion will serve to address efforts toward ending the HIV epidemic, reducing other STIs, and ensuring consistent access to contraception. To effectively implement telehealth findings, suggest a need to ensure adequate technological resources for patients, and a need to increase HCPs' comfort to engage patients in sexual health conversations via telehealth.

Continuity and sustainability of care in family medicine: Assessing its association with quality of life and health outcomes in older populations-A systematic review

BACKGROUND

Continuity of care is a core principle of family medicine associated with improved outcomes. However, fragmentation challenges sustaining continuous relationships. This review aimed to provide timely and critical insights into the benefits of continuity and sustainability of care for older adults.

METHODS

PubMed, EMBASE, CINAHL, Cochrane Library were systematically searched for studies on continuity/sustainability models in family medicine and effects on older adults. 14 studies met inclusion criteria for final synthesis. Quality was assessed using ROBINS-I. Outcomes were narratively and thematically synthesized.

RESULTS

Greater continuity of care was consistently associated with reduced healthcare utilization including lower emergency department visits and hospitalizations. Continuity also correlated with improved chronic disease management, care coordination, patient-reported experiences, and quality of life. Patient-centered medical homes and care coordination models showed potential to strengthen continuity and sustainability. Thoughtful telehealth integration and technology tools augmented continuity.

CONCLUSION

Continuous healing relationships are vital for patient-centered care of older adults. While current fragmentation challenges sustainability, innovations in primary care teaming, coordination, telehealth, and health information technology can extend continuity's benefits. Realizing improvements requires system-wide reorientation toward relationships and whole-person care.

Clinical Pharmacist-Led Collaboration of Multiple Clinical Professions Model Focusing on Continuity of Pharmacotherapy: Japanese Version of the Lund Integrated Medicines Management (LIMM) Model

(1) Background: In general, it is known that continuity of care can contribute to an increase in patient satisfaction, reduce health care costs, and improve patient outcomes. A guarantee of continuity in pharmacotherapy is a big challenge facing Japanese health care as a system that encourages cooperation/collaboration for pharmacists with other health care professions is currently lacking. (2) Method: This is a narrative review. (3) Results: The Lund Integrated Medicine Management (LIMM) model describes a systematic approach to individuals and was developed in Sweden to optimize pharmacotherapy among elderly inpatients. The aim of the LIMM model is to provide patients with continuous pharmacotherapy at different levels of care. The LIMM model, in which a clinical pharmacist is the catalyst and leads other health care professions in completing the process, has the potential to reduce potentially inappropriate prescriptions, reduce rehospitalization risk, unscheduled hospital revisits due to problems related to medications, reduce total medical expenditure, and provide a comprehensive understanding of patients' conditions of taking medicine. (4) Conclusions: Introducing a framework such as Sweden's LIMM model, anchored by clinical pharmacists, could provide a good opportunity to promote collaborations among different health care professionals and improve continuity in pharmacotherapy.

Exploring the lack of continuity of care in older cancer patients under China's 'integrated health system' reform

BACKGROUND

Continuity of care is essential to older patients' health outcomes, especially for those with complex needs. It is a key function of primary healthcare. Despite China's policy efforts to promote continuity of care and an integrated healthcare system, primary healthcare centres (PHCs) are generally very underused.

OBJECTIVES

To explore the experience and perception of continuity of care in older cancer patients, and to examine how PHCs play a role in the continuity of care within the healthcare system in China.

METHODS

A qualitative study using semi-structured interviews was conducted in two tertiary hospitals in Nantong city, Jiangsu province, China. A combination of deductive and inductive analysis was conducted thematically.

RESULTS

Interviews with 29 patients highlighted three key themes: no guidance for patients in connecting with different levels of doctors, unmet patients' needs under specialist-led follow-up care, and poor coordination and communication across healthcare levels. This study clearly illustrated patients' lack of personal awareness and experience of care continuity, a key issue despite China's drive for an integrated healthcare system.

