Time to care: the lived experience of receiving care from a primary care service for people with frequent hospital admissions

Objective To explore the experiences and perceptions of health and healthcare of clients of a co-designed, community-based service for people with frequent hospital admissions. Design This qualitative study used semi-structured interviews guided by a schedule that covered each participant’s experience and perception of their health and healthcare and experience of receiving care from the service; what is important to them when receiving care; and what, if any, effect being a client of the service had on their health and well-being. Interviews took place in participants’ homes, were audio-recorded, transcribed verbatim and checked for accuracy. Participants were able to amend their transcript. Using thematic analysis informed by grounded theory, data were independently and iteratively analysed by two investigators and data saturation was reached. The study was guided by principles of qualitative rigour. Setting A nurse-led, multidisciplinary, community-based service comprising a nurse manager, GP, social worker, allied health assistant and administration assistant for people with frequent admissions at a public hospital in Tasmania, Australia. Participants Any past or existing client was eligible to participate. Twenty were interviewed. Their median age was 78 years, 50% were female and 55% lived alone. Results Three themes were identified: (i) the challenges of ageing, (ii) complex care needs require intensive multidisciplinary holistic care and (iii) relationships are central to care and healthcare delivery. The three themes together formed a central organising theme: time to care. Having ‘time to care’ enabled healthcare workers to provide biomedical and psychosocial care and support and help participants address their challenges of ageing. It also allowed the development of trusting and respectful relationships that were essential to participants when receiving care. Conclusion To understand and support people with frequent admissions ‘time to care’ was essential. A range of healthcare workers were required to provide relational aspects of care, as well as individualised and time-intensive care that spanned medical, spiritual, mental and socio-economic dimensions across tertiary, social and community services. Diverse strategies may be needed to allow healthcare workers ‘time to care’.