Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Spanning Boundaries and Creating Strong Patient Relationships to Coordinate Care Are Strategies Used by Experienced Chronic Condition Care Coordinators

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Spanning Boundaries and Creating Strong Patient Relationships to Coordinate Care Are Strategies Used by Experienced Chronic Condition Care Coordinators

Article excerpt

In developed countries, individuals with chronic conditions are required to navigate their own way through and around the complex health care system. This is often unfamiliar and difficult territory for them, not least because it requires a certain level of health and social literacy (Shim, 2010). It is clearly desirable for health care providers to be actively involved in assisting individuals to navigate this health care system. Coordinated care is one solution to the fragmentation that complicates the patient experience. Within the community context, general practice is considered the best site from which to coordinate patient care and assist individuals to navigate the health care system.

Coordinated care can be defined as, '... a core function of team-based primary and community care that delivers systematic, responsive and supportive care to people with complex chronic disease care needs and includes: (1) coordination and management of health care services for an individual client to create a comprehensive and continuous experience; (2) coordination of providers to encourage team work and shared knowledge; and (3) coordination of service delivery organisations to create an integrated network' (Ehrlich, Kendall, Muenchberger, & Armstrong, 2009, p. 622). Other researchers have concluded that coordinated care, '... is a defining principle of primary care ... [but] it requires far more effort than physicians alone can deliver' (Stille, Jerant, Bell, Meltzer, & Elmore, 2005, p. 700). Thus, although research distinguishes coordinated care as a philosophy of care from a deliberate care strategy requiring the shared efforts of health care professionals, the distinction is less clear in real world practice.

In countries such as the United Kingdom, community based registered nurses (RNs; called 'community matrons') have been employed to assist people navigate the health care environment (Woodend, 2006). Although this practice has not been applied in Australia, community-based RNs have been used to coordinate care for people with complex chronic conditions in general practice settings. In the Australian National Coordinated Care Trials in 1997-1999 and 2002-2005 (Department of Health and Ageing [DOHA], 2007) each trial site targeted and recruited different participant groups, and applied a range of models of care coordination. Although the trials resulted in positive outcomes, it was not possible to compare outcomes between trial sites (DOHA, 2007). Thus, the trials did not equip general practice with a clear direction regarding the best way to implement care coordination. Rather, general practice is faced with a number of complex programs which aim to improve the quality of chronic condition care, but which lack integration and create significant administrative burden (Harris & Zwar, 2007).

Research has shown that RNs who work in general practice settings are well-situated to coordinate the care of patients with complex care needs (Patterson, Muenchberger, & Kendall, 2007). However, similar to the findings of the coordinated care trials, there is a reported lack of clarity about care coordination as a distinct implementation strategy, and how this may differ from, or align with, usual quality health care for people with chronic conditions in general practice. RNs in general practice settings can move beyond treatment room work to take responsibility for broader health promotion and illness prevention (Price, 2007). Importantly, nurses are often available to patients in a way that doctors are not, making health care more accessible (Phillips et al., 2007). For a model of RN-provided care coordination to be successful, however, it needs to be integrated into the routine care provided in general practice. Embedding new models of care within established care settings is challenging (Elwyn, Legare, van der Weijden, Edwards, & May, 2008; Finch, 2008) because new models need to fit with the existing system of care (May & Finch, 2009). …

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