Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Geriatrics
Published in: BMC Geriatrics 1/2015

Open Access 01-12-2015 | Research article

Community-based primary health care for older adults: a qualitative study of the perceptions of clients, caregivers and health care providers

Authors: Claire Lafortune, Kelsey Huson, Selena Santi, Paul Stolee

Published in: BMC Geriatrics | Issue 1/2015

Login to get access

Abstract

Background

Older persons are often poorly served by existing models of community-based primary health care (CBPHC). We sought input from clients, informal caregivers, and health care providers on recommendations for system improvements.

Methods

Focus group interviews were held with clients, informal caregivers, and health care providers in mid-sized urban and rural communities in Ontario. Data were analyzed using a combination of directed and emergent coding. Results were shared with participants during a series of feedback sessions.

Results

An extensive list of barriers, facilitators, and recommended health system improvements was generated. Barriers included poor system integration and limited access to services. Identified facilitators were person and family-focused care, self-management resources, and successful collaborative practice. Recommended system improvements included expanding and integrating care teams, supports for system navigation, and development of standardized information systems and care pathways.

Conclusions

Older adults still experience frustrating obstacles when trying to access CBPHC. Identified barriers and facilitators of improved system integration aligned well with current literature and Wagner’s Chronic Care Model. Additional work is needed to implement the recommended improvements and to discern their impact on patient and system outcomes.
Appendix
Available only for authorised users
Literature
1.
2.
Vedel I, Monette M, Béland F, Monette J, Bergman H. Ten years of integrated care: backwards and forwards. The case of the province of Québec, Canada. Int J Integr Care. 2011;11(Special 10th Anniversary Edition):e004.PubMedPubMedCentral
3.
Health Canada. Taking action to improve the health of Canadians. Ottawa, ON: Parliament of Canada; 2012.
4.
Bergman H, Béland F, Lebel P, Contandriopoulos AP, Tousignant P, Brunelle Y, et al. Care for Canada’s frail elderly population: fragmentation or integration? CMAJ. 1997;157:1116–21.PubMedPubMedCentral
5.
6.
Béland F, Bergman H, Lebel P, Clarfield AM, Tousignant P, Contandriopoulos AP, et al. A system of integrated care for older persons with disabilities in Canada: results from a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2006;61:367–73.CrossRefPubMed
7.
Adams WL, Mcllvain HE, Lacy NL, Magsi H, Crabtree BF, Yenny SK, et al. Primary care for elderly people: why do doctors find it so hard? Gerontologist. 2002;42:835–42.CrossRefPubMed
8.
Aminzadeh F, Dalziel WB. Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Ann Emerg Med. 2002;39:238–47.CrossRefPubMed
9.
Rothman AA, Wagner EH. Chronic illness management: what is the role of primary care? Ann Intern Med. 2003;138:256–61.CrossRefPubMed
10.
11.
Crane SJ, Tung EE, Hanson GJ, Cha S, Chaudhry R, Takahashi PY. Use of an electronic administrative database to identify older community dwelling adults at high-risk for hospitalization or emergency department visits: the elders risk assessment index. BMC Health Serv Res. 2010;13:338.CrossRef
12.
Canadian Institute of Health Information. National Health Expenditure Trends, 1975 to 2013. Report. 2013;5:51–8.
13.
Lubben JE, Damron-Rodriguez J. An international approach to community health care for older adults. Fam Community Health. 2003;26:338–49.CrossRefPubMed
14.
Heckman GA, Hillier L, Manderson B, McKinnon-Wilson J, Santi SM, Stolee P. Developing an integrated system of care for frail seniors. Healthc Manage Forum. 2013;2013(26):200–8.CrossRef
15.
Byrne K, Orange JB, Ward-Griffin C. Care transition experiences of spousal caregivers: from a geriatric rehabilitation unit to home. Qual Health Res. 2011;21:1371–87.CrossRefPubMed
16.
McLeod J, McMurray J, Walker JD, Heckman GA, Stolee P. Care transitions for older patients with musculoskeletal disorders: continuity from the providers’ perspective. Int J Integr Care. 2011; e014. Epub.
17.
Toscan J, Mairs K, Hinton S, Stolee P, The InfoRehab Team. Integrated transitional care: patient, informal caregiver and health care provider perspectives on care transitions for older persons with hip fracture. Int J Integr Care. 2012;12:e13. Epub.CrossRefPubMedPubMedCentral
18.
Manderson B, McMurray J, Piraino E, Stolee P. Navigation roles support chronically ill older adults through healthcare transitions: a systematic review of the literature. Health Soc Care Community. 2012;20:113–27.CrossRefPubMed
19.
Toscan J, Manderson B, Santi SM, Stolee P. ‘“Just another fish in the pond’“: the transitional care experience of a hip fracture patient. Int J Integr Care. 2013;13:e023.CrossRefPubMedPubMedCentral
20.
Glenny C, Stolee P, Sheiban L, Jaglal S. Communicating during care transitions for older hip fracture patients: family caregiver and health care provider’s perspectives. Int J Integr Care. 2013;13:e044. eCollection.CrossRefPubMedPubMedCentral
21.
