Article Figures & Data
Tables
- Table 1
Studies Included in the Metasummary, in Chronological Order, Showing Author, Year, Country, Qualitative Design, and Patient Population
Author Year, Country Qualitative Design Patient Population and Setting American Hospital Association and The Picker Institute29 1997, USA Focus groups (n = 31) and Picker Institute patient surveys Adult patients (public perceptions of health care and hospitals in 12 different states in the United States Burkey et al30 1997, UK In-depth semistructured interviews (n = 43); follow-up with 37 at 6 months Patients followed at 5 general medical outpatient clinics (3 or more attendances) and discharged in April–May 1995 Adewuyi-Dalton et al31 1998, UK Semistructured interviews about routine hospital follow-up (n=113) Women with breast cancer in remission discharged to usual care Armitage et al32 1998, Australia Telephone semistructured interviews (n = 29) at home (5 to 36 days after discharge) about discharge planning Patients (inpatient >2 days) discharged from 3 medical wards of a large tertiary referral teaching hospital Gallagher et al33 1999, Canada 10 Individual semistructured interviews Seniors from across Canada who use 2 or more health services, recruited in their community by Advisory Council members, themselves seniors Wallace et al34 1999, UK Focus groups (n = 3) Women with epilepsy recruited from tertiary hospital’s Epilepsy Clinic and through the epilepsy support group Wallace et al35 1999, Canada Focus groups (n = 9) with patients and family members separately (n = 41) Psychiatry patients discharged from inpatient unit and still being treated in the outpatient department, and family members McCourt et al36 2000, UK Semistructured narrative individual interviews (n=20) Visible minority women, one-half receiving caseload midwifery care and one-half conventional maternity care (ethnic categories: black Caribbean and African, South and East Asian, and Mediterranean or Middle Eastern) Radwin et al37 2000, USA Interviews about quality nursing care with a semistructured schedule (n = 22) Oncology patients in outpatient treatment at an urban medical center (19 hospitalized for cancer treatment at least once) Bakker et al38 2001, Canada Interviews relatively unstructured in patient’ home (n=28) Patients receiving chemotherapy at 1 of the 13 community chemotherapy clinics after medical oncology consultation at regional cancer center Kai et al5 2001, UK Individual in-depth interviews (n=34) Patients with enduring mental ill health registered with 4 general practices referred to 2 consultant psychiatrist-led community mental health teams at a local hospital inpatient unit Bain et al39 2002, Scotland Focus groups (n = 4), 22 patients with colorectal cancer (and 10 of their relatives) and in-depth interviews conducted in the participants homes (n = 39 patients and 24 relatives) Oncology and surgical outpatient clinics for colorectal cancer and from chemotherapy outpatients and in-patients. North and Northeast of Scotland Harrison et al40 2002, Canada In-depth personal interviews and short telephone interviews to understand coordination of care Patients (n = 26) discharged from an acute care hospital into the community with home care support, (n = 5 urban and 1 rural) McKinney et al41 2002, UK Phenomenological approach (interpretative Heideggerian approach, n = 6) Patients (n = 6) who have been transferred from intensive care to general ward; before and after transfer from intensive care unit Murray et al42 2002, UK In-depth interviews every 3 months for 1 year with patients and their main caregiver plus professional identified as key by patients. Two multidisciplinary focus groups. Postbereavement interviews with caregivers and key professionals Patients with inoperable lung cancer (n = 20) and patients with advanced cardiac failure (n = 20) receiving community terminal care, with caregivers and key professional carers Osse et al43 2002, The Netherlands In-depth interviews with patients (n = 9) and relatives (n = 7) followed by interviews using a checklist (n = 31 and 15) Adults cancer patients with metastatic disease in a palliative phase of cancer. Patients were selected through randomly chosen general practitioners and through patient organizations Kroll et al44 2003, USA Semistructured telephone interviews (n = 30) People with cerebral palsy, multiple sclerosis, or spinal cord injury, with reported problems of health insurance coverage and accessibility; across all services O’Connell et al45 2003, Australia Focus groups (n = 12), mixed groups about transition from pediatric to adult care Young adults (aged 16–25 years) with a disability, their caregivers, and health care service clinicians Tarrant et al46 2003, UK Narrative-based individual interviews, “framework” approach. Followed by focus groups with patients (n = 4) and with health professionals (n = 4) Adult patients (n = 40), practitioners (n = 13), practice and community nurses (n = 10), and practice administrative staff (n = 6) in 6 general practices in Leicestershire Ware et al14 2003, USA Ethnographic study using data collected