Clinical Interventions in Aging (Nov 2023)
Facilitators and Barriers of Integrated Care for Older Adults with Multimorbidity: A Descriptive Qualitative Study
Abstract
Jingjie Wu,1 Erxu Xue,1 Siyuan Huang,2 Yujia Fu,3 Dandan Chen,1 Jing Shao,3 Hui Zhang,4 Leiwen Tang,1 Zhihong Ye1 1Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 2Nursing Department, the First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, People’s Republic of China; 3School of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 4Nursing Department, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, People’s Republic of ChinaCorrespondence: Zhihong Ye, Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3rd of East Qingchun Road, Hangzhou, Zhejiang Province, People’s Republic of China, Tel +8613606612119, Email [email protected]: A lack of coordinated care leads to multiple adverse effects for older adults with multimorbidity, including high treatment burdens, adverse health outcomes, reduplicated healthcare service utilization, and catastrophic healthcare expenditure. To foster healthy aging, person-centered integrated care that is responsive to older adults has been proposed by the World Health Organization. The objective of this study was to identify factors that impact the successful implementation of integrated care for older adults with multimorbidity in China.Patients and Methods: From July 2022 to May 2023, 33 healthcare providers and managers involved in the delivery and management of healthcare services for older adults with multimorbidity were recruited from Zhejiang Province, China using purposeful and maximum variation sampling methods. Semi-structured, face-to-face in-depth interviews were conducted by the same interviewer in the participants’ native Chinese language until data saturation was reached. Inductive thematic analysis was used to analyze the data, and then, themes were mapped onto six dimensions using the Rainbow Model of Integrated Care to allow for a comprehensive view of the study’s findings.Results: Eleven themes were generated as facilitators and barriers to integrated care for older adults with multimorbidity in China. These themes include (1) clinical integration: patient-centered care, (2) professional integration: interdisciplinary teams and training, (3) organizational integration: resources and accessibility, (4) system integration: community and funds, incentives, and health insurance, (5) functional integration: electronic health record systems, workforce, and guidelines, and (6) normative integration: shared mission.Conclusion: Guided by the Rainbow Model of Integrated Care, various factors at both micro, meso, and macro levels that impact the implementation of integrated care for older adults with multimorbidity in the Chinese context have been identified in this study. The strategies for future interventions and policies should focus on promoting facilitators and addressing barriers.Keywords: delivery of health care, integrated, aged, older adult, multiple chronic conditions, facilitator, barrier
