Removing the blindfold: The centrality of care in caring for patients with multiple chronic conditions

Abstract

Chronic multimorbidity is one of the most important problems in contemporary health care. The average middle-aged American lives with at least one chronic condition, and nearly everyone ages with chronic multimorbidity. In this supplement on the care of patients with multiple chronic conditions, readers of Health Service Research will find a collection of reports that offer evidence about health services research's response to the problem of chronic multimorbidity.In this commentary, I focus on the role that primary care and health services research can play in responding to this challenge, with particular attention to the centrality of care itself.How to cite this article: Montori VM. Removing the blindfold:The centrality of care in caring for patients with multiple chronic conditions.

The Role of Primary Care in Improving Population Health

“…77,113,114 Other observers have articulated the third simple rule, to personalize care, through such strategies as helping people to find a sense of safety, not only as part of the process of providing primary care but also as an important aspect of people's lives. 78 Some have identified the benefits of recognizing whether patient encounters are routines, ceremonies, or dramas, and importantly, 115 of protecting people from the dangers of overtreatment, 56 of integrating primary care and behavioral health, 48 of managing complexity 36,64,116 and multimorbidity, 36,117 and of providing sufficient time to move beyond the superficial to know people and their problems in context and to identify and actualize meaningful solutions. [118][119][120] Early exemplars linked knowing individuals and families with knowledge of the community 121 and early bottom-up manifestations such as community-oriented primary care 122,123 now are being reinvented as clinical population medicine, 124 population health, 125 and as the (sometimes for-profit) 126 integration of the social determinants of health 127,128 into health care.…”

“…Other observers have articulated the third simple rule, to personalize care, through such strategies as helping people to find a sense of safety, not only as part of the process of providing primary care but also as an important aspect of people's lives. 78 Some have identified the benefits of recognizing whether patient encounters are routines, ceremonies, or dramas, and importantly, 115 of protecting people from the dangers of overtreatment, 56 of integrating primary care and behavioral health, 48 of managing complexity 36 , 64 , 116 and multimorbidity, 36 , 117 and of providing sufficient time to move beyond the superficial to know people and their problems in context and to identify and actualize meaningful solutions. 118 , 119 , 120 …”

Managing Multiple Chronic Conditions during COVID-19 Among Patients with Social Health Risks

“…Optimal care for persons with multiple chronic medical conditions (MCC) requires primary and specialty care continuity, easy access to multiple providers, self-management support, identifying and managing competing demands, goal-oriented care, and shared decision making. [1][2][3] The COVID-19 pandemic abruptly changed primary care delivery to increase reliance on telehealth and virtual care and to prioritize acute and urgent care needs over chronic disease management. 4,5 Self-management is central to living with MCC.…”

Does the duration of ambulatory consultations affect the quality of healthcare? A systematic review

“…Their completion leaves less time to listen and appreciate the patient’s situation and to co-create plans of care that make intellectual, emotional and practical sense to the patient. Without time, hurried and harried consultations may be more likely to produce generic, burdensome, ineffective, unsafe and unaffordable treatments that may contribute to overwhelmed patients, burned out clinicians and low-quality care 15. Thus, to reliably estimate the association between the duration of ambulatory visits and quality of care, we must rely on controlled experimental evidence.…”