Health professionals, patients and chronic illness policy: a qualitative study

• Published in: Health expectations : an international journal of public participation in health care and health policy 2011-03, Vol.14 (1), p.10-20
• Main Authors: Yen, Laurann, Gillespie, James, RN, Yun-Hee Jeon, Kljakovic, Marjan, Brien, Jo-anne, Jan, Stephen, Lehnbom, Elin, Pearce-Brown, Carmen, Usherwood, Tim
• Format: Article
• Language: English
• Subjects: Allied health professionals; Attitude to Health; Australia; Caregivers; Carers; Chronic Disease - economics; Chronic Disease - psychology; Chronic Disease - therapy; chronic illness; Chronic illnesses; Chronic obstructive pulmonary disease; Chronic sickness; Comorbidity; Compensation; compliance; Content analysis; Continuity of Patient Care - organization & administration; Diabetes; Diabetes mellitus; Disease management; Doctors; Financial management; Focus groups; fragmentation; Government agencies; Health care policy; Health Personnel; Health Policy; Health professionals; Health status; Humans; Illnesses; Information; Innovations; Management; Medical personnel; Medicare; Morbidity; Nurses; Original Research Papers; Patient Compliance; Patient satisfaction; Patients; Pharmacists; Physicians; policy; Primary care; Professional attitudes; Professionals; Qualitative analysis; Qualitative Research; Research methodology; Segmentation; Self Care - economics; Self Care - methods; Selfmanagement; Urban areas
• ISSN: 1369-6513; 1369-7625; 1369-7625
• DOI: 10.1111/j.1369-7625.2010.00604.x

Background and objective  This study investigates health professionals’ reactions to patients’ perceptions of health issues – a little‐researched topic vital to the reform of the care of chronic illness. Methods  Focus groups were undertaken with doctors, nurses, allied health staff and pharmacists (n = 88) in two Australian urban regions. The focus groups explored responses to patient experiences of chronic illness (COPD, Diabetes, CHF) obtained in an earlier qualitative study. Content analysis was undertaken of the transcripts assisted by NVivo7 software. Results  Health professionals and patients agreed on general themes: that competing demands in self‐management, financial pressure and co‐morbidity were problems for people with chronic illness. However where patients and carers focused on their personal challenges, health professionals often saw the patient experience as a series of failures relating to compliance or service fragmentation. Some saw this as a result of individual shortcomings. Most identified structural and attitudinal issues. All saw the prime solution as additional resources for their own activities. Fee for service providers (mainly doctors) sought increased remuneration; salaried professionals (mainly nurses and allied health professionals) sought to increase capacity within their professional group. Conclusions  Professionals focus on their own resources and the behaviour of other professionals to improve management of chronic illness. They did not factor information from patient experience into their views about systems improvement. This inability to identify solutions beyond their professional sphere highlights the limitations of an over‐reliance on the perspectives of health professionals. The views of patients and carers must find a stronger voice in health policy.