Expectations and experiences with physician care among patients receiving post-acute care in US skilled nursing facilities

Abstract

Background In the US, post-acute care in skilled nursing facilities (SNFs) is common and outcomes vary greatly across facilities. Little is known about the expectations of patients and their caregivers about physician care during the hospital to SNF transition. Our objectives were to (1) describe the experiences and expectations of patients and their caregivers with SNF physicians in SNFs, and (2) identify patterns that differed between patients with vs. without cognitive impairment. Methods This qualitative study used grounded theory approach to analyze data collected from semi-structured interviews at five SNFs in January–August 2018. Patients admitted for short-term SNF care 5–10 days prior were eligible to participate. Thematic analysis was performed to detect recurrent themes with a focus on modifiable aspects of physician care. Analysis was stratified by patient cognitive impairment (measured by the Montreal Cognitive Assessment at the time of the interview). Results Fifty patients and six caregivers were interviewed. Major themes were: (1) patients had poor awareness of the physician in charge of their care; (2) they were dissatisfied with the frequency of interaction with the physician; and (3) participants valued the perception of receiving individualized care from the physician. Less cognitively impaired patients were more concerned about limited interactions with the physicians and were more likely to report attempts to seek out the physician. Conclusion Patient and caregiver expectations of SNF physicians were not well aligned with their experiences. SNFs aiming to improve satisfaction with care may focus efforts in this area, such as facilitating frequent communication between physicians, patients and caregivers.

Functional Impairments and Rehabilitation Outcomes of Patients With Immunotherapy-Induced Acute Inflammatory Demyelinating Polyradiculoneuropathy, Myasthenia Gravis, and Myositis

“…This could represent that the sickest and most neurologically devastated patients were not able to return home and required rehabilitation for longer periods to regain their functional independence. Physician or physiatrist monitoring may not be as frequent, which may impact the medical and functional improvements as well as rehospitalization rate, 20 with studies showing that one quarter of the 1.5 million patients discharged annually are rehospitalized or die within 30 days. 20,21 More studies of the functional impact of immunotherapy-related GBS, MG, and myositis are still needed to determine the long-term effects of subacute rehabilitation in this population.…”

The Future Includes Nurse Practitioner Models of Care in the Long-Term Care Sector

“… 4 The lack of on-site availability of PCPs may contribute to adverse health outcomes among residents 5 and dissatisfaction from residents and their families related to the frequency of interactions with their physician. 6 , 7 Finding physicians focused on care of LTC residents will no doubt become increasingly more challenging, with data from the United States demonstrating that these providers have decreased from 83% in 2008 to 59% in 2018. 8 In contrast, there has been a growth in full-time NPs from 14% in 2008 to 36% in 2018, representing 60% of full-time PCPs in the LTC sector.…”