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Effective health care for older people living and dying in care homes: a realist review

Goodman, C, Dening, T, Gordon, AL, Davies, SL, Meyer, J, Martin, FC, Gladman, JRF, Bowman, C, Victor, C, Handley, M, Gage, HM, Iliffe, S and Zubair, M (2016) Effective health care for older people living and dying in care homes: a realist review BMC Health Services Research.

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Abstract

Abstract Background Care home residents in England have variable access to health care services. There is currently no coherent policy or consensus about the best arrangements to meet these needs. The purpose of this review was to explore the evidence for how different service delivery models for care home residents support and/or improve wellbeing and health-related outcomes in older people living and dying in care homes. Methods We conceptualised models of health care provision to care homes as complex interventions. We used a realist review approach to develop a preliminary understanding of what supported good health care provision to care homes. We completed a scoping of the literature and interviewed National Health Service and Local Authority commissioners, providers of services to care homes, representatives from the Regulator, care home managers, residents and their families. We used these data to develop theoretical propositions to be tested in the literature to explain why an intervention may be effective in some situations and not others. We searched electronic databases and related grey literature. Finally the findings were reviewed with an external advisory group. Results Strategies that support and sustain relational working between care home staff and visiting health care professionals explained the observed differences in how health care interventions were accepted and embedded into care home practice. Actions that encouraged visiting health care professionals and care home staff jointly to identify, plan and implement care home appropriate protocols for care, when supported by ongoing facilitation from visiting clinicians, were important. Contextual factors such as financial incentives or sanctions, agreed protocols, clinical expertise and structured approaches to assessment and care planning could support relational working to occur, but of themselves appeared insufficient to achieve change. Conclusion How relational working is structured between health and care home staff is key to whether health service interventions achieve health related outcomes for residents and their respective organisations. The belief that either paying clinicians to do more in care homes and/or investing in training of care home staff is sufficient for better outcomes was not supported.

Item Type: Article
Subjects : Economics
Divisions : Faculty of Arts and Social Sciences > School of Economics
Authors :
AuthorsEmailORCID
Goodman, CUNSPECIFIEDUNSPECIFIED
Dening, TUNSPECIFIEDUNSPECIFIED
Gordon, ALUNSPECIFIEDUNSPECIFIED
Davies, SLUNSPECIFIEDUNSPECIFIED
Meyer, JUNSPECIFIEDUNSPECIFIED
Martin, FCUNSPECIFIEDUNSPECIFIED
Gladman, JRFUNSPECIFIEDUNSPECIFIED
Bowman, CUNSPECIFIEDUNSPECIFIED
Victor, CUNSPECIFIEDUNSPECIFIED
Handley, MUNSPECIFIEDUNSPECIFIED
Gage, HMUNSPECIFIEDUNSPECIFIED
Iliffe, SUNSPECIFIEDUNSPECIFIED
Zubair, MUNSPECIFIEDUNSPECIFIED
Date : 16 July 2016
Identification Number : 10.1186/s12913-016-1493-4
Copyright Disclaimer : © The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Depositing User : Symplectic Elements
Date Deposited : 18 Jul 2016 11:34
Last Modified : 18 Jul 2016 11:34
URI: http://epubs.surrey.ac.uk/id/eprint/811241

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