“Standing on common ground” - a qualitative study of self-management support for patients with multimorbidity in primary health care

Abstract

Background Multimorbidity, the co-existence of two or more chronic conditions in an individual, is present in most patients over 65 years. Primary health care (PHC) is uniquely positioned to provide the holistic and continual care recommended for this group of patients, including support for self-management. The aim of this study was to explore professionals’, patients’, and family caregivers’ perspectives on how PHC professionals should support self-management in patients with multimorbidity. This study also includes experiences of using telemedicine to support self-management. Methods A mixed qualitative method was used to explore regular self-management support and telemedicine as a tool to support self-management. A total of 42 participants (20 physicians, 3 registered nurses, 12 patients, and 7 family caregivers) were interviewed using focus group interviews (PHC professionals), pair interviews (patients and family caregivers), and individual interviews (registered nurses, patients, and family caregivers). The study was performed in urban areas in central Sweden and rural areas in southern Sweden between April 2018 and October 2019. Data were analyzed using content analysis. Results The main theme that emerged was “Standing on common ground enables individualized support.” To achieve such support, professionals needed to understand their own views on who bears the primary responsibility for patients’ self-management, as well as patients’ self-management abilities, needs, and perspectives. Personal continuity and trustful relationships facilitated this understanding. The findings also indicated that professionals should be accessible for patients with multimorbidity, function as knowledge translators (help patients understand their symptoms and how the symptoms correlated with diseases), and coordinate between levels of care. Telemedicine supported continual monitoring and facilitated patient access to PHC professionals. Conclusion Through personal continuity and patient-centered consultations, professionals could collaborate with patients to individualize self-management support. For some patients, this means that PHC professionals are in control and monitor symptoms. For others, PHC professionals play a less controlling role, empowering patients’ self-management. Development and improvement of eHealth tools for patients with multimorbidity should focus on improving the ability to set mutual goals, strengthening patients’ inner motivation, and including multiple caregivers to enhance information-sharing and care coordination.

Integrated self-management support provided by primary care nurses to persons with chronic diseases and common mental disorders: a scoping review

“…According to Harris et al [ 73 ], a quality relationship based on mutual trust facilitates individualization of the SMS, communication, engagement, and would increase the person’s willingness to consider the nurse’s advice. In a qualitative study exploring how SMS should be applied in a multimorbidity clientele [ 74 ], the presence of a trusting relationship; an individualized SMS “by taking the patient’s agenda into account” (p. 6); relational continuity; and support “that went beyond information and disease management” (p. 6) are important elements. Another study reports similarities, noting that an SMS was perceived to be more effective in the presence of a needs-based (rather than disease-focused) relationship involving information exchange, negotiation and relational continuity [ 75 ].…”

“…Central to several models of person-centered and integrative approaches [ 27 , 80 – 83 ], the biopsychosocial perspective is another defining feature of the integrated SMS, as it allows for the management of all health issues. However, it seems more difficult to apply a biopsychosocial SMS to each session and a few reasons may explain this: a lack of expertise in the field of psychosocial support and mental health; administrative priorities (e.g., data collection, funding) favoring physical CD; short encounters limiting holistic management; and predominantly biomedical clinical targets [ 23 , 73 , 74 ]. To improve the biopsychosocial approach and the clinical integration of SMS, the reviewed studies made several recommendations to enhance nurses’ training on the biopsychosocial approach [ 41 , 44 ], patient engagement [ 41 ], behavioral change management and behavioral activation [ 41 , 56 ], motivational interviewing [ 41 , 44 , 58 ], psychosocial support [ 41 , 57 ], anxiety [ 57 ], and listening [ 60 ].…”

eHealth in Care Coordination for Older Adults Living at Home: Scoping Review

“…See an overview of the study designs and participant characteristics in Table 1. Qualitative study Freilich et al [52], Sweden a COPD: chronic obstructive pulmonary disease. In total, 44% (7/16) of the studies were conducted in the United States [39,40,42,43,[46][47][48][49].…”

How do nurses support chronically ill clients’ participation and self-management in primary care? A cross-country qualitative study

“…For the chronically ill, primary care is the first and continuous point of contact in the healthcare system [ 8 ]. Particularly in more recent care models, these are the nurses who often encourage patients with chronic illness to participate in their own care by enhancing their health literacy [ 9 , 10 ] and promoting self-management [ 11 – 13 ].…”