Exploring interprofessional, interagency multimorbidity care: case study based observational research.

Area of Science:

• Healthcare Management
• Public Health
• Chronic Illness Care

Background:

• Growing prevalence of multimorbidity (co-occurring chronic illnesses) presents a significant healthcare challenge.
• Patients with multiple chronic conditions require complex, coordinated care across various health professionals and agencies.
• A frequent patient experience is a lack of integrated care, leading to fragmented health management.

Purpose of the Study:

• To investigate the daily help-seeking behaviors of patients experiencing multimorbidity.
• To understand how healthcare professionals collaborate and coordinate care for patients with multiple chronic conditions.
• To identify characteristics and perceptions of effective interprofessional and interagency care models for multimorbidity.

Main Methods:

• Employed a case study observational research design.
• Utilized multiple data sources from four patients with multimorbidity, identified by general practitioners.
• Presented two detailed case studies, analyzing patient-professional and interprofessional communication and interactions.

Main Results:

• Case studies revealed diverse patient profiles (multimorbidity, social context, capabilities) despite similar demographics.
• Professional engagement varied, often lacking clear leadership or care coordination.
• Interactions predominantly consisted of one-to-one consultations, with limited coordination, collaboration, or patient inclusion in professional communications.

Conclusions:

• Day-to-day interprofessional, interagency care for multimorbidity is complex.
• While consultations are common, coordinated and collaborative interactions, crucially including patients, are highly effective.
• Future efforts should focus on developing and facilitating these effective interactions and clarifying leadership roles in multimorbidity care.