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Multimorbidity, service organization and clinical decision making in primary care: a qualitative study

Multimorbidity, service organization and clinical decision making in primary care: a qualitative study
Multimorbidity, service organization and clinical decision making in primary care: a qualitative study
BACKGROUND: Primary care professionals often manage patients with multiple long-term health conditions, but managing multimorbidity is challenging given time and resource constraints and interactions between conditions.

OBJECTIVE: To explore GP and nurse perceptions of multimorbidity and the influence on service organization and clinical decision making.

METHODS: A qualitative interview study with primary care professionals in practices in Greater Manchester, U.K. Interviews were conducted with 15 GPs and 10 practice nurses.

RESULTS: Primary care professionals identified tensions between delivering care to meet quality targets and fulfilling the patient's agenda, tensions which are exacerbated in multimorbidity. They were aware of the inconvenience suffered by patients through attendance at multiple clinic appointments when care was structured around individual conditions. They reported difficulties managing patients with multimorbidity in limited consultation time, which led to adoption of an 'additive-sequential' decision-making model which dealt with problems in priority order until consultation resources were exhausted, when further management was deferred. Other challenges included the need for patients to co-ordinate their care, the difficulties of self-management support in multimorbidity and problems of making sense of the relationships between physical and mental health. Doctor and nurse accounts included limited consideration of multimorbidity in terms of the interactions between conditions or synergies between management of different conditions.

CONCLUSIONS: Primary care professionals identify a number of challenges in care for multimorbidity and adopt a particular model of decision making to deliver care for multiple individual conditions. However, they did not describe specific decision making around managing multimorbidity per se.

chronic disease, co-morbidity, decision making, primary health care
0263-2136
579-587
Bower, P.
a1242859-1e67-4fb3-85a7-35ebffc4ada7
Macdonald, W.
a4e7eab2-090a-4795-ba50-5823e1014482
Harkness, E.
da71f849-71fd-4108-95b6-db99535af061
Gask, L.
6da8be4a-cf36-4efd-8c33-162cb3503d4e
Kendrick, T.
c697a72c-c698-469d-8ac2-f00df40583e5
Valderas, J.M.
e3b54c37-824b-4cf2-b154-92742669f32e
Dickens, C.
a41afee4-9852-4e66-a96d-938151d8fd3a
Blakeman, T.
917b8a58-9728-4cdb-80c9-f09e8cb14c1c
Sibbald, B.
d825e99c-fcf4-4b07-a2a9-2ca4e14dadbb
Bower, P.
a1242859-1e67-4fb3-85a7-35ebffc4ada7
Macdonald, W.
a4e7eab2-090a-4795-ba50-5823e1014482
Harkness, E.
da71f849-71fd-4108-95b6-db99535af061
Gask, L.
6da8be4a-cf36-4efd-8c33-162cb3503d4e
Kendrick, T.
c697a72c-c698-469d-8ac2-f00df40583e5
Valderas, J.M.
e3b54c37-824b-4cf2-b154-92742669f32e
Dickens, C.
a41afee4-9852-4e66-a96d-938151d8fd3a
Blakeman, T.
917b8a58-9728-4cdb-80c9-f09e8cb14c1c
Sibbald, B.
d825e99c-fcf4-4b07-a2a9-2ca4e14dadbb

Bower, P., Macdonald, W., Harkness, E., Gask, L., Kendrick, T., Valderas, J.M., Dickens, C., Blakeman, T. and Sibbald, B. (2011) Multimorbidity, service organization and clinical decision making in primary care: a qualitative study. Family Practice, 28 (5), 579-587. (doi:10.1093/fampra/cmr018). (PMID:21613378)

Record type: Article

Abstract

BACKGROUND: Primary care professionals often manage patients with multiple long-term health conditions, but managing multimorbidity is challenging given time and resource constraints and interactions between conditions.

OBJECTIVE: To explore GP and nurse perceptions of multimorbidity and the influence on service organization and clinical decision making.

METHODS: A qualitative interview study with primary care professionals in practices in Greater Manchester, U.K. Interviews were conducted with 15 GPs and 10 practice nurses.

RESULTS: Primary care professionals identified tensions between delivering care to meet quality targets and fulfilling the patient's agenda, tensions which are exacerbated in multimorbidity. They were aware of the inconvenience suffered by patients through attendance at multiple clinic appointments when care was structured around individual conditions. They reported difficulties managing patients with multimorbidity in limited consultation time, which led to adoption of an 'additive-sequential' decision-making model which dealt with problems in priority order until consultation resources were exhausted, when further management was deferred. Other challenges included the need for patients to co-ordinate their care, the difficulties of self-management support in multimorbidity and problems of making sense of the relationships between physical and mental health. Doctor and nurse accounts included limited consideration of multimorbidity in terms of the interactions between conditions or synergies between management of different conditions.

CONCLUSIONS: Primary care professionals identify a number of challenges in care for multimorbidity and adopt a particular model of decision making to deliver care for multiple individual conditions. However, they did not describe specific decision making around managing multimorbidity per se.

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More information

Published date: 25 May 2011
Keywords: chronic disease, co-morbidity, decision making, primary health care
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 353927
URI: https://eprints.soton.ac.uk/id/eprint/353927
ISSN: 0263-2136
PURE UUID: 8a69d5fa-3b4f-4102-bd07-dc864df02a05
ORCID for T. Kendrick: ORCID iD orcid.org/0000-0003-1618-9381

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Date deposited: 25 Jun 2013 11:00
Last modified: 06 Jun 2018 12:56

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Contributors

Author: P. Bower
Author: W. Macdonald
Author: E. Harkness
Author: L. Gask
Author: T. Kendrick ORCID iD
Author: J.M. Valderas
Author: C. Dickens
Author: T. Blakeman
Author: B. Sibbald

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