Experiences of care planning in England: interviews with patients with long term conditions

Abstract

Background The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority in England for chronic disease management. However, it is not clear how care planning is currently understood, translated and implemented in primary care. This study explores experience of care planning in patients with long term conditions in three areas in England. Methods We conducted semi-structured interviews with 23 predominantly elderly patients with multiple long term conditions. The interviews were designed to explore variations in and emergent experiences of care planning. Qualitative analysis of interview transcripts involved reflexively coding and re-coding data into categories and themes. Results No participants reported experiencing explicit care planning discussions or receiving written documentation setting out a negotiated care plan and they were unfamiliar with the term ‘care planning’. However, most described some components of care planning which occurred over a number of contacts with health care professionals which we term”reactive” care planning. Here, key elements of care planning including goal setting and action planning were rare. Additionally, poor continuity and coordination of care, lack of time in consultations, and patient concerns about what was legitimate to discuss with the doctor were described. Conclusions Amongst this population, elements of care planning were present in their accounts, but a structured, comprehensive process and consequent written record (as outlined in English Department of Health policy) was not evident. Further research needs to explore the advantages and disadvantages of different approaches to care planning for different patient groups.

Care models for people with chronic diseases: integrative review

“…This is a strategy that health services and social services use to support patients in their care, and that can result in the organization of a care plan in the form of a document with definition of agreed goals. 7 This model is also understood as a process of cooperation between a health professional, the patient with complex conditions and the social support network, to plan, monitor and evaluate care alternatives, in order to provide a qualified care, that may increase the functional ability and preserve the individual and family autonomy. 5 The English Department of Health seeks a care planning based on case management.…”

“…One study found that when patients are assisted based on case management, they felt surprised and were not familiar with the term "care planning". 7 Other studies reported that case management can improve the quality of communication between the health team and patients and help to satisfy those involved in the experience of care, whether doctors, patients or families. 8,16,19 The use of the GRACE and PACE models and Gundersen program, patients reported receiving more information about their conditions, they had fewer needs that were not cared for, and the last aspect led to change the outbreak of the disease for the patient.…”

Qualitative Study on The Implementation of Public Health Nursing: Objective, Resources, and Work Procedure on Home Care Patients in Surakarta

“…Hal ini sesuai dengan penelitian Newbould et al, (2012) bahwa dalam perencanaan kegiatan home care, dibutuhkan diskusi bersama antara pasien dengan perawat. Karena dalam kegiatan perencanaan tidak hanya terkait rencana tindakan dan jadwal perencanaan tetapi diperlukan adanya kesepakatan terkait output kegiatan…”

Care planning for long term conditions in primary care: indicators of embeddedness

“…It requires the 4 following inter-dependent elements: 1) engaged and informed patients; 2) healthcare professionals committed to partnership working; 3) facilitative organisational structures & 4) supportive commissioning processes [15]. Although adoption in practice has been variable [16,17], formal evidence of effectiveness of care planning is beginning to emerge [13,15,18,19].…”

“…We used NPT to describe the steps undertaken by practitioners in making sense of the care planning model and adapting it to their particular practice contexts. As such, this paper responds to calls for research to further understanding of the ways that care planning is integrated and embedded in primary care for people with complex needs [17].…”