![]() ![]() By definition, integrated care aims to incorporate service delivery designed to create connectivity, alignment, and collaboration within the care sectors, but it has been challenged by changes in healthcare provision, e.g., strong specialization (so-called silo structures) in hospital care, new requirements from guidelines, and an aging population with complex needs in a healthcare system with limited resources. The patients with multimorbidity report a lack of holistic patient-centered care and high levels of treatment burden, i.e., the work required by patients to manage their conditions. However, the extensive care required for treating patients with multiple long-term conditions is regarded as challenging, fragmented, and uncoordinated, and the GPs report to have little time and limited capacity. The coordinating role of the general practitioner (GP) is a cornerstone in the universal healthcare system in Denmark. Furthermore, poor continuity of care has also been linked to more hospital admissions, inappropriate medication use, and increased mortality. Care fragmentation produces adverse consequences, including economic inefficiency, inequality in health, and depersonalization of the patient. This may lead to inadequate transfer of information, unclear treatment responsibilities, and ultimately fragmented healthcare. For these patients, the coordination of care is often complicated by the high number of clinicians involved in their treatment, including multiple appointments, involvement of both primary care and specialists in secondary care, repeated referrals, and parallel outpatient trajectories with duplicate services in a highly specialized healthcare system. Despite increased healthcare delivery, they report impaired daily functioning, poor quality of life, and adverse health outcomes. Patients with multiple long-term conditions, i.e., multimorbidity, are frequent users of services in all healthcare sectors. Frequent contact to the usual provider, fewer transitions, and better coordination were associated with better patient outcomes regardless of morbidity level. Care fragmentation was associated with higher rates of potentially inappropriate medication and increased mortality even when adjusting for the most important confounders. Several clinical indicators of care fragmentation were associated with morbidity level. For the associations between fragmentation measures and patient outcomes, there were no clear interactions with number of conditions. Having less than 25% of contacts with your usual provider was associated with an incidence rate ratio of potentially inappropriate medication of 1.49 (95% CI 1.40–1.58) and a mortality hazard ratio of 2.59 (95% CI 2.36–2.84) compared with full continuity. The strongest associations with potentially inappropriate medication and mortality were found for ≥ 20 contacts versus none (incidence rate ratio 2.83, 95% CI 2.77–2.90) and ≥ 20 hospital trajectories versus none (hazard ratio 10.8, 95% CI 9.48–12.4), respectively. High levels of care fragmentation were associated with higher rates of potentially inappropriate medication and increased mortality on all fragmentation measures after adjusting for demographic characteristics, socioeconomic factors, and morbidity. The proportion of contacts to the patient’s own general practice remained stable across morbidity levels. Patients with 3 versus 6 conditions had a mean of 4.0 versus 6.9 involved providers and 6.6 versus 13.7 provider transitions. The number of involved healthcare providers, provider transitions, and hospital trajectories rose with increasing morbidity levels. The patient outcomes were potentially inappropriate medication and all-cause mortality adjusted for demographics, socioeconomic factors, and morbidity level. Formal fragmentation indices assessed care concentration, dispersion, and contact sequence. Clinical fragmentation indicators included number of healthcare contacts, involved providers, provider transitions, and hospital trajectories. ![]() All healthcare contacts to primary care and hospitals during 2018 were recorded. ![]() We conducted a register-based nationwide cohort study with 4.7 million Danish adult citizens. We aimed to quantify care fragmentation using various measures and to analyze the associations with patient outcomes. Yet, this has never been examined across healthcare sectors on a national scale. Patients with multimorbidity are frequent users of healthcare, but fragmented care may lead to suboptimal treatment. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |