Search results

1 – 2 of 2
Per page
102050
Citations:
Loading...
Access Restricted. View access options
Article
Publication date: 5 March 2020

Philippa Miskelly, Ngaire Kerse and Janine Wiles

Managing patients in advanced age is complex, especially when it comes to multi-morbidities and polypharmacy. The purpose of this qualitative study is to investigate challenges…

183

Abstract

Purpose

Managing patients in advanced age is complex, especially when it comes to multi-morbidities and polypharmacy. The purpose of this qualitative study is to investigate challenges, opportunities and potential solutions from a primary healthcare provider perspective.

Design/methodology/approach

Fifty-seven participants joined in group discussions on challenges and opportunities of working with advanced age. Participants included general practitioners (GPs), practice nurses, students and administration staff working in ten general practices. A thematic analysis was developed, supported by NVivo software.

Findings

Poor lines of communication and fragmentation of services between differing levels of health care services available for older people were highlighted. This has implications for quality of care and equity of services. Participants also reported challenges in treatment and funding regimes.

Research limitations/implications

The small sample size and regional nature of the study, along with the semi-structured nature of the group discussions and rigorous thematic analysis, indicate that this qualitative data is transferable, dependable, confirmable and credible. Comparing the views of tertiary and community services would be useful.

Practical implications

A range of potential strategies and solutions to the current fragmented services was offered by GPs. For example, adequately funded and staffed community-based health hubs; IT platforms enabling timely flow of patient information between primary and tertiary health providers and creation of medical, nursing and allied health roles aimed at improving synergy between GP and tertiary services.

Originality/value

Obtaining the perspectives of general practice highlights the challenges and complexities of caring for those in advanced age brings. These insights have not been previously been explored in-depth within this setting in New Zealand.

Details

Quality in Ageing and Older Adults, vol. 21 no. 1
Type: Research Article
ISSN: 1471-7794

Keywords

Access Restricted. View access options
Article
Publication date: 16 November 2015

Kathryn Peri, Ngaire Kerse, Simon Moyes, Shane Scahill, Charlotte Chen, Jae Beom Hong and Carmel M Hughes

– The purpose of this paper is to establish the relationship between organisational culture and psychotropic medication use in residential care.

408

Abstract

Purpose

The purpose of this paper is to establish the relationship between organisational culture and psychotropic medication use in residential care.

Design/methodology/approach

Cross-sectional analyses of staff and resident’s record survey in residential aged care facilities in Auckland, New Zealand (NZ). The competing values framework categorised organisational culture as clan, hierarchical, market driven or adhocracy and was completed by all staff. The treatment culture tool categorised facilities as having resident centred or traditional culture and was completed by registered nursing staff and general practitioners (GP). Functional and behavioural characteristics of residents were established by staff report and health characteristics and medications used were ascertained from the health record. Multiple regression was used to test for associations between measures of culture with psychotropic medication use (anxiolytics, sedatives, major tranquillisers).

Findings

In total 199 staff, 27 GP and 527 residents participated from 14 facilities. On average 8.5 medications per resident were prescribed and 42 per cent of residents received psychotropic medication. Having a diagnosis of anxiety or depression (odds ratio (OR) 3.18, 95 per cent confidence interval (CI) 1.71, 5.91), followed by persistent wandering (OR 2.53, 95 per cent CI 1.59, 4.01) and being in a dementia unit (OR 2.45, 95 per cent CI 1.17, 5.12) were most strongly associated with psychotropic use. Controlling for resident- and facility-level factors, health care assistants’ assignation of hierarchical organisational culture type was independently associated with psychotropic medication use, (OR 1.29, CI 1.08, 1.53) and a higher treatment culture score from the GP was associated with lower use of psychotropic medication (OR 0.95, CI 0.92, 0.98).

Originality/value

Psychotropic medication use remains prevalent in residential care facilities in NZ. Interventions aimed at changing organisational culture towards a less hierarchical and more resident-centred culture may be another avenue to improve prescribing in residential aged care.

Details

Journal of Health Organization and Management, vol. 29 no. 7
Type: Research Article
ISSN: 1477-7266

Keywords

1 – 2 of 2
Per page
102050