‘Continuity of care’: a critical interpretive synthesis of how the concept was elaborated by a national research programme

Heaton, Janet; Corden, Anne; Parker, Gillian

doi:10.5334/ijic.794

Cited by 48 publications

(62 citation statements)

References 22 publications

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“…[42][43][44] Recent discourse around continuity has moved towards a partnership paradigm in which continuity is recognised to be coconstructed by patients, families and professionals, all of whom have an active part to play in its accomplishment. 33,45 In this model 'professionals do not deliver continuity to service users but work with them and their carers/families to assess needs and preferences and facilitate contact and continuity' (p. 597). 46 Freeman and colleagues 40 have identified three main aspects of continuity: relationship continuity, management continuity and informational continuity.…”

Section: Continuity Of Carementioning

confidence: 99%

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Bunn

Burn

Goodman

et al. 2016

Health Serv Deliv Res

116

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BackgroundAmong people living with dementia (PLWD) there is a high prevalence of comorbid medical conditions but little is known about the effects of comorbidity on processes and quality of care and patient needs or how services are adapting to address the particular needs of this population.ObjectivesTo explore the impact of dementia on access to non-dementia services and identify ways of improving the integration of services for this population.DesignWe undertook a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews with health-care professionals (HCPs). We focused specifically on three conditions: diabetes, stroke and vision impairment (VI). The analysis was informed by theories of continuity of care and access to care.ParticipantsThe study included 28 community-dwelling PLWD with one of our target comorbidities, 33 family carers and 56 HCPs specialising in diabetes, stroke, VI or primary care.ResultsThe scoping review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. Our qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play in managing health-care conditions of PLWD and facilitating continuity and access to care, this recognition did not translate into their routine involvement in appointments or decision-making about their family member. Although we found examples of good practice, these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. Pathways and guidelines for our three target conditions do not address the possibility of a dementia diagnosis or provide decision-making support for practitioners trying to weigh up the risks and benefits of treatment for PLWD.ConclusionsSignificant numbers of PLWD have comorbid conditions such as stroke, diabetes and VI. The presence of dementia complicates the delivery of health and social care and magnifies the difficulties that people with long-term conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Continuity Of Carementioning

confidence: 99%

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Bunn

Burn

Goodman

et al. 2016

Health Serv Deliv Res

116

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“…In this position, the family caregivers asked for help, thus revealing the potential to enhance collaboration and enable continuity of care. However, the formal caregivers primarily referred to the patients and did not discuss informational links with family caregivers, a finding that fits the professional paradigm of continuity of care described by Heaton et al (2012). The formal caregivers assumed that their local and professional expertise was sufficient to make decisions in collaboration with patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, a considerable amount of literature focuses on continuity of care in general, as a complex and important concept within care services (Gulliford, Naithani, & Morgan, 2006;Haggerty et al, 2003;Heaton, Corden, & Parker, 2012). A review by Uijen, Schers, Schellevis, and van den Bosch (2012) that focussed on continuity of care revealed overlap among many other terms and found that researchers use these terms interchangeably without definition.…”

Section: Continuity Of Carementioning

confidence: 99%

“…In addition to 'The Freeman model' research programme previously mentioned, one study explored the evolution of the continuity of care concept along a time axis and identified three paradigms: professional, perspectivist, and partnership (Heaton et al, 2012). The first paradigm, 'professional', referred to the period before the 1990s, where formal caregivers were responsible for achieving continuity of care.…”

Section: Continuity Of Carementioning

confidence: 99%

“…This paradigm emphasizes the relational, collective and dynamic processes within care networks. Within this kind of continuity, the empowered 6 patient is important as well as inter-professional teams working together with patient and family caregivers to improve care while making health care services more efficient (Heaton et al, 2012). This paper relies on the intertwined three-dimensional framework of continuity of care first suggested by Reid et al (2002) in addition to the three continuity of care paradigms suggested by Heaton, Corden and Parker (2012).…”

Section: Continuity Of Carementioning

confidence: 99%

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Continuity of home-based care for persons with dementia from formal and family caregivers’ perspective

2016

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Western health care policy emphasizes continuity of care for people with dementia. This paper presents formal and family caregivers' descriptions of collaboration in home-based dementia care and explores whether this collaboration inhibits or enables continuity of care and the use of the statutory individual plan. Empirical data were derived from eighteen indepth interviews with formal and family caregivers and brief fieldwork. The results reveal dynamic positions in collaborative practice and, from these positions, discrepancies in descriptions of practices and the needs of the person with dementia. Such micro-level discrepancies may serve as barriers for macro-level continuity of care objectives. To ensure continuity of care, formal and family caregivers must be aware of their positions and discuss specific expectations for information flow, involvement and care responsibilities. Individual plan can serve as a starting point for such discussions.

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A systematic review and critical appraisal of qualitative metasynthetic practice in public health to develop a taxonomy of operations of reciprocal translation

Melendez‐Torres

Grant

Bonell

2015

Research Synthesis Methods

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‘Continuity of care’: a critical interpretive synthesis of how the concept was elaborated by a national research programme

Cited by 48 publications

References 22 publications

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Continuity of home-based care for persons with dementia from formal and family caregivers’ perspective

A systematic review and critical appraisal of qualitative metasynthetic practice in public health to develop a taxonomy of operations of reciprocal translation

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