Continuity of care in hospital rehabilitation services: a qualitative insight from inpatients’ experience

doi:10.1016/j.bjpt.2017.03.002

Brazilian Journal of Physical Therapy

Volume 21, Issue 2, March–April 2017, Pages 85-91

https://doi.org/10.1016/j.bjpt.2017.03.002 Get rights and content

Highlights

•
Continuity of care is a multidimensional construct.
•
Three types of continuity are relevant for inpatients receiving rehabilitation.
•
Management continuity is the component with the most negative experiences.
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Most problems experienced by the participants are aspects that can be modified.

Abstract

Background

Few empirical studies have been conducted on the continuity of rehabilitation services, despite the fact that it may affect clinical outcomes, patient satisfaction, the perception of quality, and safety.

Objectives

The aim of this study was to explore experiences and perceptions of inpatients receiving physical rehabilitation in an acute care hospital and how these experiences may have led to perceived gaps in the continuity of rehabilitation care.

Method

Using qualitative research methods, fifteen semi-structured interviews were conducted with patients who received physical rehabilitation during hospital stay in an acute care hospital in Murcia, Spain. Interviews were transcribed verbatim, analyzed, and grouped into predetermined and emergent codes.

Results

Patients described three main themes in continuity of care: informational, management, and relational continuity. Several factors were described as influencing the perceived gaps in these three types of continuity. Informational continuity was influenced by the transfer of information among care providers. Relational continuity was influenced by patient–therapist relations and consistency on the part of the provider. Management continuity was influenced by consistency of care between providers and the involvement of patients in their own care.

Conclusion

The participants in this study identified several gaps in three types of continuity of care (informational, management, and relational). Inpatients often perceive their experiences of rehabilitation as being disconnected or incoherent over time.

Introduction

Physical rehabilitation plays an important role in the maintenance and restoration of function and the avoidance of complications in patients suffering from an injury or illness requiring acute hospitalization.¹ Due to the complexity and fragmented nature of modern hospitals, rehabilitation interventions in acute situations are usually provided individually by the separate disciplines (doctors, nurses, physical therapists, etc.) with no formal coordination or communication.1, 2 This absence of appropriate coordination and communication among different professionals can lead to gaps in patient care³ and affect clinical outcomes, patient satisfaction, the perception of quality, and safety.3, 4 In fact, international research exploring the quality of hospital care has demonstrated a fairly high rate of problems related with the coordination of care and preparation for discharge.⁵

These findings have led to growing interest among rehabilitation providers concerning the development of policies that foster the continuity of rehabilitation care.6, 7 This interest is consistent with international efforts to maintain and enhance continuity of care within the health system and avoid its fragmentation.6, 8 However, despite increased interest, few empirical studies have been conducted into the continuity of rehabilitation care, particularly in acute-care services. In addition, most of these studies have focused on only one aspect of continuity, such as the time a patient sees the same provider over time (longitudinal continuity)9, 10 and have ignored the patient's point of view. Nevertheless, obtaining the perspective of patients is an important and valuable way of evaluating healthcare services.¹¹

For patients, the experience of continuity is the perception that providers know what has happened before, that different providers agree on a management plan, and that a provider who knows them will care for them in the future.¹² Therefore, the continuity concept involves many aspects of care beyond simply measuring the time that the patient is in contact with a single therapist.

The investigation of continuity from the patients’ perspective poses an opportunity to improve the quality and increase the number of studies on continuity of care. According to the model proposed by Reid et al.¹³ in a systematic review and a subsequent workshop, this experience is dependent on patients’ experiences in three types of continuity: informational, management, and relational continuity. Informational continuity refers to the use of information from previous events to provide the patient with adequate care. Management continuity is viewed as the provision of complementary services with shared management. Relational continuity is described as the ongoing relationship between a patient and one or more health providers.¹³

This qualitative study aimed to contribute to the knowledge base in rehabilitation about continuity from the patients’ perspective. Therefore, two central questions were explored: (i) ‘How do inpatients experience continuity of care in acute-care rehabilitation settings?’ and (ii) ‘Which aspects of care lead inpatients to perceive a break in continuity of rehabilitation care?’.

