Community-based primary health care for older adults: a qualitative study of the perceptions of clients, caregivers and health care providers.
BACKGROUND
Older persons are often poorly served by existing models of community-based primary health care (CBPHC). We sought input from clients, informal caregivers, and health care providers on recommendations for system improvements.


METHODS
Focus group interviews were held with clients, informal caregivers, and health care providers in mid-sized urban and rural communities in Ontario. Data were analyzed using a combination of directed and emergent coding. Results were shared with participants during a series of feedback sessions.


RESULTS
An extensive list of barriers, facilitators, and recommended health system improvements was generated. Barriers included poor system integration and limited access to services. Identified facilitators were person and family-focused care, self-management resources, and successful collaborative practice. Recommended system improvements included expanding and integrating care teams, supports for system navigation, and development of standardized information systems and care pathways.


CONCLUSIONS
Older adults still experience frustrating obstacles when trying to access CBPHC. Identified barriers and facilitators of improved system integration aligned well with current literature and Wagner's Chronic Care Model. Additional work is needed to implement the recommended improvements and to discern their impact on patient and system outcomes.
School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. celafort@uwaterloo.ca.
Claire
C
Lafortune
School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. khuson@uwaterloo.ca.
Kelsey
K
Huson
Institutional Research, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. selena.santi@uwaterloo.ca.
Selena
S
Santi
School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. stolee@uwaterloo.ca.
Paul
P
Stolee
D000368:Aged; D001291:Attitude of Health Personnel; D017028:Caregivers; D003153:Community Health Services; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D009864:Ontario; D017060:Patient Satisfaction; D011320:Primary Health Care; D036301:Qualitative Research; D012648:Self Care