The Experience of Adults with Multimorbidity: A Qualitative Study

Abstract

BackgroundFindings from several countries indicate that the prevalence of multimorbidity is very high among clients of primary healthcare. A deeper understanding of patients’ experiences from their own perspective can greatly enrich any intervention to help them live as well as possible with multimorbidity.ObjectiveTo describe the fundamental structure of adults’ experience with multimorbidity.DesignA phenomenological study was undertaken to describe the experiences of 11 adults with multimorbidity. These adults participated in two semi-structured interviews, the content of which was rigorously analyzed.ResultsAt the core of the study participants’ multimorbidity experience are the impression of aging prematurely, difficulties with self-care management, and issues with access to the healthcare system, which contribute to the problem’s complexity. Despite these issues, participants with multimorbidity report attempting to take control of their situation and adjusting to daily living.ConclusionsThe description of this experience, through the systemic vision of participants, provides a better understanding of the realities experienced by people with multimorbidity.Journal of Comorbidity 2014;4:11–21

Effect of multimorbidity on health service utilisation and health care experiences

“…6,8 Despite this, health care delivery remains focused on the management of single diseases, creating major challenges for both patients and clinicians. 2,9 People with multimorbidity face many health service challenges including: short consultation times and the requirement to arrange multiple appointments with different health care professionals; 9,10 poorly coordinated care and conflicting information from different health providers; [11][12][13][14][15][16] and difficulties accessing health care due to financial constraints, transport difficulties or limited understanding of the health care system. [17][18][19][20] New Zealand research is limited, but has found that multimorbidity has a considerable impact on people's lives 19,21 and is challenging for general practitioners (GPs) and practice nurses to manage.…”

Is Australian primary care practice equipped to provide multimorbidity care?

“…As the previous discussion has outlined, individuals must make substantial investments in the day-to-day management of a chronic illness, but for those with multiple conditions the challenges of living with chronic illness are amplified (16,111,(191)(192)(193)(194). Multimorbidity, "the most common chronic condition experienced by adults", places significant demands on individuals, clinicians and the health system (25).…”

“…Such changes are often difficult to implement as individuals with multiple chronic conditions, experience greater disability and physical impairment than is generally associated with one condition (73,79,93,(111)(112)(113)192,193,212).…”

“…This burden has been linked with psychosocial distress, feelings of powerlessness, stigma, loneliness, humiliation, anger, despair (73,93,106,193,213), elevated rates of depression (93,105), and reduced quality of life (79,(214)(215)(216).…”

“…Kleinman et al (64), and others argue (64,149,150,193), it is not the physiological aspects of the disease, but the broader social and emotional experience of illness that is central to the patient. As In reflecting on the contributions of the clinician and patient, it is clear that both explanatory models are legitimate: neither should be given primacy nor considered in isolation as the implications for management and care are potentially detrimental (132,137,179).…”