Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Primary Care
Published in: BMC Primary Care 1/2021

Open Access 01-12-2021 | Care | Research article

Making care more patient centered; experiences of healthcare professionals and patients with multimorbidity in the primary care setting

Authors: Sanne Jannick Kuipers, Anna Petra Nieboer, Jane Murray Cramm

Published in: BMC Primary Care | Issue 1/2021

Login to get access

Abstract

Background

The present study describes how primary care can be improved for patients with multimorbidity, based on the evaluation of a patient-centered care (PCC) improvement program designed to foster the eight PCC dimensions (patient preferences, information and education, access to care, physical comfort, coordination of care, continuity and transition, emotional support, and family and friends). This study characterizes the interventions implemented in practice as part of the PCC improvement program and describes the experiences of healthcare professionals and patients with the resulting PCC delivery.

Methods

This study employed a mixed-methods design. Semi-structured interviews were conducted with nine general practitioners and nurse practitioners from seven primary care practices in Noord-Brabant, the Netherlands, that participated in the program (which included interventions and workshops). The qualitative interview data were examined using thematic analysis. A longitudinal survey was conducted with 138 patients with multimorbidity from these practices to assess perceived improvements in PCC and its underlying dimensions. Paired sample t tests were performed to compare survey responses obtained at a 1-year interval corresponding to program implementation.

Results

The PCC improvement program is described, and themes necessary for PCC improvement according to healthcare professionals were generated [e.g. Aligning information to patients’ needs and backgrounds, adapting a coaching role]. PCC experiences of patients with multimorbidity improved significantly during the year in which the PCC interventions were implemented (t = 2.66, p = 0.005).

