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What is needed for continuity of care and how can we achieve it?: - Perceptions among multiprofessionals on the chronic care trajectory
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.ORCID iD: 0000-0003-0338-7610
Umeå University, Sweden;Region Västerbotten, Sweden.
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Karolinska Institutet, Sweden. (ReAction)ORCID iD: 0000-0002-4108-391x
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Karolinska Institutet, Sweden;Region Stockholm, Sweden.
2022 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, no 1, article id 686Article in journal (Refereed) Published
Abstract [en]

Background Continuity of care (CoC) implies delivery of services in a coherent, logical and timely fashion. Continuity is conceptualized as multidimensional, encompassing three specific domains - relational, management and informational continuity - with emphasis placed on their interrelations, i.e., how they affect and are affected by each other. This study sought to investigate professionals' perceptions of the prerequisites of CoC within and between organizations and how CoC can be realized for people with complex care needs. Methods This study had a qualitative design using individual, paired and focus group interviews with a purposeful sample of professionals involved in the chain of care for patients with chronic conditions across healthcare and social care services from three different geographical areas in Sweden, covering both urban and rural areas. Transcripts from interviews with 34 informants were analysed using conventional content analysis. Results CoC was found to be dependent on professional and cross-disciplinary cooperation at the micro, meso and macro system levels. Continuity is dependent on long-term and person-centred relationships (micro level), dynamic stability in organizational structures (meso level) and joint responsibility for cohesive care and enabling of uniform solutions for knowledge and information exchange (macro level). Conclusions Achieving CoC that creates coherent and long-term person-centred care requires knowledge- and information-sharing that transcends disciplinary and organizational boundaries. Collaborative accountability is needed both horizontally and vertically across micro, meso and macro system levels, rather than a focus on personal responsibility and relationships at the micro level.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022. Vol. 22, no 1, article id 686
Keywords [en]
Continuity of care, Integrated care, Healthcare organization, Conventional content analysis
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
URN: urn:nbn:se:lnu:diva-114215DOI: 10.1186/s12913-022-08023-0ISI: 000800945700006PubMedID: 35606787Scopus ID: 2-s2.0-85130491304OAI: oai:DiVA.org:lnu-114215DiVA, id: diva2:1670972
Available from: 2022-06-16 Created: 2022-06-16 Last updated: 2023-09-26Bibliographically approved
In thesis
1. Patients’ experiences of continuity of care: What is needed and how can it be measured?
Open this publication in new window or tab >>Patients’ experiences of continuity of care: What is needed and how can it be measured?
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim for this thesis was to explore continuity of care through patients’, family carers’, and health care personnel’s perceptions, and to develop and evaluate a patient-reported experience measure of continuity of care.

Method: This thesis consists of four studies; I have a qualitative explorative design and II have a qualitative descriptive design, whereas III and IV are methodological studies. In studies I and II, data were collected from four geographically disparate areas in Sweden; in studies III and IV, data were collected in one of these areas. Data were collected using individual (I, II, III), focus groups, pair interviews (II), and questionnaires (III, IV). Data were analyzed using constructivist grounded theory (I), conventional content analysis (II), and according to classical test theory (III), and Rasch measurement theory (IV).

Results: For patients to experience continuity of care, all aspects were interconnected, as access to tailored information was essential for gaining mutual understanding regardless of who was performing a care task. This required clarity in responsibilities and roles, interprofessional collaboration, and a trusting relationship over time and space between each link in the patient’s care trajectory (I). Further, Study II showed that to achieve continuity of care, professional and cross disciplinary cooperation at micro, meso and macro levels were needed. Continuity of care is dependent on long-term and person-centered relationships, dynamic stability in the organizational structure, and shared responsibility for cohesive care enabling uniform solutions for knowledge and information exchange (II). Studies III and IV resulted in the Patient-Experienced Continuity of care Questionnaire (PECQ). The instrument contains 20 items measuring four dimensions of continuity of care: Information (four items), Relation (six item), Management (five item), and Knowledge (five item). Overall, the PECQ showed satisfactory measurement properties according to classical test theory and Rasch measurement theory (III, IV) regarding factor structure, unidimensional, local independence, response category function, differential item functioning for age and sex, and internal consistency reliability.

Conclusion: Continuity of care is perceived as multidimensional, containing several important aspects working in synergy and varying over time. To achieve continuity of care, information and knowledge sharing need to cross disciplinary and organizational boundaries. Collaborative responsibility is needed, vertically through all levels of the system, instead of focusing on personal responsibility horizontally. The PECQ can provide information on different dimensions of continuity, useful for driving quality improvements in the primary care context. 

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press, 2023. p. 107
Series
Linnaeus University Dissertations ; 506
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-124894 (URN)10.15626/LUD.506.2023 (DOI)9789180820790 (ISBN)9789180820806 (ISBN)
Public defence
2022-10-20, Azur, Hus vita, Kalmar, 09:00 (Swedish)
Opponent
Supervisors
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2017-00202
Available from: 2023-09-26 Created: 2023-09-26 Last updated: 2024-03-19Bibliographically approved

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Ljungholm, LindaEkstedt, Mirjam

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