JMIR Publications

ABSTRACT

Background:

The SARS-CoV-2 pandemic impacted the access to inpatient rehabilitation services. At the current state of research, it is unclear to what extent the adaptation of rehabilitation services to infection-protective standards affected patient-centred care in Germany.

Objective:

Thus, this study aims to explore which aspects of patient-centred care are relevant for patients in inpatient rehabilitation clinics under early-phase pandemic conditions.

Methods:

This is a deductive-inductive framework analysis of online patient reports posted on a leading German hospital rating website. Following a theoretical sampling approach, online reports up-loaded between March 2020 and September 2021 of rehabilitation stays, independently of medical specialty groups, in two federal states of Germany (Brandenburg; Saarland) were in-cluded. The applied framework for patient-centredness contains domains of (I) staff prerequi-sites, (II) patient-centred processes, (III) the care environment and (IV) expected outcomes. Keywords addressing framework domains were analysed descriptively. Potential differences of keyword distributions across states were tested via Chi-Square distribution. A qualitative in-depth analysis of online reports completed the sequential process of analysis.

Results:

In total, 649 online reports reflecting inpatient rehabilitation services of 31 clinics (Branden-burg N = 23; Saarland N = 8) were analysed. Keywords addressing the care environment were most frequently reported (59.9%) followed by staff prerequisites (33.0%), patient-centred processes (4.5%) and expected outcomes (2.6%). Significant differences of keyword distribu-tions across states were observed in domains of staff prerequisites and the care environment. Qualitative in depth-analysis revealed SARS-CoV-2 related reports to be predominantly asso-ciated with domains of patient-centred processes and staff prerequisites. Discontinuous com-munication of infection protection standards was perceived to threaten patient autonomy. This mechanism was amplified by a tangible gratification crisis of medical staff. Established and emotional supportive relationships to clinicians and peer-groups offered the potential to miti-gate adverse effects of infection protection standards.

Conclusions:

This study provides insights into pandemic-related adaptation mechanisms of German inpa-tient rehabilitation clinics and offers approaches of action to unite patient-centred care with infection-protective standards. Continuous communication of infection-protective legislation, relationship building, and smooth organizational routines represent promising approaches to facilitate patient autonomy. In future, it will be essential to critically evaluate which limita-tions come along with online patient reports as scientific data source.