RT Journal Article
SR Electronic
T1 Capturing the experiences of patients across multiple complex interventions: a meta-qualitative approach
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e007664
DO 10.1136/bmjopen-2015-007664
VO 5
IS 9
A1 Fiona Webster
A1 Jennifer Christian
A1 Elizabeth Mansfield
A1 Onil Bhattacharyya
A1 Gillian Hawker
A1 Wendy Levinson
A1 Gary Naglie
A1 Thuy-Nga Pham
A1 Louise Rose
A1 Michael Schull
A1 Samir Sinha
A1 Vicky Stergiopoulos
A1 Ross Upshur
A1 Lynn Wilson
YR 2015
UL http://bmjopen.bmj.com/content/5/9/e007664.abstract
AB Objectives The perspectives, needs and preferences of individuals with complex health and social needs can be overlooked in the design of healthcare interventions. This study was designed to provide new insights on patient perspectives drawing from the qualitative evaluation of 5 complex healthcare interventions.Setting Patients and their caregivers were recruited from 5 interventions based in primary, hospital and community care in Ontario, Canada.Participants We included 62 interviews from 44 patients and 18 non-clinical caregivers.Intervention Our team analysed the transcripts from 5 distinct projects. This approach to qualitative meta-evaluation identifies common issues described by a diverse group of patients, therefore providing potential insights into systems issues.Outcome measures This study is a secondary analysis of qualitative data; therefore, no outcome measures were identified.Results We identified 5 broad themes that capture the patients’ experience and highlight issues that might not be adequately addressed in complex interventions. In our study, we found that: (1) the emergency department is the unavoidable point of care; (2) patients and caregivers are part of complex and variable family systems; (3) non-medical issues mediate patients’ experiences of health and healthcare delivery; (4) the unanticipated consequences of complex healthcare interventions are often the most valuable; and (5) patient experiences are shaped by the healthcare discourses on medically complex patients.Conclusions Our findings suggest that key assumptions about patients that inform intervention design need to be made explicit in order to build capacity to better understand and support patients with multiple chronic diseases. Across many health systems internationally, multiple models are being implemented simultaneously that may have shared features and target similar patients, and a qualitative meta-evaluation approach, thus offers an opportunity for cumulative learning at a system level in addition to informing intervention design and modification.