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

BMC Family Practice. 2017;18(1):1-11 DOI 10.1186/s12875-017-0622-4

 

Journal Homepage

Journal Title: BMC Family Practice

ISSN: 1471-2296 (Online)

Publisher: BMC

LCC Subject Category: Medicine: Medicine (General)

Country of publisher: United Kingdom

Language of fulltext: English

Full-text formats available: PDF, HTML

 

AUTHORS

Tim Stokes (Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago)
Emma Tumilty (Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago)
Fiona Doolan-Noble (Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago)
Robin Gauld (Otago Business School, University of Otago)

EDITORIAL INFORMATION

Open peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 18 weeks

 

Abstract | Full Text

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.