Primary Care Physician Perceptions on Caring for Complex Patients with Medical and Mental Illness

Loeb, Danielle F.; Bayliss, Elizabeth A.; Binswanger, Ingrid A.; Candrian, Carey; deGruy, Frank V.

doi:10.1007/s11606-012-2005-9

Cited by 86 publications

(76 citation statements)

References 36 publications

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“…Using systematic nonprobabilistic sampling to achieve a Danielle F. Loeb balanced distribution of sex, years in practice, and type of practice, we recruited physicians from 2 university clinics and 3 community health clinics. 15 We limited our study to internal medicine physicians to increase consistency in their training background. After 3 initial pilot interviews, we sent invitations to participate by e-mail to all physicians in the practices, including 34 and 28 physicians from the university and community health clinics, respectively.…”

Section: Methodsmentioning

confidence: 99%

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Primary Care Physician Insights Into a Typology of the Complex Patient in Primary Care

Loeb

Binswanger

Candrian

et al. 2015

The Annals of Family Medicine

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PURPOSE Primary care physicians play unique roles caring for complex patients, often acting as the hub for their care and coordinating care among specialists. To inform the clinical application of new models of care for complex patients, we sought to understand how these physicians conceptualize patient complexity and to develop a corresponding typology. METHODSWe conducted qualitative in-depth interviews with internal medicine primary care physicians from 5 clinics associated with a university hospital and a community health hospital. We used systematic nonprobabilistic sampling to achieve an even distribution of sex, years in practice, and type of practice. The interviews were analyzed using a team-based participatory general inductive approach. RESULTSThe 15 physicians in this study endorsed a multidimensional concept of patient complexity. The physicians perceived patients to be complex if they had an exacerbating factor-a medical illness, mental illness, socioeconomic challenge, or behavior or trait (or some combination thereof)-that complicated care for chronic medical illnesses.CONCLUSION This perspective of primary care physicians caring for complex patients can help refine models of complexity to design interventions or models of care that improve outcomes for these patients. INTRODUCTIONP rimary care physicians (PCPs) play unique roles caring for complex patients, often acting as the hub for their care and coordinating care among specialists. Algorithms that focus on numbers of conditions, medications, or both, however, may not align with clinicians' definitions of complexity.1,2 Early definitions of patient complexity focused on those factors.2,3 Newer models of complexity have been developed that incorporate mental health, social influences, and economic factors that substantially affect chronic disease outcomes. [4][5][6][7][8][9][10][11][12][13][14] For example, building on the work of Stiefel et al 10 with the INTERMED instrument, Peek et al 4 developed the Minnesota Complexity Assessment Method, which assesses 5 domains: illness (both medical and mental illness), readiness to engage, social, health system, and resources for care. It is unclear, however, whether PCPs' perceptions of complexity are aligned with these newer models.If endorsed by PCPs, newer models of complexity could potentially contribute to improving algorithms for risk adjustment for primary care patient panels, controlling for complexity in secondary database analysis, and designing interventions for complex patients. To inform the clinical application of new models of care for complex patients, we sought to understand how PCPs conceptualize patient complexity and to develop a corresponding typology. METHODSWe used a qualitative study design to conduct in-depth, open-ended interviews with PCPs. Using systematic nonprobabilistic sampling to achieve a 452balanced distribution of sex, years in practice, and type of practice, we recruited physicians from 2 university clinics and 3 community health clinics. 15 We limited o...

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Section: Methodsmentioning

confidence: 99%

“…15 We limited our study to internal medicine physicians to increase consistency in their training background. After 3 initial pilot interviews, we sent invitations to participate by e-mail to all physicians in the practices, including 34 and 28 physicians from the university and community health clinics, respectively.…”

mentioning

confidence: 99%

Primary Care Physician Insights Into a Typology of the Complex Patient in Primary Care

Loeb

Binswanger

Candrian

et al. 2015

The Annals of Family Medicine

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“…Strikingly, it has been found that between 20% and 76% of patients who commit suicide had visited their primary care physician the month before (Luoma et al 2002;Carrigan and Lynch 2003). Loeb et al (2012) investigated the viewpoints of primary care physicians regarding patient, physician, and system factors impacting care for patients presenting with mental health and medical issues. Physicians indicated that the type of mental illness, acuity of presentation, and patient communication style are all important issues.…”

Section: Services Of Care Pyramidmentioning

confidence: 99%

“…Physicians indicated that the type of mental illness, acuity of presentation, and patient communication style are all important issues. Primary care physicians also wanted enhanced training regarding mental health issues and to take part in collaborative care models (Loeb et al 2012). Patients described frustration regarding issues such as inadequate resources and disjointed care.…”

Section: Services Of Care Pyramidmentioning

confidence: 99%

Applying a Bauhaus design approach to conceptualize an integrated system of mental health care: Lessons from a large urban hospital

Ungar

Taube-Schiff

Stergiopoulos

2017

FACETS

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We have applied a Bauhaus design lens to inform a visual conceptual framework for a rational mental health care system. We believe that Canada's healthcare system can often be fragmented and does not always allow for service delivery to easily meet patient care needs. Within our proposed framework, the form of services provided follows patient-and healthcare-centred needs. The framework is also informed by the ethics and values of social responsibility, population health, and principles of quality of care. We review evidence for this framework (based on need, acuity, risk, service intensity, and provider level) and describe patient care pathways from intake/triage to three patient-centred tiers of care: (1) primary care (low needs), (2) acute ambulatory transitional care (moderate needs), and (3) acute hospital and complex care (high needs). Within each tier, various models of care are organized from low to high service intensity as informed by reports from the British Columbia Ministry of Health and the World Health Organization. We hope that our model may help to better conceptualize and organize our mental health care system and help providers clarify roles, responsibilities, and accountabilities to improve quality of care.

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“…This dialogue has been broadened to include multiple sources of complexity, moving well beyond pathophysiology and multiple co-occurring medical conditions, to behavioral and psychosocial sources of complexity that often overshadow physiology as a barrier to achieving optimal health. 3,4 In this issue of JGIM, Hong, et al cite their earlier studies demonstrating that this broad conceptualization of complexity resonates with primary care physicians. 5,6 In those studies, primary care physicians recognized multiple influences on what makes a patient complex, including psychosocial and behavioral domains, not just medical comorbidities.…”

mentioning

confidence: 99%

The Complexity of Complex Patients

Safford

2015

J GEN INTERN MED

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Primary Care Physician Perceptions on Caring for Complex Patients with Medical and Mental Illness

Cited by 86 publications

References 36 publications

Primary Care Physician Insights Into a Typology of the Complex Patient in Primary Care

Primary Care Physician Insights Into a Typology of the Complex Patient in Primary Care

Applying a Bauhaus design approach to conceptualize an integrated system of mental health care: Lessons from a large urban hospital

The Complexity of Complex Patients

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