through observation and open-ended interviewing Severely mentally ill persons (n = 9) and their health professional, in public mental health services, Boston, Massachusetts Arthur et al47 2004, UK Semistructured interviews (n = 10) Rheumatology outpatients using antirheumatic drugs Dolovich et al9 2004, Canada Focus groups with patients (n = 7) and health care clinicians (n = 2), approximately one-half being physicians Patients with a diabetes diagnosis registered in a multidisciplinary health service organization in Ontario Infante et al4 2004, Australia Focus groups (n = 12) Health consumers with chronic illnesses, followed in general practice Miles et al48 2004, UK Single semistructured interviews (n = 7) about transition Adolescent patients human immunodeficiency virus (HIV) infection transferred from hospital pediatric unit to the adult HIV outpatient center Williams et al49 2004, Australia Colaizzi’s phenomenological method using single semistructured interviews (n = 12) Patients with multiple chronic illnesses for approximately 5 years, admitted to acute care hospital from home, during hospital care of at least 4 days’ duration Woodward et al50 2004, Canada Interviews home care case managers (n = 13), home service clinicians (n = 19), clients (n = 25), and their caregivers (n = 5) and 3 physicians Home care cases with different entry mechanisms to home care (from hospital or from the community) and different availability of family caregivers Pâquet et al51 2005, Canada Focus groups (n = 3) from rural, semirural and urban milieu, about cardiac rehabilitation programs Adults hospitalized for a cardiovascular event: myocardial infarction, angina, or percutaneous angioplasty Alazri et al6 2006, UK Focus groups (n = 12) about primary diabetes care Patients with type 2 diabetes from 2 rural and 5 urban practices in Leeds of different sizes Fraenkel et al52 2006, UK and USA Focus groups (n = 8, 4 per setting) Patients with hepatitis C attending the outpatient liver clinics in 2 different settings McCurdy et al53 2006, Canada Qualitative case study approach, 4 focus groups with young adults about pediatric to adult care transition Patients aged 19–24 years, after transfer at 18 years from pediatric to adult center after kidney, liver, or heart transplant Naithani et al54 2006, UK In-depth semistructured interviews in patient’ home Type 2 diabetic patients from general practices in 2 inner London boroughs with young, mobile, and ethnically diverse populations and high level of deprivation Hildingsson et al3 2007, Sweden Written response to 1 open-ended question about maternity services Women seen in a Swedish prenatal clinic Lester et al55 2007, UK Focus groups (n = 18) (separate with patients, physicians, practice nurses) Patients with broadly defined serious mental illness in 6 primary care trusts, West Midlands Burns et al13 2007, UK In-depth interviews with 20 psychotic patients and 11 nonpsychotic patients Patients with mental illness (and their caregivers) in 2 London mental health National Health Service accessing a variety of health and social services - Table 2
Summary of Identified Themes Related to Experienced Continuity of Care When Seeing Multiple Clinicians
Dimension Emerging Finding Overarching themes Connectedness experienced as security and confidence, not seamlessness
Connectedness beyond health care encounters: between personal lives and health care
Patients as active agents: for most but not all patientsManagement continuity or experienced coordination Coordination assumed, not observed
Clinician care plans are not patient care plans; patients want to know what to expect, what to do
Every transition benefits from discharge planningInformational continuity Information among clinicians experienced through gaps
Information from clinicians enables patient agency and empowermentRelational continuity One, most trusted clinician among many
Beyond empathy to partnershipCare coordinator An identified and proactive connector and advocate who knows the patient
Additional Files
The Article in Brief
Experienced Continuity of Care When Patients See Multiple Clinicians: A Qualitative Metasummary
Jeannie L. Haggerty , and colleagues
Background Tools are needed to measure continuity of care (consistent and coherent care management) between different clinicians. In this study, researchers identify continuity-related themes through a metasummary of previous qualitative research on patients' experience of care from multiple clinicians.
What This Study Found Patients experience continuity of care as security and confidence rather than as seamlessness. Patients' desire for connectedness extends beyond health care encounters to include connection between health care and the rest of the patient's life, which translates to a sense of security and confidence.
Implications
- Although most continuity-related reforms emphasize integration of information and services, this study underlines the need to support and protect relational continuity with trusted and trustworthy clinicians who act as partners in care.
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