CONCLUSION

The need for continuity of care at each stage of cancer care is largely unmeasured in the current healthcare system for older patients. PHCs offer benefits which include convenience, less burdened doctors with more time, and lower out-of-pocket payment compared to tertiary hospitals, especially for patients with long-term healthcare needs. However, addressing barriers such as the absence of integrated medical records and unclear roles of PHCs are needed to improve the crucial role of PHCs in continuity of care.

Effect of comprehensive nursing care for the liver cancer patients undergoing interventional therapy in China: A systematic review and meta-analysis

AIMS

This review aims to assess the effect of comprehensive nursing care on liver cancer patients undergoing interventional therapy in China.

METHODS

In accordance with PRISMA guidelines, we reviewed randomized controlled trials and observational studies assessing the effect of comprehensive nursing care against standard care on liver cancer patients undergoing specific interventional therapies in China, including PubMed, Embase, CENTRAL and CINAHL till June 2023. Data synthesis was conducted using a random-effects model and reported as pooled odds ratio (OR) or mean difference (MD) or standardized mean differences (SMD).

RESULTS

Ten Chinese studies with 1682 participants were evaluated. Comprehensive nursing care significantly enhanced patient outcomes in liver cancer treatment. Quality of life improved markedly (OR: 0.16, 95% CI: 0.06-0.41). Notable reductions were observed in anxiety (MD: -8.96, 95% CI: -11.52 to -6.40) and depression (MD: -9.47, 95% CI: -11.79 to -7.14). Patients also experienced increased physical (SMD: 1.70, 95% CI: 1.15-2.25), social (SMD: 1.65, 95% CI: 1.14-2.16) and activity scores (SMD: 1.94, 95% CI: 1.49-2.39), alongside a decrease in post-treatment complications (OR: 0.28, 95% CI: 0.21-0.37), demonstrating the multifaceted benefits of comprehensive care.

CONCLUSION

Comprehensive nursing care may improve patient outcomes in liver cancer treatment, offering potential benefits in reducing the side effects of interventional therapy.

Implementing and evaluating integrated care models for non-communicable diseases in fragile and humanitarian settings

In this commentary, we advocate for the wider implementation of integrated care models for NCDs within humanitarian preparedness, response, and resilience efforts. Since experience and evidence on integrated NCD care in humanitarian settings is limited, we discuss potential benefits, key lessons learned from other settings, and lessons from the integration of other conditions that may be useful for stakeholders considering an integrated model of NCD care. We also introduce our ongoing project in North Lebanon as a case example currently undergoing parallel tracks of program implementation and process evaluation that aims to strengthen the evidence base on implementing an integrated NCD care model in a crisis setting.

Importance of continuity of care from a patient perspective - a cross-sectional study in Swedish health care

OBJECTIVE

The primary objective of this study was to evaluate the patients' view on continuity of care (CoC), including preference for a certain general practitioner (GP) and importance and access to a regular general practitioner (RGP).

DESIGN

Cross-sectional study.

SETTING

Primary care center in Halland County, in the western part of Sweden.

SUBJECTS

Patients ≥18 years old and having at least one appointment at the primary care center during October-December 2022.

MAIN OUTCOME MEASURES

Preference for a certain GP and importance of and accessibility for an RGP.

RESULTS

The study included 404 patients. Importance of having an RGP was considered by 86% of the patients. Preference for a certain GP was thought by 73% of the patients, and when asked as a bivariate question, 69% considered having an RGP. Both the importance of an RGP and preference for a certain GP were more often considered by patients ≥65 years (p < .0001). Regarding accessibility, 67% of the patients reported having access to their RGP 'always/most of the time or a lot of the time' and 62% reported seeing their RGP at last visit.