Section snippets

Study design

A qualitative design using semi-structured in-depth interviews was used to allow a more detailed perspective of patients’ experiences and gain an in-depth understanding of their experiences related to continuity of care.14, 15 The Research Ethics Board of the University of Murcia, as well as the Queen Sofia Hospital, in Murcia, Spain, approved this study (P1EMCA06/12).

Setting and participants

Participants were recruited from an acute care hospital in the Murcia Region of Spain. Rehabilitation services in this hospital

Results

Fifteen participants (8 female) with a mean age of 65.6 years (SD 9.5) and a mean length-of-stay of 10.4 days (SD 4.5) were involved in this study. The individual characteristics of the fifteen participants are outlined in Table 1.

All subjects reported that they had at least one experience that led them to perceive gaps in their continuity of care. These experiences were related to one of the three types of continuity of care (relational, informational, and management). Thus, all experiences

Discussion

We examined experiences and perceptions of inpatients receiving physical rehabilitation that may affect the continuity of their care. Our data suggest that three types of continuity of care are relevant for patients receiving rehabilitation in the hospital. These types are often parallel and assume a different degree of importance, depending on the situation¹³; however, the factors influencing these three types of continuity differ.

The transfer of information among providers was seen to impact

Conclusions

For patients, continuity of care may be the result of good interpersonal skills on the part of providers, information flow between providers, and/or their own involvement in the care process, and most of the problems mentioned can be modified by improving this continuity. Although our study provides a broad framework to study continuity of care in rehabilitation, the findings are specific to the participants of this study and therefore not generalizable to other settings. We also believe that

Conflicts of interest

The authors declare no conflicts of interest.

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Longitudinal continuity of care is associated with high patient satisfaction with physical therapy

Phys Ther

(2005)

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Citation Excerpt :
Currently the patient professional ratio can be highly disproportionate, which is evidenced mainly in public sectors and this fact may have satisfaction level impact.9 It would be necessary that professionals prioritize patients who need more attention and to consider patient's point of view which often results in a compromise on service quality provided.9,10 However, in hospital environment satisfaction level with physical therapy care remains poorly known.
Patient's satisfaction level is considered an indicator that interferes with interventions effectiveness. There is evidence from other health professionals that patients with higher satisfaction level recover faster. However, benefits toward physical therapy intervention is poorly known.
To measure the inpatient satisfaction level receiving physical therapy care and to evaluate which aspects of these treatments are flawed.
Patients admitted to hospital were evaluated using MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care (MRPS) that scores from 1 to 5 (higher values indicate higher satisfaction) for each item. Patients clinical and demographic characteristics and the Global Perceived Effect (GPE) were also collected. Exploratory factor analysis was conducted.
200 patients were evaluated (50.9 ± 18.81 years, 58% male). Most of MRPS items were above 4. The highest scoring item (4.75) was physical therapist's respect to the patient. The lowest scoring item (1.82) was in relation to physical therapy guidelines at hospital discharge. Mean MRPS total score and GPE were 46.09 ± 4.93 and 2.18 ± 1.18, respectively.
The majority of patients are satisfied and showed improvement after physical therapy treatment. There is the need for advances and intervention in relation to physical therapy guidelines at hospital discharge. MRPS instrument proved to be appropriate to measure inpatient's satisfaction level with physical therapy care.
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Original ResearchContinuity of care in hospital rehabilitation services: a qualitative insight from inpatients’ experience

Highlights

Abstract

Background

Objectives

Method

Results

Conclusion

Introduction

Section snippets

Study design

Setting and participants

Results

Discussion

Conclusions

Conflicts of interest

Arch Phys Med Rehabil

Arch Phys Med Rehabil

J Pediatr Nurs

Arch Phys Med Rehabil

Rationale and principles of early rehabilitation care after an acute injury or illness

Disabil Rehabil

Continuity of hospital care: beyond the question of personal contact

BMJ

Gaps in the continuity of care and progress on patient safety

BMJ

Patients’ experiences with hospital care in five countries

Health Aff (Millwood)

White book on physical and rehabilitation medicine in Europe

J Rehabil Med

National Listening Exercise: Report of the Findings

Longitudinal continuity of care is associated with high patient satisfaction with physical therapy

Phys Ther

Original Research
Continuity of care in hospital rehabilitation services: a qualitative insight from inpatients’ experience