Abstract
Evaluations of integrated care often focus on systemic or clinical outputs. Theoretically informed research emphasising values, preferences and voice of older persons in relation to the experiential dimensions of PCIC for service users is less prominent.
This paper presents key findings and recommendations of a multiple qualitative case study exploring older persons’ and caregivers’ experiences of PCIC in NICPOP, an Irish integrated care programme. Conceptual underpinnings of person-centred care (PCC) and of McCormack and McCance’s interprofessional Person-Centred Practice Framework (PCPF) (McCormack and McCance, 2021) were used as a sensitising framework to interpret data generated in 23 interviews with 32 service users across 3 heterogeneous NICPOP sites. This study addressed the dearth of research on older people’s experiences of PCIC. While the terms ‘integrated care’ and ‘PCC’ abound in health care policy and practice documents, there remain contested definitions on integrated care (Baxter et al, 2018), PCC (Mitchell, 2022), and PCIC (Greenfield, 2014) and a lack of data concerning service users’ felt experiences of PCIC.
A key finding of this study was the central importance of the therapeutic relationship and
alliance between NICPOP staff and the client and caregiver and the significant value participants
placed on this. Participants cited relational processes of care as more important to them
than clinical or transactional processes in terms of constituting a good care experience
for them. Findings reveal the importance of care context and model of care delivery for this care relationship. An intensive and long-term case management model was found to foster and maintain this trusted relationship, ensuring that clients and caregivers had a single and consistent point of contact with NICPOP. This in turn enabled enhanced service provider understandings of complex and changing needs in the context of chronic illness and multimorbidity and required holistic care responses. Case manager relationships resulted in reassuring felt experiences of coordination of care for service users.
Home-based, as compared with clinical hub based, models of care enabled relationship building, providing for greater insight into the psychosocial contexts of older people and their families, revealing vulnerabilities, priorities and related care needs, and facilitating more personalised holistic care. Findings suggest that longer-term models of care or finite interventions with the capacity of a follow-up check-in built in following discharge to enable re-engagement where necessary contribute to felt experiences of management and relational continuity. Findings also elucidated the necessity of understanding the power dynamics at play within relationships between service providers and service users and caregivers. Power and power relations were evident in terms of PCIC that empowers, and health system fragmentation and related inaccessibility of services that are disempowering and disenfranchising for clients and their caregivers.
Finally, this paper presents recommendations for policy and practice regarding the further development of NICPOP. These include the continuation of longer-term home-based models of care, especially for more vulnerable and complex presentations and the establishment of dynamic and adaptive approaches to longer-term engagement and incorporation of the potential to re-engage with ICTOP in response to emerging needs, ensuring management continuity of care.