“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

Research Article

Jerry J Murphy¹  Ahmet Fuat¹  Mark de Belder²  A Pali S Hungin³  James M Mason³  Helen Close³  Helen Hancock³ 

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

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

DOI  :  10.1186/1471-2318-13-69

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

来源: Springer

【 摘 要 】

BackgroundOlder 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.MethodsThis 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).ResultsParticipants 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.ConclusionsHF 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 registrationISRCTN: ISRCTN19781227

【 授权许可】

CC BY   
© Close et al.; licensee BioMed Central Ltd. 2013