The impact on patients of the tertiary-primary healthcare interface in kidney failure: a qualitative study
Authors:
Samantha Welke, Emily Duncanson, Chris Bollen, Anne Britton, Fiona Donnelly, Randall Faull, Andrew Kellie, Richard Le Leu, Jo-Anne Manski-Nankervis, Stephen McDonald, Katherine Richards, Tiffany Whittington, Jackie Yeoh, Shilpanjali Jesudason
Clinicians and patients have reported fragmentation in the primary and tertiary healthcare interface. However, perspectives of service navigation and the impacts of fragmentation are not well defined, particularly for patients transitioning to dialysis. This study aimed to define patient perspectives of the functioning of the health service interface and impacts on healthcare experiences and engagement, informing patient-centred and outcomes-focused service models.
Methods
A qualitative study was conducted through semi-structured interviews with 25 dialysis patients (16 males) aged 34–78 receiving dialysis across a multi-site tertiary service. Transcripts were analysed thematically.
Results
Three main themes were identified: (1) The Changing Nature of General Practitioner (GP) Patient Relationships; (2) Ownership and Leadership in Kidney Care; and (3) The Importance of Nephrologist—GP Communications. Patients perceived an unreliable primary-tertiary service interface which lacked coordinated care and created challenges for primary care continuity. These impacted perceptions of healthcare provider expertise and confidence in healthcare systems. Patients subsequently increased the healthcare sought from tertiary kidney clinicians. The fractured interface led some to coordinate communication between health sectors, to support care quality, but this caused additional stress.
Conclusions
A fragmented primary-tertiary healthcare interface creates challenges for patient service navigation and can negatively impact patient experiences, leading to primary care disengagement, reduced confidence in health care quality and increased stress. Future studies are imperative for assessing initiatives facilitating health system integration, including communication technologies, healthcare provider training, patient empowerment, and specific outcomes in health, economic and patient experience measures, for patients transitioning to dialysis.
The impact on patients of the tertiary-primary healthcare interface in kidney failure: a qualitative study
Authors
Samantha Welke Emily Duncanson Chris Bollen Anne Britton Fiona Donnelly Randall Faull Andrew Kellie Richard Le Leu Jo-Anne Manski-Nankervis Stephen McDonald Katherine Richards Tiffany Whittington Jackie Yeoh Shilpanjali Jesudason
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