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Delivering better primary health care to people with multimorbidity in Otago: Qualitative study

Wednesday 7 January 2015 1:18pm

Professor Tim Stokes and collaborators Fiona Doolan-Noble and Professor Robin Gauld have been awarded a Health Care Otago Charitable Trust grant to look at how GPs and practice nurses currently provide care for people with multimorbidity with the intention of using the findings to inform better local health care delivery and integration of care between primary care and hospitals and community services.

More people are developing two or more chronic diseases (for example, heart failure and osteoarthritis) over their lifetime as the population gets older. This is known as multimorbidity. People with multimorbidity are more likely to experience poor health and make use of both inpatient and outpatient services. General practice plays a key role in looking after people with multimorbidities. At present health care services in Otago, like the rest of New Zealand, are configured to treat people who have only one chronic condition (for example, diabetes) which means that people with multimorbidity are likely to receive care that is not seamless and is frequently duplicated (for example, attending more than one outpatient clinic). There is therefore a need to improve local health care services across primary and secondary care to ensure services are integrated for those with multimorbidity.

Multimorbidity is a major issue in primary care. Despite having a strong first contact primary health care system the NZ health care system is struggling to cope with the rise in long term conditions as well as the increasing prevalence of multimorbidity in our ageing population. There is a pressing need for research that shows how multimorbidity can best be managed and what health care system redesign is needed as multiple disease care, not single disease care, becomes the norm in an aging society.

This study will explore GP and practice nurse accounts of managing multimorbidity and its impact on local health care delivery and clinical decision making in a context of alliance planning. Semi-structured interviews will be conducted with GPs and practice nurses working in general practices throughout Otago.

This research seeks to provide insight as to:

a) how GPs and practice nurses could utilise existing local health services more effectively for patients with multiple chronic conditions (multimorbidity);

b) what areas of local health care delivery need to be changed in order to optimise care for the people with multimorbidity and

c) the management of patients with single and multiple conditions by GPs and practice nurses in the clinical consultation and what resources (e.g., time or support) or support are needed to improve care for patients with multimorbidity.

If local health care services are to be redesigned to better meet the needs of patients living with multimorbidity, and this is a requirement of alliances throughout New Zealand, then it is critical that this is informed by an understanding of the barriers and enablers to primary care’s role in the management of such patients.

The information provided by this study will be utilised by both the Southern DHB and Southern PHO through Alliance South to help ensure that planned initiatives across primary and secondary care to provide better integrated chronic condition management are tailored to the needs of patients with multimorbidity as well as those with single disease conditions. The findings will also be transferrable to the wider New Zealand health care community.