“It’s Somebody else’s responsibility” - perceptions of general practitioners, heart failure nurses, care home staff, and residents towards heart failure diagnosis and management for older people in long-term care: a qualitative interview study

BMC Geriatrics

A Pali S Hungin²  Mark de Belder³  Ahmet Fuat¹  Jerry J Murphy¹  James M Mason²  Helen Hancock²  Helen Close² 

[1] Department of Cardiology, Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust, Hollyhurst Road, Darlington DL3 6HX, UK;Durham Clinical Trials Unit, School of Medicine, Pharmacy and Health, Durham University, Queen’s Campus, Wolfson Research Institute, University Boulevard, Stockton-on-Tees TS17 6BH, UK;Department of Cardiology, The James Cook University Hospital, South Tees Acute Hospitals NHS Foundation Trust, Marton Road, Middlesbrough TS4 3BW, UK

关键词: Older people;    Long-term care;    Quality of care and outcomes;    Heart failure;   

Others  :  857563
DOI  :  10.1186/1471-2318-13-69

 received in 2012-09-18, accepted in 2013-06-27,  发布年份 2013

【 摘 要 】

Background

Older people in care-facilities may be less likely to access gold standard diagnosis and treatment for heart failure (HF) than non residents; little is understood about the factors that influence this variability. This study aimed to examine the experiences and expectations of clinicians, care-facility staff and residents in interpreting suspected symptoms of HF and deciding whether and how to intervene.

Methods

This was a nested qualitative study using in-depth interviews with older residents with a diagnosis of heart failure (n=17), care-facility staff (n=8), HF nurses (n=3) and general practitioners (n=5).

Results

Participants identified a lack of clear lines of responsibility in providing HF care in care-facilities. Many clinical staff expressed negative assumptions about the acceptability and utility of interventions, and inappropriately moderated residents’ access to HF diagnosis and treatment. Care-facility staff and residents welcomed intervention but experienced a lack of opportunity for dialogue about the balance of risks and benefits. Most residents wanted to be involved in healthcare decisions but physical, social and organisational barriers precluded this. An onsite HF service offered a potential solution and proved to be acceptable to residents and care-facility staff.

Conclusions

HF diagnosis and management is of variable quality in long-term care. Conflicting expectations and a lack of co-ordinated responsibility for care, contribute to a culture of benign neglect that excludes the wishes and needs of residents. A greater focus on rights, responsibilities and co-ordination may improve healthcare quality for older people in care.

Trial registration

ISRCTN: ISRCTN19781227

【 授权许可】

   
2013 Close et al.; licensee BioMed Central Ltd.

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