Barriers Against Providing Home Health Care Delivery to Ventilator-Dependent Patients: A Qualitative Content Analysis

Background: Home health care (HHC) as a part of the health care delivery continuum has continued to be developed over the past decade. The number of patients receiving home mechanical ventilation (HMV) is increasing. The continuity of care from the hospital to the home is very important. However, these patients have various special care needs, and different conditions may affect the quality of care delivered to them. Objectives: This study was conducted to assess the barriers against service provided to the patients receiving HMV in the distinctive cultural, financial, spiritual, and emotional context of Iran. Methods: The present study was performed using the method of qualitative content analysis with purposive sampling. In general, 18 participants, including seven nurses, three physicians, and two physiotherapists working in homes, and six family members who each had a patient receiving mechanical ventilation at home, were interviewed during 2013 to 2014. Semi-structured interviews were conducted in quiet places offered by the study participants. Results: The barriers against home care for patients depending upon mechanical ventilation in this study are classified into three main categories, including policy-based barriers, agency-based barriers, and family-based barriers. The main policy-based barriers were the legal framework restrictions, insurance limitations, and an inefficient social support network. Lack of a professional team, lack of an independent home care organization, and problems related to physician visits were considered as agency-based barriers. Family-based barriers included fatigue and distress of the families and financial drainage. Conclusions: It seems that providing quality HHC is one of the most important challenges faced by our country’s health system, but the relevant infrastructure and policies have not been adequately considered. The results of this study could be used for improving the current challenges in delivering quality care to ventilator-dependent patients at home.