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Patient-specific versus Organisational Barriers to Program Adherence: A Multivariate Analysis.

Sara Fokdal Lehn1,2, Ann-Dorthe Zwisler3, Solvejg Gram Henneberg Pedersen4

  • 1Department of Medicine, Holbæk University Hospital, Smedelundsgade 60, Holbæk, DK.

International Journal of Integrated Care
|March 29, 2019
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Summary

Organizational factors significantly impact adherence to integrated care programs for older patients. Adherence varied by hospital, municipality, and general practice, with patient gender being the only significant patient-related factor.

Keywords:
adherenceimplementationintegrated care programolder patientsorganizational factorspatient-specific factors

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Area of Science:

  • Gerontology
  • Healthcare Management
  • Public Health

Background:

  • Integrated care programs aim to improve healthcare delivery for older patients.
  • Adherence to program guidelines is crucial for program effectiveness.
  • Understanding factors influencing adherence is essential for optimizing care for frail older adults.

Purpose of the Study:

  • To investigate patient-specific and organizational factors affecting adherence to an integrated care program for older patients.
  • To identify specific points of failure in the referral and follow-up processes.
  • To inform strategies for improving adherence and care integration.

Main Methods:

  • A cohort of 1,659 patients receiving post-discharge follow-up was studied.
  • Adherence was measured in two steps: successful hospital referral and completed follow-up visit.
  • Data were collected from hospitals, municipalities, and administrative registers.

Main Results:

  • Overall adherence was low: 69% for hospital referral and 54% for follow-up visits.
  • Hospital factors and prior municipal home care influenced referral adherence.
  • Municipality, general practitioner type, and patient gender affected follow-up adherence.

Conclusions:

  • Adherence is strongly linked to organizational factors across hospital, municipality, and general practice levels.
  • Significant challenges exist in the vertical integration of care.
  • Patient gender was the sole patient-related factor influencing adherence.