“It’s Somebody else’s responsibility” - perceptions of general practitioners, heart failure nurses, care home staff, and residents towards heart failure diagnosis and management for older people in long-term care: a qualitative interview study

Close, Helen; Hancock, Helen; Mason, James M; Murphy, Jerry J; Fuat, Ahmet; de Belder, Mark; Hungin, A Pali S

Abstract

Background: Older people in care-facilities may be less likely to access gold standard diagnosis and treatment for heart failure (HF) than non residents; little is understood about the factors that influence this variability. This study aimed to examine the experiences and expectations of clinicians, care-facility staff and residents in interpreting suspected symptoms of HF and deciding whether and how to intervene. Methods: This was a nested qualitative study using in-depth interviews with older residents with a diagnosis of heart failure (n=17), care-facility staff (n=8), HF nurses (n=3) and general practitioners (n=5). Results: Participants identified a lack of clear lines of responsibility in providing HF care in care-facilities. Many clinical staff expressed negative assumptions about the acceptability and utility of interventions, and inappropriately moderated residents’ access to HF diagnosis and treatment. Care-facility staff and residents welcomed intervention but experienced a lack of opportunity for dialogue about the balance of risks and benefits. Most residents wanted to be involved in healthcare decisions but physical, social and organisational barriers precluded this. An onsite HF service offered a potential solution and proved to be acceptable to residents and care-facility staff. Conclusions: HF diagnosis and management is of variable quality in long-term care. Conflicting expectations and a lack of co-ordinated responsibility for care, contribute to a culture of benign neglect that excludes the wishes and needs of residents. A greater focus on rights, responsibilities and co-ordination may improve healthcare quality for older people in care. Trial registration: ISRCTN: ISRCTN19781227

Citation

Close, H., Hancock, H., Mason, J. M., Murphy, J. J., Fuat, A., de Belder, M., & Hungin, A. P. S. (2013). “It’s Somebody else’s responsibility” - perceptions of general practitioners, heart failure nurses, care home staff, and residents towards heart failure diagnosis and management for older people in long-term care: a qualitative interview study. BMC Geriatrics, 13, Article 69. https://doi.org/10.1186/1471-2318-13-69

• Journal Article Type: Article
• Acceptance Date: Jun 27, 2013
• Publication Date: Jul 5, 2013
• Deposit Date: Apr 19, 2012
• Publicly Available Date: Oct 9, 2014
• Journal: BMC Geriatrics
• Electronic ISSN: 1471-2318
• Publisher: BioMed Central
• Peer Reviewed: Peer Reviewed
• Volume: 13
• Article Number: 69
• DOI: https://doi.org/10.1186/1471-2318-13-69
• Keywords: Heart failure, Quality of care and outcomes, Long-term care, Older people.
• Public URL: https://durham-repository.worktribe.com/output/1500478