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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Family Practice 1/2017

Multimorbidity, clinical decision making and health care delivery in New Zealand Primary care: a qualitative study

Zeitschrift:
BMC Family Practice > Ausgabe 1/2017
Autoren:
Tim Stokes, Emma Tumilty, Fiona Doolan-Noble, Robin Gauld
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12875-017-0622-4) contains supplementary material, which is available to authorized users.

Abstract

Background

Multimorbidity is a major issue for primary care. We aimed to explore primary care professionals’ accounts of managing multimorbidity and its impact on clinical decision making and regional health care delivery.

Methods

Qualitative interviews with 12 General Practitioners and 4 Primary Care Nurses in New Zealand’s Otago region. Thematic analysis was conducted using the constant comparative method.

Results

Primary care professionals encountered challenges in providing care to patients with multimorbidity with respect to both clinical decision making and health care delivery. Clinical decision making occurred in time-limited consultations where the challenges of complexity and inadequacy of single disease guidelines were managed through the use of “satisficing” (care deemed satisfactory and sufficient for a given patient) and sequential consultations utilising relational continuity of care. The New Zealand primary care co-payment funding model was seen as a barrier to the delivery of care as it discourages sequential consultations, a problem only partially addressed through the use of the additional capitation based funding stream of Care Plus. Fragmentation of care also occurred within general practice and across the primary/secondary care interface.

Conclusions

These findings highlight specific New Zealand barriers to the delivery of primary care to patients living with multimorbidity. There is a need to develop, implement and nationally evaluate a revised version of Care Plus that takes account of these barriers.
Zusatzmaterial
Additional file 1: Interview Topic Guide. The semi-structured interview topic guide questions and probes. (PDF 261 kb)
12875_2017_622_MOESM1_ESM.pdf
Additional file 2: COREQ-32 reporting checklist. An assessment of the study reporting against the domains of the COREQ-32 reporting checklist for interviews and focus groups. (PDF 208 kb)
12875_2017_622_MOESM2_ESM.pdf
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