Caring, Chronicity and Community

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Caring, Chronicity and Community

• an emergent model of community health services
  provision for people living with chronic illness
• Dr. Denis Ryan
• University of Limerick

2
Background

• Scoping exercise in 2006 to inform the
  requirements for a planned formal evaluation
• objective measurement of outcomes would be likely
  to be difficult to achieve as neither baseline
  data nor reliable or valid outcome measures had
  been employed in a structured manner to that time
  by the service
• In a pilot programme it may have proved somewhat
  difficult and even inappropriate to put such
  measures in place as the service was in a phase
  of establishing a client base.
• In retrospect, the client base has proven to be
  fairly eclectic and the service is now in a
  better position (on completion of the pilot
  phase) to know the types of measures that are
  likely to prove useful in informing future
  evaluative processes, than they would have been
  at the commencement of the project

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Evaluation

• the evaluation adopted a pluralistic stance
• the main reasons for using this approach were
  that
• it adopts a situational stance and
• is more in keeping with the philosophy and
  structure of the service than other approaches.

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Guiding Principles

• it values the contribution of all key
  stakeholders
• gives a real voice to all stakeholder
  perspectives.
• It is holistic, inclusive and democratic
• purposively avoided being narrowly focused on
  either activities, or outputs, although it
  certainly takes account of them

5
Methods/Design Issues

• Sources of Data
• Activity Data
• Service Users
• Service Providers
• Referral Agents
• Concerned persons
• Design
• Data Triangulation/Mixed Methods
• Method well recognised and increasingly relied
  upon in Evaluative research
• Ethical Issues
• Access approved by CEART
• Ethical approval provided for work with Service
  Users by HSE

6
Activity Data Main findings

• 385 people were referred for consultation to the
  service. Of those, a total of 366 people were
  provided with interventions
• 67 female to 33 male
• The ages ranged between 17 and 94 years, with the
  mean age being 49 years
• The clients were referred by a total of 45
  General Practitioners.
• While some 77 of referrals emanated from 6
  General Practitioners
• What does this Mean?

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Major Diagnostic Categories
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Sessions
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Qualitative data

• Focus Groups With service Providers
• Interdisciplinary Team (IDT), Governance Group
• Focus Groups with Service Consumers
• Concerned persons Service Users
• Individual Semi-structured Interviews
• Referral Agents

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Analysis

• Burnards Framework (1991)
• Data divided into Categories/Sub-categories

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Categories
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Some conclusions

• In reviewing the activity data, two questions
  were of paramount importance.
• Firstly, was the profile of service users
  consistent with the stated aim for which the
  service was established?
• Secondly were the range and scope of therapeutic
  interventions as well as the level of activity
  appropriate to meet the service users needs?

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Answers!

• The client base in CEART certainly is consistent
  with the nature of the service planned.
• Generally speaking, most of the clients are from
  the original catchment area for which it was
  established, although the service did accept
  clients from outside that area.
• The pattern of referrals expanded due to demand
  from outside the original catchment area and was
  also probably influenced by positive media
  attention.
• The majority of referrals, however, came
  principally from within Primary Care sources.

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Therapeutic Appropriateness

• When considered in terms of the Primary
  Diagnostic Category on initial presentation, 65
  of service users had a diagnosis of either a
  musculoskeletal or neurological disorder, and a
  further 20 having a diagnosis involving a
  psychological disorder as a primary diagnostic
  category.
• Within that context, the range and type of
  therapies offered seem appropriate to the needs
  of the service users.

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Experiences of Service Provision

• Phase one of the evaluation effectively
  established the fact that the service had met its
  stated aim of providing an holistic or integrated
  model of care.
• That, in many ways left a different key question
  to be addressed in Phase two.
• This phase was more concerned with what aspects
  of CEART and the services it offered were
  effective and how they met the needs of all key
  stakeholders.
• In this phase of the study, it also emerged that
  there was virtually universal satisfaction with
  the nature and scope of the services in CEART.

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What makes it work?

• Stakeholders reported a service that based its
  core value on respect and dignity
• There was a strong belief that the service was
  underpinned by principles of holism.
• However the concept of holism seemed to be used
  interchangeably with that of integrated care
• Value was something that was both sensed and
  experienced across all stakeholder groups.
• Ethos of the service
• A service embedded within the local community

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An Emergent Model
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Finally

• Thank you for attention.
• Contact Details

Dr. Denis Ryan, Senior Lecturer, Department of
Nursing Midwifery, Faculty of Education and
Health Sciences, University of Limerick E-mail
denis.ryan_at_ul.ie
Ms. Julianne Maher, Project Manager, Ceart Health
Partnership, Callan, Co. Kilkenny E-mail ceart
_at_ceart.ie