CONCLUSIONS

In conclusion, this study showed that the majority of patients value CoC in terms of importance of having an RGP. Older patients were more likely to have a preference for a certain GP. Two-third of the patients succeeded in seeing their RGP always or a lot of the time. The results in this study provide evidence that CoC is important for most patients, regardless of age and gender.Key pointsPrevious studies have showed that continuity of care (CoC) is important regarding mortality and morbidity. In primary care, there is a current debate regarding CoC, accessibility and the strive for CoC. This study showed that the majority of patients, regardless of age and gender, value CoC and consider it being important. However, there was a statistically significant difference regarding age, where patients above 65 years old thought it was more important to have a regular general practitioner and more often had a preference for a certain GP.

Digitally-mediated coordination in healthcare: the effects of teleconsultation on doctor-to-doctor relational coordination

BACKGROUND

Digitalization transforms the way in which interdependent work is coordinated, especially in healthcare settings. This work deepens the effect of teleconsultation use on health professionals' coordination. For this aim, we rely on Relational Coordination Theory (RCT), which explores coordination as an interactive process among group participants within the context of task interdependency.

METHODS

We collected data through an online survey administered to Italian specialist doctors between March and April 2023. 489 complete answers were gathered. Hypotheses have been tested through Structural Equation Modelling.

RESULTS

We found that teleconsultation frequency of use has a positive and significant effect on both components of relational coordination, confirming our hypotheses.

CONCLUSIONS

Theoretically, this research contributes to our understanding of the effect of digitally mediated coordination mechanisms on relational coordination. In practice, we shed light on the organizational implications of telemedicine under a novel perspective, focusing on the role of professional interactions in digitally mediated work and providing useful elements for the organizational design of telemedicine.

Perspectives of women living with type 1 diabetes regarding preconception and antenatal care: A qualitative evidence synthesis

INTRODUCTION

Pregnant women with type 1 diabetes may have an increased risk of complications for both the baby and themselves. Educational programmes, preconception planning, strict glycemic control and comprehensive medical care are some of the antenatal interventions that have been proposed to improve the outcomes of pregnant women with type 1 diabetes. While some evidence-based recommendations about antenatal care are included in clinical practice guidelines (CPGs), the views, and experiences of women with type 1 diabetes about these interventions are not well known.

AIM

To understand and synthesize the perceptions of women with type 1 diabetes about the interventions before pregnancy.

METHOD

A qualitative evidence synthesis (QES) was carried out with a framework analysis guided by the Cochrane Qualitative and Implementation Methods Group approach. Three online databases (Medline, Embase and Web of Science) were searched. We included qualitative articles that were published from 2011 to 2021 and which were available in English or Spanish.

FINDINGS

Ten references met the inclusion criteria of the study and were included. Three main themes were identified: (a) acceptability of antenatal care, (b) feasibility and implementation consideration and (c) equity and accessibility difficulties.

CONCLUSION

Continuity of care, coordination between health professionals and services, and a more holistic approach are the key aspects women say need to be considered for more acceptable, feasible and equitable preconception and antenatal care.

PATIENT OR PUBLIC CONTRIBUTION

This QES was carried out as part of the CPGs on diabetes mellitus type 1, carried out as part of the Spanish Network of Health Technology Assessment Agencies. In this CPG, the representatives of the patient associations are Francisco Javier Darias Yanes, from the Association for Diabetes of Tenerife, who has participated in all the phases of the CPG; Aureliano Ruiz Salmón and Julián Antonio González Hernández (representatives of the Spanish Diabetes Federation (FEDE) who have participated as collaborator and external reviewer, respectively.

UK homecare providers' views about, and experiences of, digitalisation: A national survey

Objective

Using digital systems to support the management and delivery of social care is a priority for UK governments. This study explored progress towards, and experiences of, digitalisation in the homecare sector and providers' views on contributing client data to a national policy/research dataset.

Methods

Over 150 UK homecare providers completed an on-line survey (October-December 2022). The survey was hosted on Qualtrics and comprised fixed- and free-text response questions. The recruited sample aligned with the profile of UK homecare providers in terms of use of digital systems, organisation type and size.

