Coordination of care for multimorbid patients from the perspective of general practitioners – a qualitative study

Abstract

BackgroundIn Germany, a decreasing number of general practitioners (GPs) face a growing number of patients with multimorbidity. Whilst care for patients with multimorbidity involves various healthcare providers, the coordination of this care is one of the many responsibilities of GPs. The aims of this study are to identify the barriers to the successful coordination of multimorbid patient care and these patients’ complex needs, and to explore the support needed by GPs in the care of multimorbid patients. Interviewees were asked for their opinion on concepts which involve the support by additional employees within the practice or, alternatively, external health care professionals, providing patient navigation.MethodsThirty-two semi-structured, qualitative interviews were conducted with 16 GPs and 16 medical practice assistants (MPAs) from 16 different practices in Berlin. A MPA is a qualified non-physician practice employee. He or she undergoes a three years vocational training which qualifies him or her to provide administrative and clinical support.The interviews were digitally recorded, transcribed and analysed using the framework analysis methodology.ResultsThe results of this paper predominantly focus on GPs’ perspectives of coordination within and external to general practice. Coordination in the context of care for multimorbid patients consists of a wide range of different tasks. Organisational and administrative obstacles under the regulatory framework of the German healthcare system, and insufficient communication with other healthcare providers constitute barriers described by the interviewed GPs and MPAs. In order to ensure optimal care for patients with multimorbidity, GPs may have to delegate responsibilities associated with coordinating tasks. GPs consider the deployment of an additional specifically qualified employee inside the general practice to take on coordinative and social and legal duties to be a viable option.ConclusionsThe cross-sectoral cooperation between all involved key players working within the healthcare system, as well as the coordination of the whole care process, is seemingly challenging for GPs within the complex care system of multimorbid patients. GPs are generally open to the assignment of a person to support them in coordination tasks, preferably situated within the practice team.

Perceived facilitators and barriers to chronic disease management in primary care networks: a qualitative study

“…A study by Schäfer et al (2017) indicated that one-stop-services provided at GP clinics improved accessibility, continuity and comprehensiveness of care [46]. As GPs are usually burdened by assuming organizational and administrative tasks while providing medical care, assigning the responsibility of arranging and conducting ancillary services to someone else, such as the hiring of PCCs, allowed GPs to focus on the medical care for their patients [47][48][49]. This team-based care approach as studied through a meta-analysis by Levngood et al (2019) established that team-based diabetes management improved overall clinical indicators for diabetes patients, health services utilization, diabetes-related morbidity and mortality [50].…”

“…A study by Stumm et al (2019) illustrated that the lack of adequate compensation for the coordination of tasks hinders GPs from giving optimal care to their patients [47]. Therefore, funding for manpower to complete back-o ce tasks such as the coordination of ancillary services and consolidation of data elds for the CDR is allocated.…”

Perceived facilitators and barriers to chronic disease management in primary care networks: a qualitative study

“…A study by Schäfer et al (2017) indicated that one-stop-services provided at GP clinics improved accessibility, continuity and comprehensiveness of care [25]. As GPs are usually burdened by assuming organisational and administrative tasks while providing medical care, assigning the responsibility of arranging and conducting ancillary services to designated staff allowed GPs to focus on the medical care for their patients [26][27][28]. This team-based care approach as studied through a meta-analysis by Levngood et al (2019) established that team-based diabetes management improved overall clinical indicators for diabetes patients, health services utilisation, diabetes-related morbidity and mortality [29].…”

“…A lack of adequate compensation for the coordination of tasks hinders GPs from giving optimal care to their patients [26]. Therefore, funding for manpower to complete back-o ce tasks such as the coordination of ancillary services and consolidation of data elds for the CDR was allocated.…”

Nichtmedizinische Aspekte der Versorgung multimorbider Patient*innen in der Hausarztpraxis. Welche Unterstützung und Kooperationen werden gewünscht? Fokusgruppen mit Berliner Hausärzt*innen

“…In einer vorangegangenen Interviewstudie desselben Projektes wurden beispielhaft folgende soziale und sozialrechtliche Beratungsanlässe in der Hausarztpraxis genannt: die allgemeine Sozialberatung, die Antragsstellung von Pflegegrad, Rehabilitationsmaßnahmen und Hilfsmitteln, aber auch die Erstellung einer Patient*innenverfügung. Damit geht unter anderem das Ausfüllen einer Vielzahl an Formularen, also administrativer Aufwand einher [4]. Die Ergebnisse aus der Fragebogenerhebung desselben Projektes bestätigen dies [5].…”