Disentangling the concept of "the complex older patient" in general practice: a qualitative study.

S A Zwijsen,M F I A Depla,N M Nieuwenhuizen,C M P M Hertogh,O R Maarsingh

doi:10.1186/s12875-016-0455-6

S A Zwijsen, M F I A Depla + Show 3 more

Open Access

https://doi.org/10.1186/s12875-016-0455-6

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Abstract

BackgroundThe rising life expectancy in the developed world leads to an increase in the number of older patients and the complexity of their complaints in general practice. Although interventions and support for general practitioners are available, implementation lags. Knowledge on what determines a complex older patient, the problems of which general practitioners encounter and the situations they actually need support for, is necessary for better implementation.MethodsTo provide support to general practitioners in their struggle with complex older patients, the aim of this research was to disentangle the concept of the complex older patient in general practice. A qualitative approach was used consisting of 15 semi-structured interviews with general practitioners. The general practitioner was asked to prepare a case of a complex older patient out of their own practice that could be discussed during the interview. Transcripts of the interview were analysed using inductive thematic analysis.ResultsAnalysis of the interviews resulted in twelve themes that could be categorised into five factors that contribute to the complexity of cases of older patients. The five factors are: not being in charge, different views on necessary care, encountering the boundaries of medicine, limits to providing social care, ill-equipped.ConclusionThe factors that were found imply that a better organisational structure for elderly care and consulting elderly care physicians could support general practitioners in providing care for older complex patients. Furthermore, understanding the current concept of patient autonomy seems unjustified in cases of complex older patients.

Highlights

The rising life expectancy in the developed world leads to an increase in the number of older patients and the complexity of their complaints in general practice
As part of a larger study on the possible collaboration between elderly care physicians and general practitioners (GPs), in this paper we describe an explorative qualitative study that was conducted to disentangle the concept of ‘the complex older patient’ from the GPs point of view
Relationship with participants The researcher introduced herself as an elderly care physician, and explained before each interview that the goal of the research project was to study the possibilities for collaboration between general practitioners and elderly care physicians

Summary

Introduction

The rising life expectancy in the developed world leads to an increase in the number of older patients and the complexity of their complaints in general practice. Knowledge on what determines a complex older patient, the problems of which general practitioners encounter and the situations they need support for, is necessary for better implementation. The issue of the increasing population of complex older patients in primarycare has become clear to both GPs and policymakers. Several attempts have been made to provide support for GPs. Interventions have been developed that focus on the Zwijsen et al BMC Family Practice (2016) 17:64 management of complex care by structuring the approach to a disease or problem or providing support from other care disciplines [6,7,8,9]. Attempts have been made to improve collaboration between GPs and other health care disciplines like elderly care physicians and geriatricians

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