The lack of effective systems to appropriately manage the health and social care of frail older adults - especially among those who become homebound - is becoming all the more apparent. Home-based primary care (HBPC) is increasingly being promoted as a promising model that takes into account the accessibility needs of frail older adults, ensuring that they receive more appropriate primary and community care. There remains a paucity of literature exploring patients' experiences with HBPC programmes. The purpose of this study was to explore the experiences of patients accessing HBPC delivered by interprofessional teams, and their perspectives on the facilitators and barriers to this model of care in Ontario, Canada. Using certain grounded theory principles, we conducted an inductive qualitative content analysis of in-depth patient interviews (n = 26) undertaken in the winter of 2013 across seven programme sites exploring the lived experiences and perspectives of participants receiving HBPC. Themes emerged in relation to patients' perceptions regarding the preference for and necessity of HBPC, the promotion of better patient care afforded by the model in comparison to office-based care, and the benefits of and barriers to HBPC service provision. Underlying patterns also surfaced related to patients' feelings and emotions about their quality of life and satisfaction with HBPC services. We argue that HBPC is well positioned to serve frail homebound older adults, ensuring that patients receive appropriate primary and community care - which the office-based alternative provides little guarantee - and that they will be cared for, pointing to a model that may not only lead to greater patient satisfaction but also likely contributes to bettering the quality of life of a highly vulnerable population.

Gardening programmes aim to promote improved engagement and quality of life in persons with dementia. Although a substantial literature has amassed documenting the overall positive outcomes associated with therapeutic gardening and horticulture for persons with dementia, little is known about the specific aspects of the gardening process that engender these benefits, and how and why they are important. The purpose of this research was to explore, using interpretative phenomenological analysis, the experiences of therapeutic gardening for persons with dementia, and their perspectives on the senses and emotions elicited in the gardening process that promote well-being. The themes that emerged in our analysis are to varying degrees substantiated in the literature: the usefulness of activating the senses, particularly those of touch and smell; the significance of being occupied in meaningful, productive work; the importance of cultivating a sense of curiosity, wonder, and learning; the positive gains derived from socialization in a group context; the peace and hope derived from being ‘in the moment’; and the positive mental and physical well-being derived from participating in the outdoor garden. Our findings support the integration of therapeutic gardening as a valuable practice for people with dementia.

Increasingly, interprofessional teams are responsible for providing integrated health care services. Effective teams, however, are not the result of chance but require careful planning and ongoing attention to team processes. Based on a case study involving interviews, participant observation, and a survey, we identified key attributes for effective interprofessional working (IPW) within a home-based primary care (HBPC) setting. Recognizing the importance of a theoretical model that reflects the multidimensional nature of team effectiveness research, we employed the integrated team effectiveness model to analyze our findings. The results indicated that a shared vision, common goals, respect, and trust among team members – as well as processes for ongoing communication, effective leadership, and mechanisms for conflict resolution – are vital in the development of a high-functioning IPW team. The ambiguity and uncertainty surrounding the context of service provision (clients' homes), as well the negotiation of external relationships in the HBPC field, require further investigation.