Schoen C, Osborn R, How SK, Doty MM, Peugh J. In chronic condition: experiences of patients with complex health care needs, in eight countries, 2008. Health Aff (Millwood). 2009;28:w1–16.CrossRef
22.
23.
24.
Krueger RA, Casey MA. Focus Groups: A Practical Guide for Applied Research 3rd Edition. California: Sage Publications Inc.; 2000.CrossRef
25.
Schwartz SH, Verkasalo M, Antonovsky A, Sagiv L. Value priorities and social desirability: much substance, some style. Brit J Soc Psychol. 1997;36:3–18.CrossRef
26.
Patton MQ. Qualitative Evaluation and Research Methods (2nd edition). California: Sage; 1990.
27.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–88.CrossRefPubMed
28.
29.
Krefting L. Rigor in qualitative research: the assessment of trustworthiness. Am J Occup Ther. 1991;45:214–22.CrossRefPubMed
30.
Canadian Medical Association. Health care transformation in Canada. Ottawa, ON: Canadian Medical Association; 2010.
31.
Canadian Health Services Research Foundation. Provincial and territorial health system priorities: An environmental scan. Ottawa, ON: Canadian Health Services Research Foundation; 2011.
32.
Health Council of Canada. How do sicker Canadians with chronic disease rate the health care system? Results from the 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults. In: Canadian Health Care Matters, Bulletin 6. Toronto, ON: Health Council of Canada; 2011.
33.
Canadian Institute for Health Information. Health care in Canada 2009: A decade in review. Ottawa, ON: Canadian Institute for Health Information; 2009.
34.
Marchildon GP. Canada: health system review. Health systems in transition. Health Syst Transit. 2013;15:1–179.PubMed
35.
36.
37.
Canadian Medical Association & Canadian Nurses Association. Principles to guide health care transformation in Canada. Ottawa, ON: Canadian Medical Association, Canadian Nurses Association; 2011.
38.
39.
Stewart M, Brown J, Donner A, McWhinney I, Oates J, Weston W, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49:796–804.PubMed
40.
41.
Jerant A, Moore-Hill M, Franks P. Home-based, peer-led chronic illness self-management training: findings from a 1-year randomized controlled trial. Ann Fam Med. 2009;7:319–27.CrossRefPubMedPubMedCentral
42.
Franek J. Self-management support interventions for persons with chronic disease: an evidence-based analysis. Ont Health Technol Assess Ser. 2013;13:1–60.PubMedPubMedCentral
43.
Lemieux-Charles L, McGuire W. What do we know about health care team effectiveness? A review of the literature. Med Care Res Rev. 2006;63:263–300.CrossRefPubMed
44.
Poulton B, West M. The determinants of effectiveness in primary health care teams. J Interprof Care. 1999;13:7–18.CrossRef
45.
Grumbach K, Bodenheimer T. Can health care teams improve primary care practice? JAMA. 2004;291:1246–51.CrossRefPubMed
46.
Soklaridis S, Oandasan I, Kimpton S. Family health teams: Can health professionals learn to work together? Can Fam Physician. 2007;53:1198–9.PubMedPubMedCentral
47.
48.
Bodenheimer T, Wagner E, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288:1775–9.CrossRefPubMed
49.
McMurray J, Stolee P, Hicks E, Elliot J, Johnston H, Byrne K. ‘“Trying to find information is like hating yourself every day’“: The collision of electronic information systems in transition with patients in transition. Health Informatics J. 2013;19:218–32.CrossRefPubMed
50.
McMurray J, Stolee P, Hicks E, Elliot J, Johnston H, Byrne K. The role of documentation and inter-provider information exchange in care continuity for older hip fracture patients. Stud Health Technol Inform. 2013;192:1197.PubMed
51.
Fontaine P, Ross S, Zink T. Systematic review of health information exchange in primary care practices. J Am Board Fam Med. 2010;2010(23):655–70.CrossRef
52.
Boyd C, Darer J, Boult C, Fried L, Boult L, Wu A. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294:716–24.CrossRefPubMed
53.
Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996;74 Suppl 4:511–44.CrossRefPubMed
Metadata
Title
Community-based primary health care for older adults: a qualitative study of the perceptions of clients, caregivers and health care providers
Authors
Claire Lafortune
Kelsey Huson
Selena Santi
Paul Stolee
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2015
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-015-0052-x

Other articles of this Issue 1/2015

BMC Geriatrics 1/2015 Go to the issue

Research article

Perceived frailty and measured frailty among adults undergoing hemodialysis: a cross-sectional analysis

Study protocol

A cluster randomized controlled trial on the effects and costs of advance care planning in elderly care: study protocol

Research article

Family visits in shared-housing arrangements for residents with dementia – a cross-sectional study on the impact on residents’ quality of life

Research article

Self-perceived memory loss is associated with an increased risk of hip fracture in the elderly: a population-based NOREPOS cohort study

Research article

Elevated circulating vascular cell Adhesion Molecule-1 (sVCAM-1) is associated with concurrent depressive symptoms and cerebral white matter Hyperintensities in older adults

Research article

Cardiovascular responses to orthostasis and their association with falls in older adults
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits