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

Goodman, Claire and Dening, Tom and Gordon, Adam L. and Davies, Susan L. and Meyer, Julienne and Martin, Finbarr C. and Gladman, John R.F. and Bowman, Clive and Victor, Christina and Handley, Melanie and Gage, Heather and Iliffe, Steve and Zubair, Maria (2016) Effective health care for older people living and dying in care homes: a realist review. BMC Health Services Research, 16 (269). pp. 1-14. ISSN 1472-6963

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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.

Item Type: Article
Keywords: Realist review, Care home, Older people, Health outcomes, Long-term care
Schools/Departments: University of Nottingham, UK > Faculty of Social Sciences > School of Sociology and Social Policy
University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Psychiatry and Applied Psychology
University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Rehabilitation and Ageing
University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Medical Sciences and Graduate Entry Medicine
Identification Number: https://doi.org/10.1186/s12913-016-1493-4
Depositing User: Gordon, Adam
Date Deposited: 16 Dec 2016 12:07
Last Modified: 18 Dec 2016 03:53
URI: http://eprints.nottingham.ac.uk/id/eprint/39403

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