Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/33612
Title: Fragmentation of care between intensive and primary care settings and opportunities for improvement.
Austin Authors: Leggett, Nina;Emery, Kate;Rollinson, Thomas C ;Deane, Adam;French, Craig;Manski Nankervis, Jo-Anne;Eastwood, Glenn M ;Miles, Briannah;Merolli, Mark;Ali Abdelhamid, Yasmine;Haines, Kimberley Joy
Affiliation: Department of Critical Care, The University of Melbourne, Parkville, Victoria, Australia.
Department of Physiotherapy, Western Health, Footscray, Victoria, Australia.
Physiotherapy
Department of Critical Care, The University of Melbourne, Parkville, Victoria, Australia.
Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.
Department of General Practice, The University of Melbourne, Parkville, Victoria, Australia.
Intensive Care
Department of Intensive Care, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Centre for Digital Transformation of Health, The University of Melbourne, Parkville, Victoria, Australia.
Issue Date: Dec-2023
Date: 2023
Publication information: Thorax 2023; 78(12)
Abstract: To explore the gaps in care provided across the transitions from the intensive care unit (ICU) to primary care, in order to improve post-ICU care. Semistructured interviews with three participant groups: intensivists, general practitioners (GPs) and patients and carers with framework analysis of textual data were used to investigate experiences of transitions of care post-ICU. Participants were purposively sampled for diversity. Eligible patients were adults, mechanically ventilated for >24 hours, with access to a video-enabled device. Exclusion criteria were non-English speaking and any cognitive/neurological limitation precluding interview participation. A total of 46 interviews (15 patients, 8 caregivers, 15 intensivists and 8 GPs) were completed. Eight themes were identified, and categorised into three healthcare tiers. Tier 1, health system factors: (1) fragmentation of care; (2) communication gaps; (3) limited awareness and recognition of issues beyond the ICU; (4) lack of a specialised ICU follow-up pathway; Tier 2, clinician factors: (5) relationships among ICU, hospitals, GPs and patients and carers; (6) need for clinician role definition and clarity in ICU follow-up; Tier 3, patient and carer factors: (7) patient autonomy and self-actualisation and (8) the evolving caregiver role. A conceptual model was developed, highlighting bidirectional feedback loops between hospital and primary care. This study identified gaps in care between ICU discharge and reintegration with primary care from the lived experience of patients, caregivers, intensivists and GPs. These data provide foci for future interventional research to improve the integration of care for this vulnerable and underserved cohort.
URI: https://ahro.austin.org.au/austinjspui/handle/1/33612
DOI: 10.1136/thorax-2023-220387
ORCID: 0000-0002-1886-5526
0000-0002-2882-1594
Journal: Thorax
PubMed URL: 37620046
ISSN: 1468-3296
Type: Journal Article
Subjects: Critical Care
Appears in Collections:Journal articles

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