TY - JOUR T1 - Coordination of care for individuals with advanced progressive conditions: a multi-site ethnographic and serial interview study JF - British Journal of General Practice JO - Br J Gen Pract SP - e580 LP - e588 DO - 10.3399/bjgp13X670714 VL - 63 IS - 613 AU - Bruce Mason AU - Eleni Epiphaniou AU - Veronica Nanton AU - Anne Donaldson AU - Cathy Shipman AU - Barbara A Daveson AU - Richard Harding AU - Irene Higginson AU - Dan Munday AU - Stephen Barclay AU - Kirsty Boyd AU - Jeremy Dale AU - Marilyn Kendall AU - Allison Worth AU - Scott A Murray Y1 - 2013/08/01 UR - http://bjgp.org/content/63/613/e580.abstract N2 - Background Coordination of care for individuals with advanced progressive conditions is frequently poor.Aim To identify how care is coordinated in generalist settings for individuals with advanced progressive conditions in the last year of life.Design and setting A mixed methods study of three UK generalist clinical settings producing three parallel case studies: an acute admissions unit in a regional hospital, a large general practice, and a respiratory outpatient service.Method Ethnographic observations in each setting, followed by serial interviews of patients with advanced progressive conditions and their family carers in the community. A spectrum of clinicians and healthcare workers were also interviewed.Results Ethnographic observations were conducted for 22 weeks. A total of 56 patients, 25 family carers and 17 clinicians yielded 198 interviews. Very few participants had been identified for a palliative approach. Rapid throughput of hospital patients and time pressures in primary care hindered identification of palliative care needs. Lack of care coordination was evident during emergency admissions and discharges. Patient, families, and professionals identified multiple problems relating to lack of information, communication, and collaboration at care transitions. Family carers or specialist nurses, where present, usually acted as the main care coordinators.Conclusion Care is poorly coordinated in generalist settings for patients in the last year of life, although those with cancer have better coordinated care than other patients. A model to improve coordination of care for all individuals approaching the end of life must ensure that patients are identified in a timely way, so that they can be assessed and their care planned accordingly. ER -