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.
School of Nursing, Faculty of Health Sciences, Room SH2345, Somerville House, The University of Western Ontario, London, Ontario, Canada, N6A 3K7. cmcwill@uwo.ca
C L
CL
McWilliam
Barbara
B
Godfrey
Moira
M
Stewart
John
J
Sangster
Joan
J
Mitchell
Irene
I
Cohen
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