Abstract
Introduction: In the Netherlands, as in many other countries, current clinical guidelines are directed at single diseases. Patients with multiple chronic conditions may benefit from a more patient-tailored approach. Therefore, our objective is to explore the general practice care needs of patients with multimorbidity from a patient perspective. We also assessed their care experiences and the impact of chronic conditions on their daily functioning.Methods: We conducted a qualitative study, using semi-structured interviews complemented with self-report questionnaire assessments for triangulation, with consenting community-dwelling patients with three or more chronic conditions. Participants were identified through purposeful sampling in three general practices. Two researchers independently coded and thematically analyzed the audiotaped and anonymously transcribed interviews using the constant comparative method. The self-report questionnaire assessments were used to describe the patient characteristics and for triangulation of the data retrieved from the semi-structured interviews.Results: After 12 interviews, saturation was achieved. Overall, most participants were positive about their relationship with the general practitioner (GP) and practice nurse (PN) as well as the care they received in general practice. However, several unmet care need themes were observed: firstly, lack of a holistic approach (by the GP and PN), in particular, insufficient attention to the patient's state of functioning, their limitations in daily life, and their well-being; secondly, they mentioned that personal continuity of care was important to them and sometimes lacking; thirdly, lack of patient-tailored explanations about diseases and treatments.Conclusion: From a community-dwelling multimorbid patient perspective, general practice care could benefit from improving personal continuity of care, attention to personal circumstances and daily functioning, and patient-tailored communication.
Highlights
In the Netherlands, as in many other countries, current clinical guidelines are directed at single diseases
We invited six general practitioner (GP) running a practice in diverse areas and populations: some were located in a relatively deprived metropolitan area and some in a more rural area
Triangulation Mostly, the findings of the interviews were in line with the results of the self- assessments, such as the self-reported health. These findings contribute to our understanding of the care needs, care experiences, and the impact of chronic conditions on daily functioning of community-dwelling patients with multimorbidity
Summary
In the Netherlands, as in many other countries, current clinical guidelines are directed at single diseases. Our objective is to explore the general practice care needs of patients with multimorbidity from a patient perspective. We assessed their care experiences and the impact of chronic conditions on their daily functioning. In Dutch primary care, structured disease management programs are used for three highly prevalent chronic diseases: cardiovascular diseases, diabetes mellitus, and chronic obstructive pulmonary disease (COPD) The goals of these protocolized programs are to provide selective prevention and manage the chronic conditions [4]. The majority of the routine checkups are performed by the PN These programs are disease-oriented, which in case of multimorbid patients may lead to inefficient and ineffective treatments and can possibly be even harmful in terms of complex medication interactions and more hospital admissions [5]. A better understanding of the care needs of community-dwelling persons with multimorbidity from a patient perspective is essential to improve person-centered general practice care for this group
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