Healthcare providers' experiences in supporting community-living older adults to manage multiple chronic conditions: a qualitative study.

BACKGROUND: Living with multiple chronic conditions (MCC), the coexistence of two or more chronic conditions, is becoming more prevalent as the population ages. Primary care and home care providers play key roles in caring for older adults with MCC such as facilitating complex care decisions, shared decision-making, and access to community health and support services. While there is some research on the perceptions and experiences of these providers in caring for this population, much of this literature is focused specifically on family physicians. Little is known about the experiences of other primary care and home care providers from multiple disciplines who care for this vulnerable group. The purpose of this study was to explore the experiences of primary and home care healthcare providers in supporting the care of older adults with MCC living in the community, and identify ways of improving care delivery and outcomes for this group. METHODS: The study used an interpretive descriptive design. A total of 42 healthcare providers from two provinces in Canada (Ontario and Alberta) participated in individual semi-structured, face-to-face 60-min interviews. Participants represented diverse disciplines from primary care and home care settings. Inductive thematic analysis was used for data analysis. RESULTS: The experiences and recommendations of healthcare providers managing care for older adults with MCC were organized into six major themes: (1) managing complexity associated with MCC, (2) implementing person-centred care, (3), supporting caregivers, (4) using a team approach for holistic care delivery, (5) encountering challenges and rewards, and (6) recommending ways to address the challenges of the healthcare system. Healthcare providers identified the need for a more comprehensive, integrated system of care to improve the delivery of care and outcomes for older adults with MCC and their family caregivers. CONCLUSIONS: Study findings suggest that community-based healthcare providers are using many relevant and appropriate strategies to support older adults living with the complexity of MCC, such as implementing person-centred care, supporting caregivers, working collaboratively with other providers, and addressing social determinants of health. However, they also identified the need for a more comprehensive, integrated system of care.

Understanding physiotherapists' roles in ontario primary health care teams.

PURPOSE: To understand physiotherapists' roles and how they are enacted within Ontario primary health care (PHC) teams. METHODS: Following a pragmatic grounded theory approach, 12 physiotherapists practising within Ontario PHC teams participated in 18 semi-structured in-depth in-person interviews. All interviews were audiotaped and transcribed verbatim, then entered into NVIVO-8. Coding followed three progressive analytic stages and was iterative in nature, guided by grounded theory. An explanatory scheme was developed. RESULTS: Physiotherapists negotiate their place within the PHC teams through five interrelated roles: (1) manager; (2) evaluator; (3) collaborator; (4) educator; and (5) advocate. These five roles are influenced by three contextual layers: (1) inter-professional team; (2) community and population served; and (3) organizational structure and funding. Canada's PHC mandate (access, teams, information, and healthy living) frame the contexts that influence role enactment. CONCLUSIONS: To fulfill the PHC mandate, physiotherapists carry out multiple roles that are based on a broad holistic perspective of health, within the context of a collaborative inter-professional team and the community, through an evidenced-informed approach to care. There appear to be multiple ways of successfully integrating physiotherapists within PHC teams, provided that role enactment is context sensitive and congruent with the mandate of PHC.

Objectif : Comprendre les rôles des physiothérapeutes et comment ils sont appliqués au sein des équipes de fournisseurs de soins de santé primaires en Ontario. Méthodes : Suivant une méthode théorique à base empirique pratique, 12 physiothérapeutes pratiquant dans des équipes de soins de santé primaires de l'Ontario ont participé à 18 entrevues personnelles détaillées semi-structurées. Toutes les entrevues ont été enregistrées, transcrites verbatim et entrées ensuite dans NVIVO-8. Le codage a suivi trois stades analytiques progressifs et était de nature répétitive, guidé par une théorie à base empirique. On a créé un système explicatif. Résultats : Les physiothérapeutes négocient leur place au sein des équipes de soins de santé primaires en jouant cinq rôles interdépendants : (1) gestionnaire; (2) évaluateur; (3) collaborateur; (4) éducateur; (5) représentant. Ces cinq rôles subissent l'influence de trois strates contextuelles : (1) équipe interprofessionnelle; (2) communauté et population desservies; (3) structure organisationnelle et financement. Le mandat du Canada au niveau des soins de santé primaires (accès, équipe, information et vie saine) circonscrit les contextes qui agissent sur les rôles joués. Conclusions : Pour s'acquitter du mandat relatif aux soins de santé primaires, les physiothérapeutes jouent de multiples rôles qui reposent sur une perspective holistique générale de la santé dans le contexte d'une équipe interprofessionnelle basée sur la collaboration et de la communauté, en suivant une approche des soins éclairée par des éléments probants. Il semble y avoir de multiples façons d'intégrer avec succès les physiothérapeutes dans les équipes de soins de santé primaires, à condition que les rôles joués soient contextualisés et conformes au mandat relatif aux soins de santé primaires.