TY - JOUR
KW - Adult
KW - Attitude of Health Personnel
KW - Chronic Disease
KW - Colorado
KW - doctor-patient relationship
KW - Female
KW - Humans
KW - Interviews as Topic
KW - Male
KW - Medical comorbidity
KW - Medical home/patient-centered medical home
KW - Middle Aged
KW - Patient Care Team
KW - Patient-Centered Care/organization & administration
KW - Physician-Patient Relations
KW - primary care
KW - Primary Health Care/organization & administration
KW - Qualitative Research
KW - Quality of Health Care
KW - Work related stress
AU - D. F. Loeb
AU - E. A. Bayliss
AU - C. Candrian
AU - F. V. DeGruy
AU - I. A. Binswanger
A1 - 
AB - BACKGROUND: Complex patients are increasingly common in primary care and often have poor clinical outcomes. Healthcare system barriers to effective care for complex patients have been previously described, but less is known about the potential impact and meaning of caring for complex patients on a daily basis for primary care providers (PCPs). Our objective was to describe PCPs' experiences providing care for complex patients, including their experiences of health system barriers and facilitators and their strategies to enhance provision of effective care. METHODS: Using a general inductive approach, our qualitative research study was guided by an interpretive epistemology, or way of knowing. Our method for understanding included semi-structured in-depth interviews with internal medicine PCPs from two university-based and three community health clinics. We developed an interview guide, which included questions on PCPs' experiences, perceived system barriers and facilitators, and strategies to improve their ability to effectively treat complex patients. To focus interviews on real cases, providers were asked to bring de-identified clinical notes from patients they considered complex to the interview. Interview transcripts were coded and analyzed to develop categories from the raw data, which were then conceptualized into broad themes after team-based discussion. RESULTS: PCPs (N = 15) described complex patients with multidimensional needs, such as socio-economic, medical, and mental health. A vision of optimal care emerged from the data, which included coordinating care, preventing hospitalizations, and developing patient trust. PCPs relied on professional values and individual care strategies to overcome local and system barriers. Team based approaches were endorsed to improve the management of complex patients. CONCLUSIONS: Given the barriers to effective care described by PCPs, individual PCP efforts alone are unlikely to meet the needs of complex patients. To fulfill PCP's expressed concepts of optimal care, implementation of effective systemic approaches should be considered.
BT - BMC family practice
C5 - Education & Workforce; Healthcare Disparities
CY - England
DO - 10.1186/s12875-016-0433-z
JF - BMC family practice
N2 - BACKGROUND: Complex patients are increasingly common in primary care and often have poor clinical outcomes. Healthcare system barriers to effective care for complex patients have been previously described, but less is known about the potential impact and meaning of caring for complex patients on a daily basis for primary care providers (PCPs). Our objective was to describe PCPs' experiences providing care for complex patients, including their experiences of health system barriers and facilitators and their strategies to enhance provision of effective care. METHODS: Using a general inductive approach, our qualitative research study was guided by an interpretive epistemology, or way of knowing. Our method for understanding included semi-structured in-depth interviews with internal medicine PCPs from two university-based and three community health clinics. We developed an interview guide, which included questions on PCPs' experiences, perceived system barriers and facilitators, and strategies to improve their ability to effectively treat complex patients. To focus interviews on real cases, providers were asked to bring de-identified clinical notes from patients they considered complex to the interview. Interview transcripts were coded and analyzed to develop categories from the raw data, which were then conceptualized into broad themes after team-based discussion. RESULTS: PCPs (N = 15) described complex patients with multidimensional needs, such as socio-economic, medical, and mental health. A vision of optimal care emerged from the data, which included coordinating care, preventing hospitalizations, and developing patient trust. PCPs relied on professional values and individual care strategies to overcome local and system barriers. Team based approaches were endorsed to improve the management of complex patients. CONCLUSIONS: Given the barriers to effective care described by PCPs, individual PCP efforts alone are unlikely to meet the needs of complex patients. To fulfill PCP's expressed concepts of optimal care, implementation of effective systemic approaches should be considered.
PP - England
PY - 2016
SN - 1471-2296; 1471-2296
SP - 34
T1 - Primary care providers' experiences caring for complex patients in primary care: a qualitative study
T2 - BMC family practice
TI - Primary care providers' experiences caring for complex patients in primary care: a qualitative study
U1 - Education & Workforce; Healthcare Disparities
U2 - 27004838
U3 - 10.1186/s12875-016-0433-z
VL - 17
VO - 1471-2296; 1471-2296
Y1 - 2016
ER -