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

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.

My Goals Are Not Their Goals: Barriers and Facilitators to Delivery of Patient-Centered Care for Patients with Multimorbidity

“… 21 Even in VHA practices with other structural and staffing-based advantages for patient-centered care, communication was still perceived as a primary facilitator by our PCPs—underscoring its foundational role for patient-centered multimorbidity care. 20 – 22 , 29 , 30 PCP perception of communication triangulates with studies from the patient perspective of communication facilitating patient-centeredness. Patient perception of better clinician communication correlates with satisfaction, therapeutic alliance, and adherence.…”

“…Systematic reviews have summarized how PCPs approach care decisions for patients with multimorbidity. 9 , 11 , 20 Only a few studies have focused on perceived PCP ability to deliver patient-centered care for these patients, 21 , 22 and none describes this for US PCPs in the unique VHA environment. This study aimed to improve understanding of perceived barriers and facilitators to patient-centered care for complex patients with multimorbidity for this clinician group.…”

Research policy for people with multiple long-term conditions and their carers

“…There will be substantial lessons from the way that technology has been used during the lockdown phases of the COVID-19 response but it is already apparent from the literature evaluating telemedicine in primary care that we should better understand the barriers to this evolution, 18 with possible impact on goals such as personalised care, and on unintended consequences such as practitioner workload. [19][20][21] These approaches need careful evaluation to ensure that they meet the needs of service users with MLTC rather than the needs of services, and that they do not further increase health inequalities and entrench the Inverse Care Law, ensuring access to and availability of high quality, personalised care for all, especially currently under-served communities living with the highest burden from MLTC. 22 There is a need to understand for whom digital and technological approaches do not work (or which aspects of care are best managed with other approaches), as well as how they can best be implemented for those for whom they are an effective way to provide care or other management.…”

Understanding the processes behind the decisions – GPs and complex multimorbidity decision making

“…Thirdly, with organizational barriers reported by PCPs as part of the decision-making process for this group of patients efforts to identify what these are and how they may be addressed are of particular importance on a regional and national level. Dutch work reported considerable barriers to the delivery of patient-centered care, an important component of effective care for patients with multimorbidity [ 33 ], which were reported at the patient, organizational and national level [ 34 ] with a systematic review of qualitative research reporting similar challenges alongside the impact of fragmentation of healthcare and barriers to shared decision-making for PCPs when managing patients with multimorbidity [ 35 ]. The paper extends several other findings, such as the fact that care coordination is valued by primary care providers, the inadequacy of current guidelines for patients with multimorbidity, the benefits experienced by PCPs in collaborative team-based decision-making and that longer consultation times are prioritized by PCPs for patients with complex multimorbidity.…”