Effective Hospital Care Delivery Model for Older People in Nigeria with Multimorbidity: Recommendations for Practice

The importance of developing an effective action-based model of care for multimorbid patients has become common knowledge, but it remains unclear why researchers in Nigeria have not paid attention to the issue. Hence, this study assessed the quality of health services using the Donabedian model and aimed to recommend an effective hospital care delivery model for older people in Nigeria with multimorbidity. A cross-sectional study using face-to-face data was conducted between October 2021 and February 2022. The reported data were collated, checked, coded, and entered into JISC online survey software and then exported to IBM Statistical Package for Social Science (SPSS) version 27 for analysis, sourced from the University of West London, London, United Kingdom. The data were collected from the outpatient department of four high-volume public secondary hospitals in Niger State (the largest hospital in the three senatorial zones and that of the state capital). Systematic random sampling was used to select 734 patients with two or more chronic diseases (multimorbidity) aged 60 years and above who presented for routine ambulatory outpatient and consented to participate in the study. A Service Availability and Readiness Assessment (SARA) tool was used to assess the structure, and the process quality was assessed by the patients' experiences as they navigated the care pathway, whereas the outcome was measured using the patients' overall satisfaction. Using Spearman's correlation, no statistically significant association was observed between satisfaction level with the healthcare that was received and the five domains of health facility readiness (Total score Basic Amenities, Total score Basic Equipment, Total score infection control, Total score diagnostic capacity, Total score essential drugs), and the general facility readiness. Finally, the process component superseded the structure as the determinant of the quality of healthcare among multimorbid patients in Niger State. The emphasis of the process should be on improving access to quality of care, improving patient-physician relationships and timing, reducing the financial burden of medical care, and building confidence and trust in medical care. Therefore, these factors should be incorporated into designing the healthcare model for multimorbid patients in Nigeria.