Evolving the delivery of acute care services in the home.
To serve escalating acute care caseloads, physicians affiliated with one Canadian home care program have piloted a project to integrate physician services into the home (IPSITH). This paper presents the 18-month qualitative evaluation. Phenomenological methodology and in-depth interviewing were used to construct a holistic interpretation of the implementation from the experiences of all involved: patients, family caregivers, physicians, case managers, community nurses and the project's nurse practitioner. Findings revealed the central role of the nurse practitioner, who served as a clinical expert, care coordinator and case manager. Several unsolved issues were identified: the extent to which home care is a viable alternative to hospitalization, the feasibility of physician involvement, redundancies with hospital emergency services, and the limitations of system resources for funding such services. The researchers conclude that full-scale long-term integration of physician services in the home may require macro-level decisions about system design, resource allocation, and professional regulations.
McWilliam
C L
CL
School of Nursing, Faculty of Health Sciences, Room SH2345, Somerville House, The University of Western Ontario, London, Ontario, Canada, N6A 3K7. cmcwill@uwo.ca
Godfrey
Barbara
B
Stewart
Moira
M
Sangster
John
J
Mitchell
Joan
J
Cohen
Irene
I
D000208:Acute Disease / Q000451:nursing / Q000628:therapy*; D000368:Aged; D002170:Canada; D019033:Delivery of Health Care, Integrated; D005240:Feasibility Studies; D005260:Female; D006302:Health Services Research; D006699:Home Care Services / Q000458:organization & administration*; D006792:House Calls; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D024802:Nurse's Role; D010817:Physician-Patient Relations; D010865:Pilot Projects