Facilitators and Barriers of Managing Patients with Multiple Chronic Conditions in the Community: A Qualitative Study

Abstract

Background: Approximately one-third of all adults worldwide are diagnosed with multiple chronic conditions (MCCs). The literature has identified several challenges facing providers and patients coping with managing MCCs in the community, yet few studies have considered their viewpoints in combination. A qualitative study involving healthcare providers and users was thus conducted to examine facilitators and barriers of managing patients with MCCs in the community in Singapore. Methods:This study involves 26 semi-structured interviews with 10 physicians, 2 caregivers and 14 patients seeking treatment in the polyclinics that provide subsidised primary care services. Topic guides were developed with reference to the literature review, Chronic Care Model (CCM) and framework for patient-centred access to healthcare.Results: Despite the perceived affordability and availability of the support system, some patients still encountered financial difficulties in managing care. These include inadequacy of the nation-wide medical savings scheme to cover outpatient treatment and medications. Half of healthcare users did not know where to seek help. While patients could access comprehensive services in polyclinics, those who did not visit the clinics might not receive timely care. Furthermore, patients reported long consultation waiting time.Physicians were able to propose and drive quality improvement projects to improve care quality.However, there were challenges to delivering safe and quality care with limited consultation duration due to the need to manage high patient load and waiting time, inadequate communication with specialists to coordinate care, and resource constraints in managing complex patients.Although providers could equip patients with self-management and lifestyle-related guidelines, patients' actions are influenced by multiple factors, including work requirements, beliefs and environment.Conclusions: There were barriers on care access, delivery and self-management. It is crucial to adopt a whole-of-society approach involving individuals, community, institutions and policymakers to improve and support MCC management. This study has also highlighted the importance of considering the different viewpoints of healthcare providers and users in policy formulation and Kah Mun Foo is the first author of this paper.

Community Health Workers as Healthcare Navigators in Primary Care Chronic Disease Management: a Systematic Review

“…13 Studies carried out in different countries point out that lack of time during the clinical visit is one of the most important barriers to the provision of quality primary care for chronic diseases. 14 In a recent study carried out in Australian general practice, Song and colleagues 15 reported that a major barrier to access care among patients with chronic conditions was providers' inability to tailor care to patients' expectations and preferences. Culturally and linguistically diverse patients also experience barriers due to inadequate English language proficiency, lack of understanding of health system, poor health literacy, and inability to pay high out-of-pocket costs for referral services.…”