"Where do we go from here?" Health system frustrations expressed by patients with multimorbidity, their caregivers and family physicians

. 2014 May;9(4):73-89.

"Where do we go from here?" Health system frustrations expressed by patients with multimorbidity, their caregivers and family physicians

Ashlinder Gill¹, Kerry Kuluski², Liisa Jaakkimainen³, Gayathri Naganathan⁴, Ross Upshur⁵, Walter P Wodchis⁶

Affiliations

¹ Graduate Student, Institute of Health Policy, Management & Evaluation, University of Toronto, Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Active Healthcare, Toronto, ON.
² Research Scientist, Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Active Healthcare, Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON.
³ Department of Family and Community Medicine, Primary Care Research Unit, Sunnybrook Health Sciences Centre, Scientist, Institute for Clinical Evaluative Sciences, Toronto, ON.
⁴ Graduate Student, Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON.
⁵ Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Active Healthcare, Department of Family and Community Medicine, Primary Care Research Unit, Sunnybrook Health Sciences Centre, Adjunct Scientist, Institute for Clinical Evaluative Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON.
⁶ Institute of Health Policy, Management & Evaluation, University of Toronto Adjunct Scientist, Institute for Clinical Evaluative Sciences Research Scientist, Toronto Rehabilitation Institute, Toronto, ON.

PMID: 24973485
PMCID: PMC4749886

"Where do we go from here?" Health system frustrations expressed by patients with multimorbidity, their caregivers and family physicians

Ashlinder Gill et al. Healthc Policy. 2014 May.

. 2014 May;9(4):73-89.

Authors

Ashlinder Gill¹, Kerry Kuluski², Liisa Jaakkimainen³, Gayathri Naganathan⁴, Ross Upshur⁵, Walter P Wodchis⁶

Affiliations

¹ Graduate Student, Institute of Health Policy, Management & Evaluation, University of Toronto, Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Active Healthcare, Toronto, ON.
² Research Scientist, Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Active Healthcare, Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON.
³ Department of Family and Community Medicine, Primary Care Research Unit, Sunnybrook Health Sciences Centre, Scientist, Institute for Clinical Evaluative Sciences, Toronto, ON.
⁴ Graduate Student, Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON.
⁵ Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Active Healthcare, Department of Family and Community Medicine, Primary Care Research Unit, Sunnybrook Health Sciences Centre, Adjunct Scientist, Institute for Clinical Evaluative Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON.
⁶ Institute of Health Policy, Management & Evaluation, University of Toronto Adjunct Scientist, Institute for Clinical Evaluative Sciences Research Scientist, Toronto Rehabilitation Institute, Toronto, ON.

PMID: 24973485
PMCID: PMC4749886

Abstract
in English, French

Objectives: This study explored the care challenges experienced by older patients with multimorbidity, their informal caregivers and family physicians.

Approach: Semi-structured interviews were conducted with 27 patients, their informal caregivers and family physicians. Qualitative description was used to identify key themes in the interview transcripts.

Results: Participants experienced many common challenges when managing multimorbidity, including a lack of decision-making support, poor communication and uncoordinated health services. Within these themes, unique perspectives specific to the role of being a patient, caregiver or family physician emerged.

Conclusion: The study adds to a limited evidence base on the experience of patients with multimorbidity. By including the perspectives of their family caregivers and physicians, we provide important insight into the management of multimorbidity and recommend the uptake of specific strategies to address them.

Objectif: Cette étude explore les défis vécus par les patients aînés en situation de multimorbidité, leurs aidants naturels et leurs médecins de famille.

Démarche: Des entrevues semi-dirigées ont été menées auprès de 27 patients, de leurs aidants naturels et de leurs médecins de famille. Les principaux thèmes des transcriptions des entrevues ont été dégagés à l'aide d'une description qualitative.

Résultats: Les participants éprouvent plusieurs défis communs dans la gestion de la multimorbidité, notamment un manque de soutien pour la prise de décision, de mauvaises communications et des services de santé non coordonnés. Parmi ces thèmes, il y a émergence de points de vue uniques propres aux rôles du patient, de l'aidant ou du médecin.

Conclusion: L'étude s'ajoute au peu de données fondées sur l'expérience des patients en situation de multimorbidité. En incluant les points de vue des aidants naturels et des médecins, nous apportons des pistes importantes pour la gestion de la multimorbidité et nous recommandons l'adoption de stratégies particulières pour aborder la question.

