The Need for Co-Creation of Care with Multi-Morbidity Patients-A Longitudinal Perspective.

Sanne J Kuipers,Anna P Nieboer,Jane M Cramm

doi:10.3390/ijerph17093201

Abstract

Background: Primary care delivery for multimorbid patients is complex, due to single disease–oriented guidelines, complex care needs, time constraints and the involvement of multiple healthcare professionals. Co-creation of care, based on the quality of communication and relationships between healthcare professionals and patients, may therefore be valuable. This longitudinal study investigates the relationships of co-creation of care to physical and social well-being and satisfaction with care among multimorbid patients in primary care. Methods: In 2017 and 2018, longitudinal surveys were conducted among multimorbid patients from seven primary care practices in Noord-Brabant, the Netherlands (n = 138, age = 73.50 ± 9.99). Paired sample t-tests and multivariate regression analyses were performed. (3) Results: Co-creation of care improved significantly over time (t = 2.25, p = 0.026), as did social well-being (t = 2.31, p = 0.022) and physical well-being (t = 2.72, p = 0.007) but not satisfaction with care (t = 0.18, p = 0.858). Improvements in co-creation of care from T0 to T1 were associated with social well-being (B = 0.157, p = 0.002), physical well-being (B = 0.216, p = 0.000) and satisfaction with care (B = 0.240, p = 0.000). (4) Conclusions: Thus, investment in co-creation of care by primary care practices may lead to better outcomes for multimorbid patients.

Highlights

The global prevalence of multi-morbidity is increasing [1]
In the Netherlands, most care delivery for patients with multi-morbidity is managed by general practitioners (GPs) in the primary care setting [11]
Example questions are “How often do you communicate with your GP/nurse practitioner/specialist?” and “To what extent do these people (GP/nurse practitioner/specialist) share your goals?” Responses are given on a scale ranging from 1 to 5, with higher mean scores representing better co-creation of care

Summary

Introduction

The global prevalence of multi-morbidity is increasing [1]. As multi-morbidity is associated with age, its prevalence is expected to increase even further in the near future due to populational ageing [2,3]. Multi-morbidity is often described as the co-existence of two or more chronic conditions in one patient [4] It has been associated with poorer health outcomes, such as reduced functional capacity and quality of life, as well as increased healthcare use [5,6,7,8,9,10]. Primary care delivery for multimorbid patients is complex, due to single disease–oriented guidelines, complex care needs, time constraints and the involvement of multiple healthcare professionals. We used the relational co-production instrument to assess co-creation of care [23] This instrument of 7 items is used to evaluate aspects of communication (whether it is timely, accurate, frequent and problem solving), and the healthcare professional–patient relationship (shared goals, shared knowledge and mutual respect). Change in co-creation of care was measured by subtracting the mean score at T0 from that at T1

Methods

Results

Discussion

Conclusion