How to take into account people’s values, preferences and views on healthcare services when designing the strategy on chronic and integrated care of Catalonia

Abstract

Introduction: Catalonia’s Department of Health is defining a new Strategy of integrated care for people with chronic conditions. The principles of person-centered care that inform the strategy highlight the relevance of empowering people. Accordingly, the participative project launched by Department of Health is aimed at capturing people’s needs, preferences and valuese. 9 discussion groups, roughly 100 people with chronic conditions, caregivers and healthy people took place in seven cities around the country. The identified topics on the desirable characteristics of care will be included in the definition of the Strategy. Objective: To reflect the views of people on healthcare services, their preferences, values and needs for integrated services in order to include them in the construction and codesign of an updated Chronic and Integrated Care model Methodology: Exploratory qualitative study with focus groups. Group interviews were audio recorded and digitally transcribed, and thematic content analysis followed. Emergent themes and subthemes were confirmed on an iterative process. To capture the diversity around the topic of interest, selection procedure of participants was based on chronic disease experience, with 4 distinctive profiles: 1. People with chronic conditions and complex needs; 2. People caring for people with chronic diseases or included in home care programmes; 3. People with non-complex chronic diseases; 4. Healthy people. Selection of individuals using snowball sampling method, with sociodemographic, socioeconomic and territorial quota. Healthcare professionals, managers and the Patients' Consultative Council of Catalonia nominate the participants. 96 people took part in the study and 89,6% answered a survey. No sex difference. 50% were retired and 47% had higher education. 21% lived in Barcelona. Conclusions: Focus groups allow in-depth analysis of specific topics, as it includes preferences, values and past experiences. Regarding healthcare of people with chronic conditions, some of the most valued issues identified are: Professionals with communicative and relational skills, who know how to manage the emotional dimension of chronic disease and the whole process of care. Reponse should be rapid, with different levels of expertise and speed. It is particularly valued direct, fast and trustworthy access to professionals. Accompaniment in transitions between services appear in integrated care environments. A much more bio-psycho-social oriented care is required, including healthcare and emotional management and taking into account social and family environment of people. Regarding health promotion, professionals should know much better their community asset maps and should be able to prescribe community resources. It is required to promote, from the health system and at community level, actions to break isolation and empower people when dealing with illness and caregiving tasks. End of life care and palliative specific resources are highly valued (listening, accompaniment, relational skills, integrated approach).(1) To include people’s views is a useful and valuable resource when defining strategies on chronic conditions help but also to assess their implementation. References: 1- Gómez-Batiste X, Blay C, Martínez-Muñoz M. The Catalonia WHO Demonstration Project of Palliative Care: Results at 25 Years (1990-2015). J Pain Symptom Manage. 2016 Jul;52(1):92-9.

Keywords

• strategy
• discusion groups
• catalonia
• participation