Homebound Patient and Caregiver Perceptions of Quality of Care in Home‐Based Primary Care: A Qualitative Study

Abstract

Objectives To assess patient and caregiver perceptions of what constitutes quality care in home-based primary care (HBPC). Design Cross-sectional qualitative design; semi-structured interview study. Setting Academic home-based primary care program. Participants 13 homebound patients and 10 caregivers receiving HBPC. Measurements Semi-structured interviews explored experiences with a home-based primary care program and perceptions of quality care. Interviews were audio-recorded and transcribed. Qualitative content analysis was performed to identify major themes. Results Five major themes emerged related to participant perceptions of quality care: access, affordability, competency, care coordination, and goal attainment. Participants felt reliable, consistent access provided “peace of mind” and reduced hospital and emergency room utilization. Insurance coverage of program costs and coordinated care provided by an interdisciplinary team were positively regarded. Interpersonal skills and technical abilities of providers influenced patient perception of provider competency. Assessing and helping patients attain care goals contributed to perceived quality care. Conclusion Patients and caregivers associate high-quality HBPC with 24/7 access to affordable interdisciplinary providers with strong interpersonal skills and technical competency. These results expand on prior research and are concordant with HBPC goals of 24/7 access to multidisciplinary teams with the goals of reduced emergency and hospital utilization. HBPC programs should be structured to optimize access, affordability, coordinated care, and goal ascertainment and alignment. Quality indicators should be created and validated with these patient and caregiver views of care quality in mind.

A sense of security in palliative homecare in a Norwegian municipality; dyadic comparisons of the perceptions of patients and relatives - a quantitative study

“…A sense of security is reported to be an aspect of quality care [17] and a key component of palliative homecare [18][19][20][21]. Studies have revealed that patients and relatives' perceptions of security in homecare were fairly similar and encompassed a trusting relationship with the nurse, feeling respected, recognized, informed and being involved in the treatment and care [19,21].…”

“I didn't want to be in charge and yet I was”: Bereaved caregivers' accounts of providing home care for family members with advanced cancer

“…Although community-based palliative care services may allow patients to remain at home and curtail hospital costs, 31 an adequate investment is necessary to allow sufficient support for patients and caregivers, including 24-hour support. 32,33 Our study also highlights the need for better preparation and supports for caregivers in the period immediately following death, which may avert bereavement-related distress. 34 Caregivers' frank comments contrast with the generally positive reports on satisfaction surveys, 35 underlining the importance of qualitative research in this area.…”

“…Areas of care that were valued, but often not actualized, were consistency of home care providers; accessibility of staff; nursing and personal support for patients that matched the degree of need; and an efficient system that anticipated needs, rather than requiring constant intervention initiated by the caregiver. Although community‐based palliative care services may allow patients to remain at home and curtail hospital costs, an adequate investment is necessary to allow sufficient support for patients and caregivers, including 24‐hour support . Our study also highlights the need for better preparation and supports for caregivers in the period immediately following death, which may avert bereavement‐related distress …”

Can Home‐Based Primary Care Drive Integration of Medical and Social Care for Complex Older Adults?

“…The integration of medical and social care in this population optimizes results by bringing the appropriate mix of services to the right target population to achieve desired outcomes. Key drivers of those outcomes likely include 24/7 access to healthcare providers who provide concrete medical interventions and “peace of mind” at critical junctures in care trajectories . In addition, HBPC and other home‐based care delivery models, including home‐based palliative care, can interrupt the powerful glidepath of patient flow through the fragmented maze of our healthcare delivery system that shuffles patients through the paths of least resistance and relates more to the business of medicine and institutional convenience, rather than the truest needs of older adults.…”

“…Key drivers of those outcomes likely include 24/7 access to healthcare providers who provide concrete medical interventions and "peace of mind" at critical junctures in care trajectories. 19 In addition, HBPC and other homebased care delivery models, including home-based palliative care, can interrupt the powerful glidepath of patient flow through the fragmented maze of our healthcare delivery system that shuffles patients through the paths of least resistance and relates more to the business of medicine and institutional convenience, rather than the truest needs of older adults. HBPC can more readily identify the realistic and achievable goals of at-risk patients and work to secure the outcomes associated with these goals.…”