Care pathways and hybrid care needs of patients, health workers and informal carers across countries

Abstract Background Care pathways are central to organizing care. During the COVID-19 pandemic, care pathways for chronic conditions were disrupted or amended ad hoc to meet pandemic care demands. This left many patients unattended and at increased risk of complications. Protecting access to regular care is vital, with hybrid transformation of care pathways through digital integration being a possible solution. Understanding the composition of care pathways and cross-country variation is key to identifying components suitable for hybrid delivery. Methods We conducted 38 in-depth interviews with patients with type II diabetes mellitus and/or chronic heart failure, 23 with, healthcare workers (HCW) and 22 with informal care givers in Slovenia, the Netherlands and Malta, exploring patient journeys, care modifications during COVID-19, and digital care experiences. Thematic analysis informed care pathways and identified generic and country-specific sub-themes. In co-creation with HCW, informal care givers, and patients, we explored which care steps could be delivered in a hybrid way. Results Care pathways were developed for high- and low-risk conditions, with variations visualised both between and within countries. Eight generic themes emerged across all countries: care coordination, healthcare structures, patient characteristics, disease management abilities, care experiences and needs during/after COVID-19, digital/hybrid care, patient experiences, and support needs. These were divided into 40 sub-themes. The co-creation session identified opportunities to streamline care pathways by combining appointments, improving task delegation and communication, digitizing steps, as well as pre-requisites for successful patient-level implementation. Conclusions COVID-19 exposed weaknesses in regular care delivery. Hybrid transformation of care pathways, guided by multi-stakeholder input, offers a promising approach for future crises.