How do older people experience person-centred integrated care (PCIC)? Key findings and insights from a qualitative multi-site case study evaluation of a national integrated care programme in Ireland.

The phenomenon of ‘person-centred integrated care’ (PCIC) emerged in literature, policy and practice to meet the increasing care needs of a growing older population. This population is living longer with increased levels of complex chronic illness and multimorbidity and at enhanced risk of care fragmentation. Person-centredness is considered a core element of integrated care and quality care (WHO, 2021) and integrated care is central to person-centred care (PCC) (Institute of Medicine, 2001). Despite the desirability of the PCIC approach, progress has been slow (Greenfield et al, 2014; Riste et al, 2018). Evaluations of PCIC have tended to be service-centred in terms of their focus on outcomes and assessment of successful practice, rather than person-centred (Liljas et al, 2019; Berntsen et al, 2018; Greenfield et al, 2014). There is a marked lack of research on the effects of integrated care and its person-centred outcomes on service users (Baxter et al, 2018), including older people. There is also a recognised knowledge gap regarding experiences of PCIC or PCC in the context of integrated care. This knowledge gap is particularly true for older people, with few qualitative research studies focusing on their lived experiences of and perspectives on PCIC. This study sought to address these knowledge gaps regarding the successful application of person-centredness in integrated care contexts and older people’s PCIC experiences.

This study explored older peoples’ PCIC experiences in the context of the Irish National Integrated Care Programme for Older People (NICPOP), applying the Person-centred Practice Framework (PCPF) (McCormack and McCance, 2021) as its overarching theoretical framework. Its four research objectives were: i) to explore the nature of relationships experienced within integrated care; ii) to explore the integration of personhood within PCIC; iii) to ascertain the enablers and barriers to the delivery of PCIC; and iv) to identify the outcomes of PCIC. Using qualitative multi-case study methodology, the research design consisted of focus groups with three multidisciplinary staff teams at sites using diverse care models; staff summaries relating to care interventions; and 29 semi-structured interviews with 33 older people and carers.

Following reflexive thematic analysis, ten themes articulated the experiential dimension of PCIC: 1) Feeling under an umbrella; 2) Being cared for holistically; 3) Knowing that someone has my back; 4) Being able to trust the system over time; 5) Being seen and known in my own home; 6) Being supported to live well independently; 7) Knowing what to expect from integrated care; 8) Feeling involved in my care; 9) Enjoying care; and 10) Being supported as a carer. The six key insights of this study were: 1) the importance of holistic PCIC approaches informed by lived experience and psychosocial context; 2) PCIC optimises care experiences and supports older people to live well independently; 3) Experiences of coordination and management continuity of care are essential for positive PCIC experiences; 4) Significance of relational care and therapeutic relationship between staff and older person; 5) Feeling involved and enjoying care as central outcomes of PCIC; and 6) Carers as service users with PCIC needs