Results

Almost all respondents (95.5%) were using digital systems, in part or exclusively, to support care delivery. However, many (42.7%) reported a desire to further digitalise or a dissatisfaction with existing systems. Findings highlight the time and work involved in choosing a a software system, with the decision regarded as relatively high risk. Over 50 different software systems were being used across the sample. Most respondents (72.5%) supported the creation of a national dataset on homecare users. However, support and recompense are likely to needed to secure buy-in from what is a predominantly private sector context.

Conclusions

Findings suggest a complex and changing situation, with numerous different digital systems being used and the sector at different stages of digitalisation. The high-pressure, low margin context of UK homecare appeared to be exerting an influence on progress towards digitalisation. Evaluations of government strategies to stimulate and support digitalisation in this diverse and predominantly private sector context will be valuable.

End-of-Life Healthcare Utilization in Lewy Body Dementia

Background

Lewy body dementia (LBD) is the second most common neurodegenerative dementia in the US, presenting unique end-of-life challenges.

Objective

This study examined healthcare utilization and care continuity in the last year of life in LBD.

Methods

Medicare claims for enrollees with LBD, continuously enrolled in the year preceding death, were examined from 2011-2018. We assessed hospital stays, emergency department (ED) visits, intensive care unit (ICU) admissions, life-extending procedures, medications, and care continuity.

Results

We identified 45,762 LBD decedents, predominantly female (51.8%), White (85.9%), with average age of 84.1 years (SD 7.5). There was a median of 2 ED visits (IQR 1-5) and 1 inpatient stay (IQR 0-2). Higher age was inversely associated with ICU stays (Odds Ratio [OR] 0.96; 95% Confidence Interval [CI] 0.96-0.97) and life-extending procedures (OR 0.96; 95% CI 0.95-0.96). Black and Hispanic patients experienced higher rates of ED visits, inpatient hospitalizations, ICU admissions, life-extending procedures, and in-hospital deaths relative to White patients. On average, 15 (7.5) medications were prescribed in the last year. Enhanced care continuity correlated with reduced hospital (OR 0.72; 95% CI 0.70-0.74) and ED visits (OR 0.71; 95% CI 0.69-0.87) and fewer life-extending procedures (OR 0.71; 95% CI 0.64-0.79).

Conclusions

This study underscored the complex healthcare needs of people with LBD during their final year, which was influenced by age and race. Care continuity may reduce hospital and ED visits and life-extending procedures.

Delineating and clarifying the concept of self-care monitoring: a concept analysis

AIM

To delineate and clarify the meaning of the concept of self-care monitoring from a patient perspective.

METHODS

A systematic search was performed in the databases ASSIA, CINAHL, PsycInfo, and PubMed (January 2016-September 2021). A selection of 46 peer-reviewed articles was included in the study and analysed using Rodgers' Evolutionary Method for Concept Analysis.

RESULTS

The following four attributes were identified: Tracking symptoms, signs, and actions, Paying attention, Being confident, and Needing routines, creating a descriptive definition: "Self-care monitoring is an activity that means a person has to pay attention and be confident and needs routines for tracking symptoms, signs, and action." The antecedents of the concept were shown to be Increased knowledge, Wish for independence, and Commitment. The concepts' consequences were identified as Increased interaction, Perceived burden, and Enhanced well-being.

CONCLUSIONS

This concept analysis provides extensive understanding of self-care monitoring from a patient perspective. It was shown that the concept occurs when a person practices self-care monitoring at home either with or without devices. A descriptive definition was constructed and presented with exemplars to encourage practice of the concept in various healthcare settings and could be of relevance to people with chronic illnesses or other long-term conditions.

