Urgent assessment and ongoing care for infection in community-dwelling older people: a qualitative study of patient experience

Objectives To explore the experience of infection from the perspective of community-dwelling older people, including access and preferences for place of care. Design Qualitative interview study, carried out between March 2017 and August 2018. Setting Ambulatory care units in Oxfordshire, UK. Participants Adults >70 years with a clinical diagnosis of infection. Methods Semistructured interviews based on a flexible topic guide. Participants were given the option to be interviewed with their caregiver. Thematic analysis was facilitated by NVivo V.11. Results Participants described encountering several barriers when accessing an urgent healthcare assessment which were hard to negotiate when they felt unwell. They valued home comforts and independence if they received care for their infection at home, though were worried about burdening their family. Most talked about hospital admission being a necessity in the context of more severe illness. Perceived advantages included monitoring, availability of treatments and investigations. However, some recognised that admission put them at risk of a hospital-acquired infection. Ambulatory care was felt to be convenient if local, but daily transport was challenging. Conclusions Providers may need to think about protocols and targeted advice that could improve access for older people to urgent healthcare when they feel unwell. General practitioners making decisions about place of care may need to better communicate risks associated with the available options and think about balancing convenience with facilities for care.

Automated summary

Participants in this study faced barriers when accessing urgent healthcare for infections, valued home care for its comforts and independence, but were concerned about burdening family. Many saw hospital admission as necessary for severe illnesses, despite recognizing the risk of hospital-acquired infections. Ambulatory care was considered convenient if local, but transportation challenges were noted. Providers may need to improve access protocols and communicate risks to better balance convenience and care facilities.