Methods: Telephone interviews were conducted with a convenience, purposive sample of 13 case managers, 19 home services providers (eight home support workers, ten nurses and one supervisor), 25 clients, 5 family caregivers, and 3 physicians recruited through the Community Care Access Centre in Hamilton, Ontario, Canada. Interviews focused on respondents' understandings and experiences of the key factors associated with continuity and discontinuity of care in home care services. Transcribed interviews were analysed using a qualitative software program. The authors verified the authenticity of their accounts through meetings with case managers, service providers, policy makers and client advocates associated with the home care sector.

Results: Two dimensions of care--managing care and direct service provision--were found to be important to the continuity of care in home care. Continuity in the management of care involved care planning, monitoring and review, and care coordination. Attributes associated with continuity of care in direct service provision included appropriate knowledge and skills, ongoing accurate observation, trusting relationships between service provider and client/caregiver, rapport among team members, and consistent timing of care provision. These components were achieved through communication and consistent personnel. Stakeholders varied in their perceptions of the importance of the individual components of the two dimensions of care, as well as in how continuity should be achieved. Continuity of care was highlighted as particularly important for following various client groups: the elderly; end-stage palliative care clients; those with significant physical, mental health or cognitive disabilities; those with complex medical regimens; and clients with significantly stressed caregivers.

Conclusion: Clients appear to view the aspects and achievement of continuity of care somewhat differently than other stakeholders. While physicians and case managers described care planning, monitoring and review as key to continuity of care, clients appeared unaware of the development and implementation of specific plans of care. Similarly, only clients and family care givers perceived consistent timing as central to continuity of care as it relates to the facilitation of daily, personal routines, particularly for those requiring assistance with dressing and bathing. All stakeholders agreed that effective communication and consistent personnel were the means by which continuity of care can be achieved. Clients were more likely to comment on the importance of consistency in homemaking staff, and physicians more likely to view consistent nursing personnel as critical. Understanding continuity of care from the perspective of various stakeholders can help to highlight the different aspects of care they identify as central, and assist in optimizing homecare within the context of increasingly scarce family and health-care resources.

Reference: Woodward, C.A., Abelson, J, Tedford, S, Hutchison, B. What is important to continuity in home care? Perspectives of key stakeholders. Social Science & Medicine, in press. (YEAR)

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