Experiencing (dis)connection: patient experience of integrated care in the community

Patient experiences of integrated care have produced mixed results to date, yet the pursuit of integrated care continues in the NHS. Concepts of integrated care have often focused on organisational priorities rather than how the patient experiences integration and factors influencing patient reported experiences are yet to be considered in an integrated care context. In 2015, a new integrated care model involving community-based NHS teams provided an opportune moment to capture patient and carer experiences during the implementation period. Using a constructionist approach, narrative inquiry was applied to explore the experiences of patients and carers receiving integrated care involving the community. Interactions with multiple individuals and services were included in the analysis, which aligned with patient perceptions of those delivering integrated care. Semi-structured interviews and diaries were used with 22 participants and data was analysed using narrative analysis. The results found connections were the dominant narrative thematic arc in the data, reflective of receiving care in a complex health system. Different types and levels of (dis)connection helped to explain human and structural relationships and the tensions they present in patient experience narratives. This study contributes to knowledge through a new conceptual model for understanding patient experiences of integrated care and updating an existing framework of the factors influencing patient reported experiences.