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Implementing a care pathway for elderly patients, a comparative qualitative process evaluation in primary care

Røsstad, Tove; Garåsen, Helge; Steinsbekk, Aslak; Håland, Erna; Kristoffersen, Line; Grimsmo, Anders
Journal article, Peer reviewed
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s12913-015-0751-1.pdf (559.6Kb)
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http://hdl.handle.net/11250/2364864
Utgivelsesdato
2015
Metadata
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  • Institutt for pedagogikk og livslang læring [1879]
  • Institutt for samfunnsmedisin og sykepleie [1769]
  • Publikasjoner fra CRIStin - NTNU [21000]
Originalversjon
BMC Health Services Research 2015, 15(86)   doi:10.1186/s12913-015-0751-1
Sammendrag
Background: In Central Norway a generic care pathway was developed in collaboration between general hospitals

and primary care with the intention of implementing it into everyday practice. The care pathway targeted elderly

patients who were in need of home care services after discharge from hospital. The aim of the present study was

to investigate the implementation process of the care pathway by comparing the experiences of health care

professionals and managers in home care services between the participating municipalities.

Methods: This was a qualitative comparative process evaluation using data from individual and focus group interviews.

The Normalization Process Theory, which provides a framework for understanding how a new intervention becomes

part of normal practice, was applied in our analysis.

Results: In all of the municipalities there were expectations that the generic care pathway would improve care

coordination and quality of follow-up, but a substantial amount of work was needed to make the regular home care staff

understand how to use the care pathway. Other factors of importance for successful implementation were involvement

of the executive municipal management, strong managerial focus on creating engagement and commitment among all

professional groups, practical facilitation of work processes, and a stable organisation without major competing priorities.

At the end of the project period, the pathway was integrated in daily practice in two of the six municipalities. In these

municipalities the care pathway was found to have the potential of structuring the provision of home care services and

collaboration with the GPs, and serving as a management tool to effect change and improve knowledge and skills.

Conclusion: The generic care pathway for elderly patients has a potential of improving follow-up in primary care by

meeting professional and managerial needs for improved quality of care, as well as more efficient organisation of home

care services. However, implementation of this complex intervention in full-time running organisations was demanding

and required comprehensive and prolonged efforts in all levels of the organisation. Studies on implementation of such

complex interventions should therefore have a long follow-up time to identify whether the intervention becomes

integrated into everyday practice.
Utgiver
BioMed Central
Tidsskrift
BMC Health Services Research

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