Factors affecting primary care physician decision-making for patients with complex multimorbidity: a qualitative...

Area of Science:

• Health Services Research
• Primary Care Medicine
• Patient Care Management

Background:

• Patients with multiple chronic conditions (multimorbidity) and psychosocial complexity face higher risks of adverse outcomes.
• Care planning for these patients requires addressing disease interactions, self-management limitations, and guideline conflicts.
• Understanding primary care physicians' (PCPs) decision-making for complex patients in medical homes is limited.

Purpose of the Study:

• To describe factors influencing PCPs' care planning decisions for complex patients with multimorbidity.
• To explore decision-making within the patient-centered medical home setting of the Veterans Health Administration (VHA).

Main Methods:

• Qualitative study using semi-structured telephone interviews with PCPs in VHA clinics.
• Interviews conducted between April and July 2020.
• Content analyzed using deductive and inductive thematic analysis.

Main Results:

• 23 PCPs participated; most were MDs working in hospital-affiliated clinics across VHA regions.
• Physicians identified internal, external, and relationship-based factors influencing decisions.
• Factors included tailoring care to individuals, internal decision-making styles, care goals, patient resources, organizational structures, team collaboration, and physician-patient relationships.

Conclusions:

• PCPs utilize internal, external, and relationship-based factors in care planning for complex, high-risk patients.
• Effective strategies include delegating follow-up to multidisciplinary teams, optimizing visit scheduling, and building patient-centered relationships to ensure care plan adherence.