Multimorbidity and Person-Centred care in a socioeconomically deprived community: a qualitative study.

Abstract

Multimorbidity (>2 long-term conditions) has poorer outcomes in areas of high socioeconomic deprivation (SED). High-quality Person-Centred Care (PCC) is important in multimorbidity but socially vulnerable populations have not informed current PCC models. To explore how wider community factors influence management of multimorbidity in the context of high SED, how high-quality PCC is defined by patients, and whether this influences healthcare management. Ethnographically informed case study in community experiencing high SED in Scotland. Participant observation (hours = 142) within 4 community groups who also took part in 2 participatory workshops. 25 in-depth interviews with people with multimorbidity, recruited from local General Practices; emerging findings discussed with interviewees in one focus group. Field notes/transcripts analysed using inductive thematic analysis. Key aspects of PCC were "patient as person", "therapeutic relationship", "co-ordination" and "power-sharing"; power sharing was particularly enabling but rarely happened (barriers often unseen by practitioners). Shared community experiences of "being known", "stigma" and "none of the systems working" influenced how people approached health services, and healthcare decisions. High quality PCC may have been particularly effective in this setting because of its influence on ameliorating wider shared negative community experiences. In a high SED setting PCC is important and can enhance engagement. Wider community factors have a critical influence on engagement with healthcare in areas of high SED and PCC may be particularly important in this context because of its influence ameliorating these. Policy makers should prioritise and resource PCC.