Easier Said Than Done: Healthcare Professionals' Barriers to the Provision of Patient-Centered Primary Care to Patients with Multimorbidity.

Sanne J Kuipers,Anna P Nieboer,Jane M Cramm

doi:10.3390/ijerph18116057

Abstract

Patient-centered care (PCC) has the potential to entail tailored primary care delivery according to the needs of patients with multimorbidity (two or more co-existing chronic conditions). To make primary care for these patients more patient centered, insight on healthcare professionals’ perceived PCC implementation barriers is needed. In this study, healthcare professionals’ perceived barriers to primary PCC delivery to patients with multimorbidity were investigated using a constructivist qualitative design based on semi-structured interviews with nine general and nurse practitioners from seven general practices in the Netherlands. Purposive sampling was used, and the interview content was analyzed to generate themes representing experienced barriers. Barriers were identified in all eight PCC dimensions (patient preferences, information and education, access to care, physical comfort, emotional support, family and friends, continuity and transition, and coordination of care). They include difficulties achieving mutual understanding between patients and healthcare professionals, professionals’ lack of training and education in new skills, data protection laws that impede adequate documentation and information sharing, time pressure, and conflicting financial incentives. These barriers pose true challenges to effective, sustainable PCC implementation at the patient, organizational, and national levels. Further improvement of primary care delivery to patients with multimorbidity is needed to overcome these barriers.

Highlights

Patient-centered care (PCC) receives a great deal of attention and has been adopted widely in healthcare organizations throughout the world [1,2,3,4,5,6]
PCC should be delivered using a comprehensive approach, with multiple interventions tailored to the needs of the most vulnerable groups in society [2]; in practice, achieving this goal remains a huge struggle [10,11,12]. This nuanced picture of PCC in practice is especially relevant for primary care delivery to patients with multimorbidity, who are often considered to form one of the most vulnerable groups in society [14]
From seven GP practices in Noord-Brabant, the Netherlands, participated in a 1-year-long (2017–2018) PCC improvement program initiated by a regional cooperative of GPs (Zorggroep RCH Midden Brabant BV)

Summary

Introduction

Patient (or person)-centered care (PCC) receives a great deal of attention and has been adopted widely in healthcare organizations throughout the world [1,2,3,4,5,6]. PCC should be delivered using a comprehensive approach, with multiple interventions tailored to the needs of the most vulnerable groups in society (e.g., patients with less education, migration backgrounds, or low health literacy) [2]; in practice, achieving this goal remains a huge struggle [10,11,12] This nuanced picture of PCC in practice is especially relevant for primary care delivery to patients with multimorbidity (two or more co-existing chronic conditions [13]), who are often considered to form one of the most vulnerable groups in society [14].

Methods

Discussion

Conclusion