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References

1. Bayliss E.A., Edwards A.E., Stiener J.F., Main D.S. 2008. “Processes of Care Desired by Elderly Patients with Multimorbidities.” Family Practice 25: 287–93. - PMC - PubMed
1. Boyd C.M., Darer J., Boult C., Fried L.P., Boult L., Wu A.W. 2005. “Clinical Practice Guidelines and Quality of Care for Older Patients with Multiple Comorbid Diseases: Implications for Pay for Performance.” Journal of the American Medical Association 294(6): 716–24. - PubMed
1. Boult C., Karm L., Groves C. 2008. “Improving Chronic Care: The ‘Guided Care’ Model.” The Permanente Journal 12(1): 50–54. - PMC - PubMed
1. Broemeling A., Watson D.E., Prebtani F. 2008. “Population Patterns of Chronic Health Conditions, Co-morbidity and Healthcare Use in Canada.” Healthcare Quarterly 11(3): 71–78. - PubMed
1. Chouinard M.C., Hudon C., Dubois M.F., Roberge P., Loignon C., Tchouaket E. et al. 2013. “Case Management and Self-Management Support for Frequent Users with Chronic Disease in Primary Care: A Pragmatic Randomized Controlled Trial.” BMC Health Services Research 13: 49. - PMC - PubMed

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[1] Bayliss E.A., Edwards A.E., Stiener J.F., Main D.S. 2008. “Processes of Care Desired by Elderly Patients with Multimorbidities.” Family Practice 25: 287–93. - PMC - PubMed

[2] Bayliss E.A., Edwards A.E., Stiener J.F., Main D.S. 2008. “Processes of Care Desired by Elderly Patients with Multimorbidities.” Family Practice 25: 287–93. - PMC - PubMed

[3] Boyd C.M., Darer J., Boult C., Fried L.P., Boult L., Wu A.W. 2005. “Clinical Practice Guidelines and Quality of Care for Older Patients with Multiple Comorbid Diseases: Implications for Pay for Performance.” Journal of the American Medical Association 294(6): 716–24. - PubMed

[4] Boyd C.M., Darer J., Boult C., Fried L.P., Boult L., Wu A.W. 2005. “Clinical Practice Guidelines and Quality of Care for Older Patients with Multiple Comorbid Diseases: Implications for Pay for Performance.” Journal of the American Medical Association 294(6): 716–24. - PubMed

[5] Boult C., Karm L., Groves C. 2008. “Improving Chronic Care: The ‘Guided Care’ Model.” The Permanente Journal 12(1): 50–54. - PMC - PubMed

[6] Boult C., Karm L., Groves C. 2008. “Improving Chronic Care: The ‘Guided Care’ Model.” The Permanente Journal 12(1): 50–54. - PMC - PubMed

[7] Broemeling A., Watson D.E., Prebtani F. 2008. “Population Patterns of Chronic Health Conditions, Co-morbidity and Healthcare Use in Canada.” Healthcare Quarterly 11(3): 71–78. - PubMed

[8] Broemeling A., Watson D.E., Prebtani F. 2008. “Population Patterns of Chronic Health Conditions, Co-morbidity and Healthcare Use in Canada.” Healthcare Quarterly 11(3): 71–78. - PubMed

[9] Chouinard M.C., Hudon C., Dubois M.F., Roberge P., Loignon C., Tchouaket E. et al. 2013. “Case Management and Self-Management Support for Frequent Users with Chronic Disease in Primary Care: A Pragmatic Randomized Controlled Trial.” BMC Health Services Research 13: 49. - PMC - PubMed

[10] Chouinard M.C., Hudon C., Dubois M.F., Roberge P., Loignon C., Tchouaket E. et al. 2013. “Case Management and Self-Management Support for Frequent Users with Chronic Disease in Primary Care: A Pragmatic Randomized Controlled Trial.” BMC Health Services Research 13: 49. - PMC - PubMed

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"Where do we go from here?" Health system frustrations expressed by patients with multimorbidity, their caregivers and family physicians

Affiliations

"Where do we go from here?" Health system frustrations expressed by patients with multimorbidity, their caregivers and family physicians

Authors

Affiliations

Abstract
in English, French

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Cited by

References

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MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Abstract in English, French

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Cited by

References

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Abstract
in English, French