Team-based continuity of care for patients with hypertension: a retrospective primary care cohort study in Hong Kong

BACKGROUND

Continuity of care (COC) is associated with improved health outcomes in patients with hypertension. Team-based COC allows more flexibility in service delivery but there is a lack of research on its effectiveness for patients with hypertension.

AIM

To investigate the effectiveness of team-based COC on the prevention of cardiovascular disease (CVD) and mortality in patients with hypertension.

DESIGN AND SETTING

A retrospective cohort study in a primary care setting in Hong Kong.

METHOD

Eligible patients included those visiting public primary care clinics in Hong Kong from 2008 to 2018. The usual provider continuity index (UPCI) was used to measure the COC provided by the most visited physician team. Cox regression and restricted cubic splines were applied to model the association between the COC and the risk for CVDs and all-cause mortality.

RESULTS

This study included 421 640 eligible patients. Compared with participants in the lowest quartile of UPCI, the hazard ratios for overall CVD were 0.94 (95% CI = 0.92 to 0.96), 0.91(95% CI = 0.89 to 0.93), and 0.90 (95% CI = 0.88 to 0.92) in the second, third, and fourth quartiles, respectively. A greater effect size on CVD risk reduction was observed among the patients with unsatisfactory blood pressure control, patients aged <65 years, and those with a Charlson comorbidity index of <4 at baseline (Pinteraction<0.05 in these subgroup analyses), but the effect was insignificant among the participants with an estimated glomerular filtration rate of <60 ml/ min/1.73 m2 at baseline.

CONCLUSION

Team-based COC via a coordinated physician team was associated with reduced risks of CVD and all-cause mortality among patients with hypertension, especially for the patients with unsatisfactory blood pressure control. Early initiation of team-based COC may also achieve extra benefits.

Continuity of care in primary healthcare settings among patients with chronic diseases in Saudi Arabia

Introduction

Maintaining continuity of care is one of the most critical components of providing great care in primary health care. This study aimed to explore continuity of care and its predictors in primary healthcare settings among patients with chronic diseases in Saudi Arabia.

Method

Face-to-face cross-sectional interviews were conducted with patients with chronic diseases who had at least four visits to primary care facilities in Riyadh, Saudi Arabia, between November 1, 2022 and March 3, 2023. We determined patients' continuity of care levels using the Bice-Boxerman continuity of care index. A Tobit regression model was used to determine the effects of several factors on the continuity of care index.

Results

The interviews were conducted with 193 respondents with chronic diseases of interest. The mean continuity of care index of the entire sample was 0.54. Those with asthma had the highest median continuity of care index at 0.75 (interquartile range, 0.62-0.75), whereas those diagnosed with thyroid disease had a much lower continuity of care index (0.47) (interquartile range, 0.3-0.62). Tobit regression model findings showed that employed respondents with poorer general health had a negative effect on continuity of care index levels. By contrast, a higher continuity of care index was significantly associated with elderly respondents, urban residents, and those diagnosed with dyslipidemia, diabetes, hypertension, or asthma.

Conclusions

According to our findings, the continuity of care level in Saudi Arabia's primary healthcare setting is low. The data demonstrate how continuity of care varies among study group characteristics and that improving continuity of care among chronic disease patients in Saudi Arabia is multifaceted and challenging, necessitating a coordinated and integrated healthcare delivery approach.

Clinical pharmacist intervention to improve medication safety for hip fracture patients through secondary and primary care settings: a nonrandomised controlled trial

BACKGROUND

Hip fracture patients face a patient safety threat due to medication discrepancies and adverse drug reactions when they have a combination of high age, polypharmacy and several care transitions. Consequently, optimised pharmacotherapy through medication reviews and seamless communication of medication information between care settings is necessary. The primary aim of this study was to investigate the impact on medication management and pharmacotherapy. The secondary aim was to evaluate implementation of the novel Patient Pathway Pharmacist intervention for hip fracture patients.

