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Multimorbidity, clinical decision making and health care delivery in New Zealand Primary care: a qualitative study

Stokes, Tim, Tumilty, Emma, Doolan-Noble, Fiona and Gauld, Robin 2017, Multimorbidity, clinical decision making and health care delivery in New Zealand Primary care: a qualitative study, BMC family practice, vol. 18, no. 1, doi: 10.1186/s12875-017-0622-4.

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Title Multimorbidity, clinical decision making and health care delivery in New Zealand Primary care: a qualitative study
Author(s) Stokes, Tim
Tumilty, EmmaORCID iD for Tumilty, Emma orcid.org/0000-0002-4132-6467
Doolan-Noble, Fiona
Gauld, Robin
Journal name BMC family practice
Volume number 18
Issue number 1
Article ID 51
Total pages 11
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2017-04-05
ISSN 1471-2296
Keyword(s) Science & Technology
Life Sciences & Biomedicine
Primary Health Care
Medicine, General & Internal
General & Internal Medicine
Multimorbidity
Primary care
General practice
Health services
Decision making
GENERAL-PRACTITIONERS
EPIDEMIOLOGY
ORGANIZATION
PERCEPTIONS
STRUGGLE
SYSTEM
NURSES
AREAS
PLUS
Summary © 2017 The Author(s). Background: Multimorbidity is a major issue for primary care. We aimed to explore primary care professionals’ accounts of managing multimorbidity and its impact on clinical decision making and regional health care delivery. Methods: Qualitative interviews with 12 General Practitioners and 4 Primary Care Nurses in New Zealand’s Otago region. Thematic analysis was conducted using the constant comparative method. Results: Primary care professionals encountered challenges in providing care to patients with multimorbidity with respect to both clinical decision making and health care delivery. Clinical decision making occurred in time-limited consultations where the challenges of complexity and inadequacy of single disease guidelines were managed through the use of “satisficing” (care deemed satisfactory and sufficient for a given patient) and sequential consultations utilising relational continuity of care. The New Zealand primary care co-payment funding model was seen as a barrier to the delivery of care as it discourages sequential consultations, a problem only partially addressed through the use of the additional capitation based funding stream of Care Plus. Fragmentation of care also occurred within general practice and across the primary/secondary care interface. Conclusions: These findings highlight specific New Zealand barriers to the delivery of primary care to patients living with multimorbidity. There is a need to develop, implement and nationally evaluate a revised version of Care Plus that takes account of these barriers.
Language eng
DOI 10.1186/s12875-017-0622-4
Indigenous content off
Field of Research 1117 Public Health and Health Services
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2017, The Authors
Free to Read? Yes
Persistent URL http://hdl.handle.net/10536/DRO/DU:30129466

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
Open Access Collection
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.