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The work of front line community aged care staff and the impact of a changing policy landscape and consumer-directed care
- Authors:
- PRGOMET Mirela, et al
- Journal article citation:
- British Journal of Social Work, 47(1), 2017, pp.106-124.
- Publisher:
- Oxford University Press
Community aged care in Australia is facing both challenges and opportunities with the introduction of consumer-directed care and its goal to provide clients with greater choice and control over their care services. Such policy changes impact not only aged care organisations, but front line staff who manage and deliver care. This study investigated the work of front line staff and their perceptions of the impact of a changing policy landscape. Focus groups were conducted with thirteen care workers and six case managers from one Australian aged care organisation. The data revealed valuable information about the: daily activities of front line staff; information exchange mechanisms facilitating front line work; management of clients and client relationships; and implications of policy and organisational changes on front line work and clients. Front line staff highlighted the importance of care coordination, communication and continuity of care delivery, all of which impact on client relationships and quality of care. For aged care organisations and policy makers, the findings identify important areas for consideration when making decisions about changes to community care, including the key role of front line staff in fostering client relationships, providing consistency and continuity, balancing the needs and expectations of clients, and providing support and advocacy of care options. (Publisher abstract)
Individualising chronic care management by analysing patients’ needs - a mixed method approach
- Authors:
- TIMPEL P., et al
- Journal article citation:
- International Journal of Integrated Care, 17(6), 2017, Online only
- Publisher:
- International Foundation for Integrated Care
Background: Modern health systems are increasingly faced with the challenge to provide effective, affordable and accessible health care for people with chronic conditions. As evidence on the specific unmet needs and their impact on health outcomes is limited, practical research is needed to tailor chronic care to individual needs of patients with diabetes. Qualitative approaches to describe professional and informal caregiving will support understanding the complexity of chronic care. Results are intended to provide practical recommendations to be used for systematic implementation of sustainable chronic care models. Method: A mixed method study was conducted. A standardised survey (n = 92) of experts in chronic care using mail responses to open-ended questions was conducted to analyse existing chronic care programs focusing on effective, problematic and missing components. An expert workshop (n = 22) of professionals and scientists of a European funded research project 'Manage Care' was used to define a limited number of unmet needs and priorities of elderly patients with type 2 diabetes mellitus and comorbidities. This list was validated and ranked using a multilingual online survey (n = 650). Participants of the online survey included patients, health care professionals and other stakeholders from 56 countries. Results: The survey indicated that current care models need to be improved in terms of financial support, case management and the consideration of social care. The expert workshop identified 150 patient needs which were summarised in 13 needs dimensions. The online survey of these pre-defined dimensions revealed that financial issues, education of both patients and professionals, availability of services as well as health promotion are the most important unmet needs for both patients and professionals. Conclusion: The study uncovered competing demands which are not limited to medical conditions. The findings emphasise that future care models need to focus stronger on individual patient needs and promote their active involvement in co-design and implementation. Future research is needed to develop new chronic care models providing evidence-based and practical implications for the regional care setting. (Edited publisher abstract)