Conclusion

This study revealed how primary PCC can be improved for patients with multimorbidity. It emphasizes the importance of investing in PCC improvement programs to tailor care delivery to heterogenous patients with multimorbidity with diverse care needs. This study generates new perspectives on care delivery and highlights opportunities for its improvement according to the eight dimensions of PCC for patients with multimorbidity in a primary care setting.
Literature
1.
Richardson WC, Berwick D, Bisgard J, Bristow L, Buck C, Cassel C. Crossing the quality chasm: a new health system for the 21st century: Institute of Medicine. Washington: National Academy Press; 2001.
2.
Gerteis M, Edgman-Levitan S, Walker JD, Stoke DM, Cleary PD, Delbanco TL. What patients really want. Health Manag Q. 1993;15(3):2–6.
3.
Gerteis M, Edgman-Levitan S, Daley J, Delbanco TL. Through the patient’s eyes: understanding and promoting patient-centered care. J Healthcare Quality. 1997;19(3):43.
4.
Davis K, Schoenbaum SC, Audet A. A 2020 vision of patient-centered primary care. J Gen Intern Med. 2005;20(10):953–7.CrossRef
5.
Rathert C, Wyrwich MD, Boren SA. Patient-centered care and outcomes: a systematic review of the literature. Med Care Res Rev. 2013;70(4):351–79.CrossRef
6.
Kuipers SJ, Cramm JM, Nieboer AP. The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting. BMC Health Serv Res. 2019;19(1):13.CrossRef
7.
Fortin M, Bravo G, Hudon C, Vanasse A, Lapointe L. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med. 2005;3(3):223–8.CrossRef
8.
Nunes BP, Flores TR, Mielke GI, Thume E, Facchini LA. Multimorbidity and mortality in older adults: a systematic review and meta-analysis. Arch GerontolGeriatr. 2016;67:130–8.
9.
Fortin M, Lapointe L, Hudon C, Vanasse A, Ntetu AL, Maltais D. Multimorbidity and quality of life in primary care: a systematic review. Health Qual Life Outcomes. 2004;2:51.CrossRef
10.
Vetrano DL, Palmer K, Marengoni A, Marzetti E, Lattanzio F, Roller-Wirnsberger R, et al. Frailty and multimorbidity: a systematic review and meta-analysis. The Journals of Gerontology: Series A. 2019;74(5):659–66.CrossRef
11.
Makovski TT, Schmitz S, Zeegers MP, Stranges S, van den Akker M. Multimorbidity and quality of life: systematic literature review and meta-analysis. Ageing Res QueryReviews. 2019;53(100903).
12.
Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011;10(4):430–9.CrossRef
13.
Tinetti ME, Bogardus ST Jr, Agostini JV. Potential pitfalls of disease-specific guidelines for patients with multiple conditions. New Eng J Med. 2004;351(27):2870–4.CrossRef
14.
Lugtenberg M, Burgers JS, Clancy C, Westert GP, Schneider EC. Current guidelines have limited applicability to patients with comorbid conditions: a systematic analysis of evidence-based guidelines. PLoS ONE. 2011;6(10):e25987.CrossRef
15.
Navickas R, Petric VK, Feigl AB, Seychell M. Multimorbidity: what do we know? What should we do? J Comorb. 2016;6(1):4–11.CrossRef
16.
Cramm JM, Nieboer AP. Validation of an instrument to assess the delivery of patient-centred care to people with intellectual disabilities as perceived by professionals. BMC Health Serv Res. 2017;17(1):472.CrossRef
17.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
18.
Rijken M, van der Heide I. Identifying subgroups of persons with multimorbidity based on their needs for care and support. BMC FamPract. 2019;20(1):1–10.
19.
Kuipers S, Nieboer A, Cramm J. Views of patients with multi-morbidity on what is important for patient-centered care in the primary care setting. BMC FamPract. 2020;21(71):1–12.
20.
Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. 2013;3(1):10.CrossRef
21.
22.
van der Aa MJ, van den Broeke JR, Stronks K, Plochg T. Patients with multimorbidity and their experiences with the healthcare process: a scoping review. J Comorbidity. 2017;7(1):11–21.CrossRef
23.
Bayliss EA, Edwards AE, Steiner JF, Main DS. Processes of care desired by elderly patients with multimorbidities. FamPract. 2008;25(4):287–93.CrossRef
24.
Koyanagi A, Garin N, Olaya B, Ayuso-Mateos JL, Chatterji S, Leonardi M, et al. Chronic conditions and sleep problems among adults aged 50 years or over in nine countries: a multi-country study. PLoS ONE. 2014;9(12):e114742.CrossRef
25.
Scherer M, Hansen H, Gensichen J, Mergenthal K, Riedel-Heller S, Weyerer S, et al. Association between multimorbidity patterns and chronic pain in elderly primary care patients: a cross-sectional observational study. BMC FamPract. 2016;17(1):68.
26.
Arneill AB, Devlin AS. Perceived quality of care: The influence of the waiting room environment. J Environ Psychol. 2002;22(4):345–60.CrossRef
27.
Gittell JH. Relationships between service providers and their impact on customers. J Serv Res. 2002;4(4):299–311.CrossRef
28.
Van Walraven C, Oake N, Jennings A, Forster AJ. The association between continuity of care and outcomes: a systematic and critical review. J EvalClinPract. 2010;16(5):947–56.
29.
Saint-Pierre C, Herskovic V, Sepúlveda M. Multidisciplinary collaboration in primary care: a systematic review. FamPract. 2018;35(2):132–41.CrossRef
30.
Vancampfort D, Koyanagi A, Hallgren M, Probst M, Stubbs B. The relationship between chronic physical conditions, multimorbidity and anxiety in the general population: a global perspective across 42 countries. Gen Hosp Psychiatry. 2017;45:1–6.CrossRef
31.
Read JR, Sharpe L, Modini M, Dear BF. Multimorbidity and depression: a systematic review and meta-analysis. J Affect Disord. 2017;221:36–46.CrossRef
32.
Prior L, Wood F, Lewis G, Pill R. Stigma revisited, disclosure of emotional problems in primary care consultations in Wales. SocSci Med. 2003;56(10):2191–200.CrossRef
33.
Priest RG, Vize C, Roberts A, Roberts M, Tylee A. Lay people’s attitudes to treatment of depression: results of opinion poll for Defeat Depression Campaign just before its launch. BMJ. 1996;313(7061):858–9.
34.
Embuldeniya G, Veinot P, Bell E, Bell M, Nyhof-Young J, Sale JE, et al. The experience and impact of chronic disease peer support interventions: A qualitative synthesis. Patient EducCouns. 2013;92(1):3–12.CrossRef
35.
Dineen-Griffin S, Garcia-Cardenas V, Williams K, Benrimoj SI. Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice. PLoS ONE. 2019;14(8):e0220116.CrossRef
36.
Deek H, Hamilton S, Brown N, Inglis SC, Digiacomo M, Newton PJ, et al. Family-centred approaches to healthcare interventions in chronic diseases in adults: a quantitative systematic review. J AdvNurs. 2016;72(5):968–79.
37.
Van der Heide I, Snoeijs S, Quattrini S, Struckmann V, Hujala A, Schellevis F, et al. Patient-centeredness of integrated care programs for people with multimorbidity. Results from the European ICARE4EU project. Health Policy. 2018;122(1):36–43.
38.
Kringos DS, Boerma WGW, Hutchinson A, Saltman RB. Building primary care in a changing Europe. Copenhagen: WHO Regional Office for Europe; 2015.
39.
World Health Organization. People-centred health care; technical papers: Geneva; 2008.
Metadata
Title
Making care more patient centered; experiences of healthcare professionals and patients with multimorbidity in the primary care setting
Authors
Sanne Jannick Kuipers
Anna Petra Nieboer
Jane Murray Cramm
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Care
Published in
BMC Primary Care / Issue 1/2021
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-021-01420-0

Other articles of this Issue 1/2021

BMC Primary Care 1/2021 Go to the issue

Research

Self-management perspectives of elderly patients with multimorbidity and practitioners - status, challenges and further support needed?

Research

Somatic complaints as a mediator in the association between body mass index and quality of life in children and adolescents

Research

Co-creating opportunities to incorporate cessation for electronic nicotine delivery systems in family medicine – a qualitative program evaluation

Research

Cost effectiveness of using Faecal Immunochemical Testing (FIT) as an initial diagnostic investigation for patients with lower gastrointestinal symptoms suggestive of malignancy

Research

Patients’ impressions of after-hours house-call services during the COVID-19 pandemic in Japan: a questionnaire-based observational study

Research article

Continuity in general practice and hospitalization patterns: an observational study