Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Dec;20(6):1311-1319.
doi: 10.1111/hex.12571. Epub 2017 May 24.

"It's a fight to get anything you need" - Accessing care in the community from the perspectives of people with multimorbidity

Julia W Ho  1   2 , Kerry Kuluski  1   2 , Jennifer Im  1
Affiliations

"It's a fight to get anything you need" - Accessing care in the community from the perspectives of people with multimorbidity

Julia W Ho et al. Health Expect. 2017 Dec.

Abstract

Background: There is a growing interest in redesigning health-care systems to better manage the increasing numbers of people with multimorbidity. Knowing how patients experience health-care delivery and what they need from the health-care system are critical pieces of evidence that can be used to guide health system reforms.

Objective: The purpose of this study was to understand the challenges patients with multimorbidity face in accessing care in the community, and the implications for patients and their families.

Methods: A secondary analysis of qualitative data was conducted on semi-structured interviews with 116 patients who were receiving care in an urban rehabilitation facility in 2011. Exploratory interpretive analysis was used to identify themes about access to care.

Results: Challenges occurred at two levels: at the health system level and at the individual (patient) level. Issues at the health system level fell into two broad categories: availability of services (failing to qualify, coping with wait times, struggling with scarcity and negotiating the location of care) and service delivery (unreliable care, unmet needs, incongruent care and inflexible care). Challenges at the patient level fell into the themes of logistics of accessing care and financial strain. Patients interacted and responded to these challenges by: managing the system, making personal sacrifices, substituting with informal care, and resigning to system constraints.

Conclusion: Identifying the barriers patients encounter and the lengths they go to in order to access care highlights areas where policy initiatives can focus to develop appropriate and supportive services that are more person and family-centred.

Keywords: access to care; chronic disease management; multimorbidity; multiple chronic disease; patient experience; qualitative methods.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Themes of access to care in the community for patients with multimorbidity
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. World Health Organization . Global status report on noncommunicable diseases. Geneva; 2014.
    1. Canadian Institute of Health Information . Seniors and the health care system: What is the impact of multiple chronic conditions? Ottawa; 2011.
    1. Bähler C, Huber CA, Brüngger B, Reich O. Multimorbidity, health care utilization and costs in an elderly community‐dwelling population: a claims data based observational study. BMC Health Services Research. 2015;15:1‐12. - PMC - PubMed
    1. Oostrom SH, Picavet HS, Bruin SR, Stirbu I, Korevaar JC, Schellevis FG. Multimorbidity of chronic diseases and health care utilization in general practice. BMC Fam Pract. 2014;15:516‐523. - PMC - PubMed
    1. Glynn LG, Valderas JM, Healy P, Burke E, Newell J, Gillespie P. The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. Fam Pract. 2011;28:516‐523. - PubMed

Publication types

LinkOut - more resources