Family Practice Advance Access originally published online on July 14, 2008
Family Practice 2008 25(4):287-293; doi:10.1093/fampra/cmn040
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Published by Oxford University Press. 2008.
Processes of care desired by elderly patients with multimorbidities
a Kaiser Permanente Institute for Health Research, Denver, CO
b Department of Family Medicine, University of Colorado Denver, Denver, CO, USA
c Colorado Health Outcomes Program, University of Colorado Denver, Denver, CO, USA
Correspondence to Elizabeth A Bayliss, Kaiser Permanente Institute for Health Research, PO Box 378066, Denver, CO 80237-8066, USA; Email: elizabeth.bayliss{at}kp.org
Received 22 January 2008; Revised 3 June 2008; Accepted 9 June 2008.
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Abstract |
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Background. Most recommended care for chronic diseases is based on the research of single conditions. There is limited information on ‘best’ processes of care for persons with multiple morbidities. Our objective was to explore processes of care desired by elderly patients who have multimorbidities that may present competing demands for patients and providers.
Methods. Qualitative investigation using one-on-one interviews of 26 community-dwelling HMO members aged 65–84 (50% male) who had, at a minimum, the combined conditions of diabetes, depression and osteoarthritis. Participants were chosen from a stratified random sample to have a range of 4–16 chronic medical conditions.
Results. Participants’ desired processes of care included: the need for convenient access to providers (telephone, internet or in person), clear communication of individualized care plans, support from a single coordinator of care who could help prioritize their competing demands and continuity of relationships. They also desired providers who would listen to and acknowledge their needs, appreciate that these’ needs were unique and fluctuating and have a caring attitude.
Conclusions. These respondents describe an ideal process of care that is patient centered and individualized and that supports their unique constellations of problems, shifting priorities and multidimensional decision making. Individual and ongoing care coordination managed by a primary contact person may meet some of these needs. Achieving these goals will require developing efficient methods of assessing patient care needs and flexible care management support systems that can respond to patients’ needs for different levels of support at different times.
Keywords. Care management, comorbidity, geriatrics.
Bayliss EA, Edwards AE, Steiner JF and Main DS. Processes of care desired by elderly patients with multimorbidities. Family Practice 2008; 25: 287–293.
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