METHODS

Hip fracture patients were included in this nonrandomised controlled trial, comparing a prospective intervention group (n = 58) with pre-intervention controls who received standard care (n = 50). The Patient Pathway Pharmacist intervention consisted of the steps: (A) medication reconciliation at admission to hospital, (B) medication review during hospitalisation, (C) recommendation for the medication information in the hospital discharge summary, (D) medication reconciliation at admission to rehabilitation, and (E) medication reconciliation and (F) review after hospital discharge. The primary outcome measure was quality score of the medication information in the discharge summary (range 0-14). Secondary outcomes were potentially inappropriate medications (PIMs) at discharge, proportion receiving pharmacotherapy according to guidelines (e.g. prophylactic laxatives and osteoporosis pharmacotherapy), and all-cause readmission and mortality.

RESULTS

The quality score of the discharge summaries was significantly higher for the intervention patients (12.3 vs. 7.2, p < 0.001). The intervention group had significantly less PIMs at discharge (- 0.44 (95% confidence interval - 0.72, - 0.15), p = 0.003), and a higher proportion received prophylactic laxative (72 vs. 35%, p < 0.001) and osteoporosis pharmacotherapy (96 vs. 16%, p < 0.001). There were no differences in readmission or mortality 30 and 90 days post-discharge. The intervention steps were delivered to all patients (step A, B, E, F = 100% of patients), except step (C) medication information at discharge (86% of patients) and step (D) medication reconciliation at admission to rehabilitation (98% of patients).

CONCLUSION

The intervention steps were successfully implemented for hip fracture patients and contributed to patient safety through a higher quality medication information in the discharge summary, fewer PIMs and optimised pharmacotherapy.

TRIAL REGISTRATION

NCT03695081.

A Focused Review of Long-Stay Patients and the Ethical Imperative to Provide Inpatient Continuity

Long-stay patients are an impactful, vulnerable, growing group of inpatients in today's (and tomorrow's) tertiary hospitals. They can outlast dozens of clinicians that necessarily rotate on and off clinical service. Yet, care from such rotating clinicians can result in fragmented care due to a lack of continuity that insufficiently meets the needs of these patients and their families. Using long-stay PICU patients as an example, this focused review discusses the impact of prolonged admissions and how our fragmented care can compound this impact. It also argues that it is an ethical imperative to provide a level of continuity of care beyond what is considered standard of care and offers a number of strategies that can provide such continuity.

Multicomponent, high-intensity, and patient-centered care intervention for complex patients in transitional care: SPICA program

Multimorbidity is increasingly present in our environment. Besides, this is accompanied by a deterioration of social and environmental conditions and affects the self-care ability and access to health resources, worsening health outcomes and determining a greater complexity of care. Different multidisciplinary and multicomponent programs have been proposed for the care of complex patients around hospital discharge, and patient-centered coordination models may lead to better results than the traditional ones for this type of patient. However, programs with these characteristics have not been systematically implemented in our country, despite the positive results obtained. Hospital Universitario de Canarias cares for patients from the northern area of Tenerife and La Palma, Spain. In this hospital, a multicomponent and high-intensity care program is carried out by a multidisciplinary team (made up of family doctors and nurses together with social workers) with complex patients in the transition of care (SPICA program). The aim of this program is to guarantee social and family reintegration and improve the continuity of primary healthcare for discharged patients, following the patient-centered clinical method. Implementing multidisciplinary and high-intensity programs would improve clinical outcomes and would be cost-effective. This kind of program is directly related to the current clinical governance directions. In addition, as the SPICA program is integrated into a Family and Community Care Teaching Unit for the training of both specialist doctors and specialist nurses, it becomes a place where the specific methodology of those specialties can be carried out in transitional care. During these 22 years of implementation, its continuous quality management system has allowed it to generate an important learning curve and incorporate constant improvements in its work processes and procedures. Currently, research projects are planned to reevaluate the effectiveness of individualized care plans and the cost-effectiveness of the program.