Increasing Primary Care Comorbidity: A Conceptual Research and Practice Framework

Corser, William

doi:10.1891/1541-6577.25.4.238

Cited by 5 publications

(4 citation statements)

References 53 publications

(179 reference statements)

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“…Even when the focus lies on the treatment of physical conditions, in many of the programmes, mental health and the social situation are routinely addressed to facilitate treatment of physical health problems. While the interconnectedness of physical health, mental health and social circumstances has been acknowledged in the literature [36][37][38][39][40], our analysis shows how much this connection matters on a practical level to several stakeholder groups.…”

Section: Discussionmentioning

confidence: 82%

“…There is increasing consensus that integrated care of persons with complex needs cannot exclusively address physical health problems, but needs to adopt a holistic view of the person [36][37][38][39][40]. This is based on the recognition that physical health, mental health and the social situation are interconnected and should therefore not be dealt with independently.…”

Section: Holistic View Of the Patientmentioning

confidence: 99%

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The patient at the centre: evidence from 17 European integrated care programmes for persons with complex needs

Czypionka

Kraus

Reiss

et al. 2020

BMC Health Serv Res

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Background As the prevalence of multi-morbidity increases in ageing societies, health and social care systems face the challenge of providing adequate care to persons with complex needs. Approaches that integrate care across sectors and disciplines have been increasingly developed and implemented in European countries in order to tackle this challenge. The aim of the article is to identify success factors and crucial elements in the process of integrated care delivery for persons with complex needs as seen from the practical perspective of the involved stakeholders (patients, professionals, informal caregivers, managers, initiators, payers). Methods Seventeen integrated care programmes for persons with complex needs in 8 European countries were investigated using a qualitative approach, namely thick description, based on semi-structured interviews and document analysis. In total, 233 face-to-face interviews were conducted with stakeholders of the programmes between March and September 2016. Meta-analysis of the individual thick description reports was performed with a focus on the process of care delivery. Results Four categories that emerged from the overarching analysis are discussed in the article: (1) a holistic view of the patient, considering both mental health and the social situation in addition to physical health, (2) continuity of care in the form of single contact points, alignment of services and good relationships between patients and professionals, (3) relationships between professionals built on trust and facilitated by continuous communication, and (4) patient involvement in goal-setting and decision-making, allowing patients to adapt to reorganised service delivery. Conclusions We were able to identify several key aspects for a well-functioning integrated care process for complex patients and how these are put into actual practice. The article sets itself apart from the existing literature by specifically focussing on the growing share of the population with complex care needs and by providing an analysis of actual processes and interpersonal relationships that shape integrated care in practice, incorporating evidence from a variety of programmes in several countries.

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Section: Discussionmentioning

confidence: 82%

Section: Holistic View Of the Patientmentioning

confidence: 99%

The patient at the centre: evidence from 17 European integrated care programmes for persons with complex needs

Czypionka

Kraus

Reiss

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…Conceptualisations of failure tended to relate to quantifiable aspects of care [ 1 , 27 , 28 , 61 - 63 ]. This may simply reflect the nature of tools currently available to assess effectiveness and efficiency of care and learning in the context of multimorbidity.…”

Section: Resultsmentioning

confidence: 99%

“…dissatisfaction with care offered) and trainees (e.g. replication of practices which would not serve patients well) [ 13 , 27 , 28 , 37 , 50 , 57 , 63 , 64 , 70 , 71 ]. Concerns were also raised about the potential risk of disrupting good practice by imposing interventions based on assumptions rather than understanding of what had been occurring prior to the intervention [ 41 ].…”

Section: Resultsmentioning

confidence: 99%

Modelling successful primary care for multimorbidity: a realist synthesis of successes and failures in concurrent learning and healthcare delivery

et al. 2015

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BackgroundPeople are increasingly living for longer with multimorbidity. Medical education and healthcare delivery must be re-orientated to meet the societal and individual patient needs that multimorbidity confers. The impact of multimorbidity on the educational needs of doctors is little understood. There has been little critique of how learning alongside healthcare provision is negotiated by patients, general practitioners and trainee doctors. This study asked ‘what is known about how and why concurrent healthcare delivery and professional experiential learning interact to generate outcomes, valued by patients, general practitioners and trainees, for patients with multimorbidity in primary care?’MethodsThis realist synthesis is reported using RAMESES standards. Relationship-centred negotiation of needs-based learning and care was the primary outcome of interest. Healthcare, social science and educational literature were sought as evidence. Data extraction focused on context, mechanism and outcome configurations within studies and on data which might assist understanding and explain; i) these configurations; ii) the relationships between them and; iii) their role and place in evolving programme theories arising from data synthesis. Mind-mapping software and team meetings were used to aid interpretative analysis.ResultsThe final synthesis included 141 papers of which 34 contained models for workplace-based experiential learning and/or patient care. Models of experiential learning for practitioners and for patient engagement were congruent, frequently referencing theories of transformation and socio-cultural processes as mechanisms for improving clinical care. Key issues included the perceived impossibility of reconciling personalised concepts of success with measurability of clinical markers or adherence to guidelines, and the need for greater recognition of social dynamics between patients, GPs and trainees including the complexities of shared responsibilities. A model for considering the implications of concurrency for learning and healthcare delivery in the context of multimorbidity in primary care is proposed and supporting evidence is presented.ConclusionsThis study is novel in considering empirical evidence from patients, GPs and trainees engaged in concurrent learning and healthcare delivery. The findings should inform future interventions designed to produce a medical workforce equipped to provide multimorbidity care.Trial registrationPROSPERO International prospective register of systematic reviews CRD42013003862Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0234-9) contains supplementary material, which is available to authorized users.

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The SELFIE framework for integrated care for multi-morbidity: Development and description

Leijten

Struckmann²,

Ginneken³

et al. 2018

Health Policy

185

226

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Increasing Primary Care Comorbidity: A Conceptual Research and Practice Framework

Cited by 5 publications

References 53 publications

The patient at the centre: evidence from 17 European integrated care programmes for persons with complex needs

The patient at the centre: evidence from 17 European integrated care programmes for persons with complex needs

Modelling successful primary care for multimorbidity: a realist synthesis of successes and failures in concurrent learning and healthcare delivery

The SELFIE framework for integrated care for multi-morbidity: Development and description

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