Work in progress. Integrating physicians' services in the home.
OBJECTIVE
While increasing acuity levels and the concomitant complexity of service demand that physicians be involved in in-home care, conflicting evidence and opinions do not show how this can best be achieved.


METHODS
A phenomenologic research design was used to obtain insights into the challenges and opportunities of integrating physicians' services into the usual in-home services in London, Ont.


METHODS
Home care in London, Ont.


METHODS
Twelve participants included three patients, two family caregivers, two family physicians, the program's nurse practitioner, two case managers, and two community nurses.


METHODS
In-depth interviews with a maximally varied purposeful sample of patients, caregivers, and providers were analyzed using immersion and crystallization techniques.


RESULTS
Findings revealed the potential for enhanced continuity of care and interdisciplinary team functioning. Having a nurse practitioner, interdisciplinary team-building exercises and meetings, regular face-to-face contact among all providers, support for family caregivers, and 24-hour coverage for physicians were found to be essential for success.


CONCLUSIONS
Integration of services takes time, money, and sustained commitment, particularly when undertaken in geographically isolated communities. Informed choice and a fair remuneration system remain important considerations for family physicians.
McWilliam
C L
CL
School of Nursing, Faculty of Health Sciences, University of Western Ontario, London. cmcwill@uwo.ca
Stewart
M
M
Sangster
J
J
Cohen
I
I
Mitchell
J
J
Sutherland
C
C
Ryan
B
B
D000328:Adult; D000368:Aged; D017028:Caregivers; D019090:Case Management; D003266:Continuity of Patient Care; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005194:Family Practice; D005260:Female; D019538:Health Care Surveys; D006699:Home Care Services; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D009864:Ontario; D010348:Patient Care Team; D010819:Physician's Role; D000078329:Workforce