Patient perspectives on primary care for multimorbidity: An integrative review

Abstract

Introduction Improving healthcare for people with multiple chronic or ongoing conditions is receiving increased attention, particularly due to the growing number of people experiencing multimorbidity (MM) and concerns about the sustainability of the healthcare system. Primary care has been promoted as an important resource for supporting people with MM to live well with their conditions and to prevent unnecessary use of health care services. However, traditional primary care has been criticized for not centring the needs and preferences of people with MM themselves. Our aim was to conduct a review that centred on the perspective of people with MM in multiple ways, including having patient partners co‐lead the design, conduct and reporting of findings, and focusing on literature that reported the perspective of people with MM, irrespective of it being experimental or nonexperimental. Methods We searched for published literature in CINAHL with Full Text (EBSCOhost) and MEDLINE All (Ovid). Findings from experimental and nonexperimental studies were integrated into collaboration with patient partners. Results Twenty‐nine articles were included in the review. Findings are described in five categories: (1) Care that is tailored to my unique situation; (2) meaningful inclusion in the team; (3) a healthcare team that is ready and able to address my complex needs; (4) supportive relationships and (5) access when and where I need it. Conclusion This review supports a reorientation of primary care systems to better reflect the experiences and perspectives of people with MM. This can be accomplished by involving patient partners in the design and evaluation of primary care services and incentivizing collaboration among health and social supports and services for people with MM. Patient or Public Contribution Patient partners were involved in the design and conduct of this review, and in the preparation of the manuscript. Their involvement is further elucidated in the manuscript text.

The Subjective Evaluation of Health Status of Multimorbid Patients in Primary Health Care

“…Nepaisant to, poliligotumas lemia iššūkius, susijusius su kasdiene žmogaus veikla, pavyzdžiui, judėjimu, savipriežiūra, namų ruoša, darbu. Tai, kaip konkrečiam pacientui pavyksta susitvarkyti su gyvenimo pokyčiais susirgus, lemia, kaip jis vertins savo sveikatos būklę [8].…”

“…Tačiau kiti tyrėjai pastebi, kad keletu lėtinių ligų sergantys vyrai, lyginant su moterimis, dažniau patiria problemų, susijusių su mobilumu, įprasta veikla, taip pat jie dažniau jaučia stipresnį skausmą [11]. Pažymima, kad blogesnis sveikatos būklės vertinimas priklauso ir nuo poliligotų pacientų žemesnio išsilavinimo, vyresnio amžiaus, vienišumo, pakitusios emocinės būsenos [8].…”

An interpretative phenomenological analysis of the lived experience of people with multimorbidity in low- and middle-income countries

“…A systematic review and qualitative meta-synthesis of the lived experience of mental and physical multimorbidity identified only 19 published studies on this topic, all of which were from high-income countries 21. Another review on a similar topic identified 28 studies, none of which were from LMICs 22. A quick online search yielded one study exploring the lived experience of PLWMM in a LMIC, specifically Malawi 23.…”

Barriers to and enablers of the promotion of patient and family participation in primary healthcare nursing in Brazil, Germany and Spain: A qualitative study

“…Actively making complex care decisions and taking part in work, family and social life simultaneously can be overwhelming for chronically ill patients and their families. Such efforts are associated with high levels of psychosocial stress 1–3 . To maintain their participation in health care and social life, affected persons need support from health professionals 4–6 .…”

“…Such efforts are associated with high levels of psychosocial stress. [1][2][3] To maintain their participation in health care and social life, affected persons need support from health professionals. [4][5][6] Successful patient participation in health care is achieved when patients and health professionals cooperate in care as coproducers.…”