Barriers and enablers to good communication and information-sharing practices in care planning for chronic condition management

Sharon Lawn, Toni Delany, Linda Sweet, Malcolm Battersby, Timothy Skinner
2015 Australian Journal of Primary Health  
Our aim was to document current communication and information-sharing practices and to identify the barriers and enablers to good practices within the context of care planning for chronic condition management. Further aims were to make recommendations about how changes to policy and practice can improve communication and information sharing in primary health care. A mixed-method approach was applied to seek the perspectives of patients and primary health-care workers across Australia. Data was
more » ... ustralia. Data was collected via interviews, focus groups, non-participant observations and a national survey. Data analysis was performed using a mix of thematic, discourse and statistical approaches. Central barriers to effective communication and information sharing included fragmented communication, uncertainty around client and interagency consent, and the unacknowledged existence of overlapping care plans. To be most effective, communication and information sharing should be open, two-way and inclusive of all members of health-care teams. It must also only be undertaken with the appropriate participant consent, otherwise this has the potential to cause patients harm. Improvements in care planning as a communication and information-sharing tool may be achieved through practice initiatives that reflect the rhetoric of collaborative person-centred care, which is already supported through existing policy in Australia. General practitioners and other primary care providers should operationalise care planning, and the expectation of collaborative and effective communication of care that underpins it, within their practice with patients and all members of the care team. To assist in meeting these aims, we make several recommendations. Additional keywords: care plan, collaboration, interdisciplinary care, primary health care, self-management. What is known about the topic? * Care plans aim to facilitate communication, information sharing and collaboration between health-care teams, patients and carers; however, these processes continue to be problematic within health-care delivery. What does this paper add? * This paper identifies barriers and enablers to effective communication and information sharing in care planning, from patients' and health-care workers' perspectives, and suggests strategies to improve the effectiveness of care planning. This research sought to address these knowledge gaps by examining patients' and primary health-care (PHC) workers' perceptions of the enablers and barriers to effective communication and information sharing. Methods This study used a mixed-method approach. Qualitative components enabler to effective communication and information sharing. Seventy-two per cent (n = 418) of respondents agreed or agreed strongly that one purpose of a care plan is to engage patients in managing their condition, and 70% (n = 401) stated that patients making decisions about their health care is the best indicator of care plan success. Barriers Closed communication Patients recounted experiences where they perceived that communication and information sharing was devalued by PHC workers' use of closed questioning. This was perceived as a significant barrier to communication and information sharing as it left important patient concerns unexplored: A nurse asked me these questions; it was almost like A, B or C and she didn't want to hear anything else. When I started to say -'No, no' she said 'I want an answer, I want A, B and C'... but I don't really fit in with that. We don't all fit in a box do we? (80-year-old woman, patient, metropolitan service). Fragmented communication Fragmented communication was a central barrier identified. This term is used to group together instances of gaps and breakdowns in communication and information sharing, occurring through a range of processes including ineffective handover, ineffective referral systems and one-way communication around referrals:
doi:10.1071/py13087 pmid:24176299 fatcat:fxgwfu64crbvjihbshfadfzd6u