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BMC Fam Pract. 2017 Apr 5;18(1):51. doi: 10.1186/s12875-017-0622-4.

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

Author information

1
Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand. tim.stokes@otago.ac.nz.
2
Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
3
Otago Business School, University of Otago, Dunedin, New Zealand.

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.

KEYWORDS:

Decision making; General practice; Health services; Multimorbidity; Primary care

PMID:
28381260
PMCID:
PMC5382371
DOI:
10.1186/s12875-017-0622-4
[Indexed for MEDLINE]
Free PMC Article

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