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    The rhetoric and reality of integrated patient-centered care for healthcare providers: An ethnographic exploration of epilepsy care in Ireland


    Byrne, John-Paul and Power, Robert and Kiersey, Rachel and Varley, Jarlath and Doherty, Colin P. and Saris, A. Jamie and Lambert, Veronica and Fitzsimons, Mary (2019) The rhetoric and reality of integrated patient-centered care for healthcare providers: An ethnographic exploration of epilepsy care in Ireland. Epilepsy & Behavior, 94. pp. 87-92. ISSN 1525-5050

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    Abstract

    In line with healthcare reform across the world, the National Clinical Programme for Epilepsy (NCPE) in Ireland describes a model that aims to achieve holistic integrated person (patient)-centered care (PCC). While generally welcomed by stakeholders, the steps required to realize the NCPE ambition and the preparedness of those involved to make the journey are not clear. This study explored the perceptions of healthcare providers in the Irish epilepsy care ecosystem to understand their level of readiness to realize the benefits of an integrated PCC model. Ethnographic fieldwork including observations of different clinical settings across three regions in Ireland and one-to-one interviews with consultant epileptologists (n = 3), epilepsy specialist nurses (n = 5), general practitioners (n = 4), and senior healthcare managers (n = 3) were conducted. While there is a person-centered ambiance and a disposition toward advancing integrated PCC, there are limits to the readiness of the epilepsy care environment to fully meet the aspirations of healthcare reform. These are the following: underdeveloped healthcare partnerships;, poor care coordination;, unintended consequences of innovation;, and tension between pace and productivity. In the journey from policy to practice, the following multiple tensions collide: policy aims to improve services for all patients while simultaneously individualizing care; demands for productivity limit the time and space required to engage in incremental and iterative improvement initiatives. Understanding these tensions is an essential first step on the pathway to integrated PCC implementation.

    Item Type: Article
    Keywords: Ethnographic research; Beliefs; Person-centered care; Health professionals in epilepsy care; Integrated care; Chronic disease;
    Academic Unit: Faculty of Social Sciences > Anthropology
    Item ID: 14895
    Identification Number: https://doi.org/10.1016/j.yebeh.2019.02.011
    Depositing User: Dr. A. Jamie Saris
    Date Deposited: 05 Oct 2021 10:32
    Journal or Publication Title: Epilepsy & Behavior
    Publisher: Elsevier
    Refereed: Yes
    URI:

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