Seniors’ perspectives on care: a case study of the Alex Seniors health clinic, Calgary

Abstract

BackgroundPrimary care initiatives face an imperative to not only reduce barriers to care for their patients but also to uniquely accommodate the complex needs of at-risk patient populations. Patient-centered multidisciplinary care team models for primary care, like the Alex Seniors Clinic, are one approach for providing comprehensive care for marginalized seniors. The purpose of this qualitative study was to explore patient perspectives on the responsiveness of the Alex Seniors Clinic to their stated health needs.ResultsThemes reflected participants’ perspectives on factors impacting their health needs as vulnerable seniors as well as on the measures that the Alex Seniors Clinic has taken to meet those needs. Factors impacting health included: the nature of their relationships to the physical environment in which they lived, the nature of the relationships they had to others in that environment, and independence and autonomy. Participants identified accessibility, respect and support, and advocacy as the ways in which the clinic was working to address those health needs.ConclusionsWhile respect and support, as well as advocacy, effectively addressed some patient needs, participants felt that accessibility problems continue to be health-related barriers for clinic patients. This may be due to the fact that issues of accessibility reflect larger community and social problems. Nevertheless, it is only through engaging the patient community for input on clinic approaches that an understanding can be gained of how closely a clinic’s care goals are currently aligning with patient perspectives of the care and services they receive.

A Review and Synthesis of TBPCC Evaluation in Canada: Looking beyond the Quadruple Aim

“…From our review, there is considerable evidence that TBPCC can enhance patient experience of care through strategies related to accessibility, respectful supportive relationships, enhanced opportunities for knowledge sharing, self-management, and community advocacy (24,33,34,40). The availability of enhanced case management or specialized support roles also positively influences patient experience (44,45,72).…”

“…However, other studies suggest the accessibility of care is still an issue, even in highly-functioning team-based practices (33,43,46). A pan-Canadian study found that the likelihood of reporting access issues or unmet needs was not significantly different in TBC vs. non-TBC settings (68).…”

“…Four of the seven studies from the Prairie Provinces (Alberta=6, Manitoba=1) mapped to the Quadruple Aim. Two studies reported on patient experience (33,34), one on population health (35), and one on provider experience (36). Three of seven studies reported on team collaboration and function as important components of transitioning to TBC (36)(37)(38).…”

“…Emerging themes from the studies were patient needs regarding respect, support, and advocacy, and improved knowledge, independence, care received, ability to make decisions, and overall health. Other related themes included: provider and patient experience with overall delivery and quality of care (33)(34)(35)39), provider remuneration, and support for information technology, leadership, and education (38).…”

“…There was discordance for the two studies that focused on perceptions of access to care. One study emphasized that while the respect, support, and community advocacy provided to patients as a result of a TBC model was appreciated, accessibility continued to be a barrier for patients (33). Another study reported a perceived benefit improvement in access to care (34).…”