Date Published: May 16, 2019
Publisher: Public Library of Science
Author(s): Antonius J. Poot, Daisy M. Wopereis, Wendy P. J. den Elzen, Jacobijn Gussekloo, Jeanet W. Blom, Peter Van Bogaert.
Patient satisfaction with the general practitioner (GP) is lower in older persons with a higher level of complexity of health problems. This study investigates whether, in these older persons, changes in satisfaction with their GP, on receiving improved integrated care, is related to their perceived health state.Using the Integrated Systematic Care for Older People (ISCOPE) trial (aimed at improving person- centered integrated care) this study compared changes in satisfaction with the GP in older persons (aged ≥75 years) with a high level of complex health problems on receiving integrated care, stratified for perceived health state at baseline. Satisfaction with the GP was registered on a 5-point Likert scale. Perceived health state was estimated with the Older Persons and Informal Caregivers Survey-Composite End Point (TOPICS-CEP) at baseline, stratified into 33% percentiles. Differences in satisfaction change between the intervention and usual care/control groups (overall and stratified for perceived health state) are presented by percentages of ‘very satisfied’ participants and improving or deteriorating 1 or more points on the Likert scale. At baseline, the intervention (n = 151) and control group (n = 603) were mainly female (75%) and living alone (62%); mean age was 83 years. Medical status, perceived health state and characteristics of participants were similar. Overall, at baseline 44.4% of respondents in the intervention group were ‘very satisfied’ compared with 37.1% at follow-up, (difference -7.3%). In the control group, ‘very satisfied’ at baseline was 32% and at follow up 29.2% (difference -2.8%). The p-value for this difference in change is 0.56. After stratification for TOPICS-CEP the results were the same. In older persons with a high level of complexity of health problems, implementation of person- centered integrated healthcare did not influence their satisfaction with the GP, also not among those with the highest or lowest perceived health state.
Integrated and patient-centered care can be defined as: the organization and management of health services so that people get the care they need, when they need it, in ways that are user-friendly, achieve the desired results, and provide value for money . This type of care is considered necessary and advantageous for patients with complex care needs [2–5]. This applies particularly to older patients because of the higher level of complexity of their care needs, and their increasing absolute numbers and proportion in the general population . Despite that the evidence concerning the (cost) effectiveness of integrated and person-centered care interventions remains unclear, there is strong consensus about the need for implementation amongst care providers and policymakers [6–8].
Sociodemographic, functional and medical characteristics, as well as perceived health state and satisfaction for the intervention and control group are presented in Table 1. Of all patients, 75% were female and 62% were living alone. The intervention group was younger than the control group (82.1 vs 83.2; p = 0.04). Slightly more participants in the intervention group had completed a higher education (70.2% vs 61.0% p = 0.05). The groups showed no differences in gender, living situation, number of diseases/ailments, activity restriction and cognitive impairment. The perceived health state at baseline quantified by TOPICS-CEP showed no significant difference between the intervention and control group (both scoring between 6 and 7). Differences in the distribution over the five satisfaction categories were not significant (p = 0.08).
For (older) persons with complex care needs living in a community-dwelling setting where care is provided by multiple often autonomous professionals, person-centered and integrated care are widely accepted concepts. Particularly in geriatric care and primary care for older persons this is the case. Previous research has shown that this type of care is related to increased satisfaction in GP’s concerning organizational aspects of care and increased satisfaction in older persons concerning relational aspects of care.