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"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.

Authors :
Close, Helen
Hancock, Helen
Mason, James M.
Murphy, Jerry J.
Fuat, Ahmet
de Belder, Mark
Hungin, A. Pali S.
Source :
BMC Geriatrics; 2013, Vol. 13 Issue 1, p1-8, 8p, 1 Chart
Publication Year :
2013

Abstract

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. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
14712318
Volume :
13
Issue :
1
Database :
Complementary Index
Journal :
BMC Geriatrics
Publication Type :
Academic Journal
Accession number :
89638553
Full Text :
https://doi.org/10.1186/1471-2318-13-69