A qualitative study of old patients’ experiences of the quality of the health services in hospital and 30 days after hospitalization

Abstract

Background The number of people aged 80 years and above is projected to triple over the next 30 years. People in this age group normally have at least two chronic conditions (multimorbidity). The impact of multimorbidity is often significantly greater than expected from the sum of the effects of each condition. The World Health Organization has indicated that health care systems must prepare for a change in the focus of clinical care for older people. The WHO defines health care quality as care that is effective, efficient, integrated, patient centered, equitable and safe. The degree to which health care quality can be defined as acceptable is determined by services’ ability to meet the needs of users and adapt to patients’ expectations and perceptions. This study explores experiences of the quality of the health services in hospital and the first 30 days at home after discharge by patients over 80 years of age. Method We took a phenomenological perspective to explore older patients’ subjective experiences and conducted semistructured individual interviews. Eighteen patients (aged from 82 to 100 years) were interviewed twice after discharge from hospital. The interview transcriptions were analyzed thematically. Results The patients found their meetings with the health service to be complex and demanding. They reported attempting to restore a sense of security and meaning in everyday life, balancing their own needs against external requirements. Five overarching themes emerged from the interviews: hospital stay and the person behind the diagnosis, poor communication and coordination, life after discharge, relationship with their next of kin, and organizational and systemic determinants. Conclusion According to the WHO, to deliver quality health care, services must include all six of the dimensions listed above. Our findings show that they do not. Health care focused on measurable values and biomedical inquiries. Few opportunities for participation, scant information and suboptimal care coordination left the patients with a feeling of being in limbo, where they struggled to find balance in their everyday life. Further work must be done to ensure that integrated services are provided without a financial burden, centered on the needs and rights of older people.

Quality healthcare services under National Health Insurance Scheme in Ghana: perspectives from health policy implementers and beneficiaries

“…Quality healthcare services are examined in the context of the quality of emergency care (Okoroh et al, 2020) as well as the quality of maternal and childcare delivery (Atinga et al, 2018). Others focus on the quality of clinical care for the elderly (Lilleheie et al, 2020). The World Health Organisation (2018) looks at quality healthcare from six dimensions: when the service is effective, efficient, patient-centred, integrated, equitable and safe for the people.…”

Seeking healthcare services post-stroke: a qualitative descriptive study exploring family caregiver and stroke survivor perspectives in an asian setting

“…This is also aligned with our finding of adult-child caregivers reporting to be more actively involved in healthcare encounters, giving and receiving information. Although not reported in the caregiver population, a qualitative study in Norway involving older patients reported older patients in inpatient setting experiencing poor communication, lack of clear information and coordination [ 47 ]. Another study reported that patients’ perception of communication with healthcare providers varied with age of the patients [ 48 ].…”

Being well? A meta-ethnography of older patients and their relatives’ descriptions of suffering and well-being in the transition from hospital to home

“…Being seen as an object and the feeling of being excluded in the transition process were experienced in different ways. In some instances, older patients addressed it as a feeling of being invisible rather than being informed about the discharge and transition plan, as well as potentially feeling disempowered from moving on with their lives at the current stage of their illness [22,23]. Accordingly, this approach created suffering for both patients and relatives and especially forced older patients to take on a passive role [23].…”

“…In some instances, older patients addressed it as a feeling of being invisible rather than being informed about the discharge and transition plan, as well as potentially feeling disempowered from moving on with their lives at the current stage of their illness [22,23]. Accordingly, this approach created suffering for both patients and relatives and especially forced older patients to take on a passive role [23]. Although many patients chose to accept their passive role by putting their trust in the health care professionals [24,30], there was also exhaustion, insecurity, and concern due to the experienced one-way communication [23].…”