Capturing the experiences of patients across multiple complex interventions: a meta-qualitative approach.
OBJECTIVE
The perspectives, needs and preferences of individuals with complex health and social needs can be overlooked in the design of healthcare interventions. This study was designed to provide new insights on patient perspectives drawing from the qualitative evaluation of 5 complex healthcare interventions.


METHODS
Patients and their caregivers were recruited from 5 interventions based in primary, hospital and community care in Ontario, Canada.


METHODS
We included 62 interviews from 44 patients and 18 non-clinical caregivers.


METHODS
Our team analysed the transcripts from 5 distinct projects. This approach to qualitative meta-evaluation identifies common issues described by a diverse group of patients, therefore providing potential insights into systems issues.


METHODS
This study is a secondary analysis of qualitative data; therefore, no outcome measures were identified.


RESULTS
We identified 5 broad themes that capture the patients' experience and highlight issues that might not be adequately addressed in complex interventions. In our study, we found that: (1) the emergency department is the unavoidable point of care; (2) patients and caregivers are part of complex and variable family systems; (3) non-medical issues mediate patients' experiences of health and healthcare delivery; (4) the unanticipated consequences of complex healthcare interventions are often the most valuable; and (5) patient experiences are shaped by the healthcare discourses on medically complex patients.


CONCLUSIONS
Our findings suggest that key assumptions about patients that inform intervention design need to be made explicit in order to build capacity to better understand and support patients with multiple chronic diseases. Across many health systems internationally, multiple models are being implemented simultaneously that may have shared features and target similar patients, and a qualitative meta-evaluation approach, thus offers an opportunity for cumulative learning at a system level in addition to informing intervention design and modification.
Department of Family and Community Medicine and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Fiona
F
Webster
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Jennifer
J
Christian
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Elizabeth
E
Mansfield
Department of Family and Community Medicine and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
Onil
O
Bhattacharyya
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Gillian
G
Hawker
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Wendy
W
Levinson
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Gary
G
Naglie
Department of Family and Community Medicine and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada South East Toronto Family Health Team, Toronto East General Hospital, Toronto, Ontario, Canada.
Thuy-Nga
TN
Pham
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, Toronto East General Hospital, Toronto, Ontario, Canada.
Louise
L
Rose
Department of Medicine, University of Toronto, Toronto, Ontario, Canada Health System Planning & Evaluation Research Program, Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Michael
M
Schull
Health System Planning & Evaluation Research Program, Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Samir
S
Sinha
Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Vicky
V
Stergiopoulos
Department of Family and Community Medicine and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada Bridgepoint Health, Bridgepoint Collaboratory for Research and Innovation, Toronto, Ontario, Canada.
Ross
R
Upshur
Department of Family and Community Medicine and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Lynn
L
Wilson
D001294:Attitude to Health; D017028:Caregivers; D002908:Chronic Disease / Q000523:psychology / Q000628:therapy*; D019033:Delivery of Health Care, Integrated; D006801:Humans; D007407:Interviews as Topic; D009864:Ontario; D011369:Professional-Patient Relations; D011446:Prospective Studies; D036301:Qualitative Research
MENTAL HEALTH; PRIMARY CARE; QUALITATIVE RESEARCH