Journal article
My Goals Are Not Their Goals: Barriers and Facilitators to Delivery of Patient-Centered Care for Patients with Multimorbidity
Journal of general internal medicine : JGIM, Vol.37(16), pp.4189-4196
12/01/2022
DOI: 10.1007/s11606-022-07533-1
PMCID: PMC9126696
PMID: 35606644
Abstract
Background
Patient-centered care reflecting patient preferences and needs is integral to high-quality care. Individualized care is important for psychosocially complex or high-risk patients with multiple chronic conditions (i.e., multimorbidity), given greater potential risks of interventions and reduced benefits. These patients are increasingly prevalent in primary care. Few studies have examined provision of patient-centered care from the clinician perspective, particularly from primary care physicians serving in integrated, patient-centered medical home settings within the US Veterans Health Administration.
Objective
We sought to clarify facilitators and barriers perceived by primary care physicians in the Veterans Health Administration to delivering patient-centered care for high-risk or complex patients with multimorbidity.
Design
We conducted semi-structured telephone interviews from April to July 2020 among physicians across 20 clinical sites. Findings were analyzed with deductive content analysis based on conceptual models of patient-centeredness and hierarchical factors affecting care delivery.
Participants
Of 23 physicians interviewed, most were female (
n
= 14/23, 61%), serving in hospital-affiliated outpatient clinics (
n
= 14/23, 61%). Participants had a mean of 21 (SD = 11.3) years of experience.
Key Results
Facilitators included the following: effective physician-patient communication to individualize care, prioritize among multiple needs, and elicit goals to improve patient engagement; access to care, enabled by interdisciplinary teams, and dictating personalized care planning; effortful but worthwhile care coordination and continuity; meeting complex needs through effective teamwork; and integrating medical and non-medical care aspects in recognition of patients’ psychosocial contexts. Barriers included the following: intra- and interpersonal (e.g., perceived patient reluctance to engage in care); organizational (e.g., limited encounter time); and community or policy impediments (e.g., state decisional capacity laws) to patient-centered care.
Conclusions
Physicians perceived individual physician-patient interactions were the greatest facilitators or barriers to patient-centered care. Efforts to increase primary care patient-centeredness for complex or high-risk patients with multimorbidity could focus on targeting physician-patient communication and reducing interpersonal conflict.
Details
- Title: Subtitle
- My Goals Are Not Their Goals: Barriers and Facilitators to Delivery of Patient-Centered Care for Patients with Multimorbidity
- Creators
- Linnaea Schuttner - VA Puget Sound Health Care SystemStacey Hockett Sherlock - University of IowaCarol E. Simons - VA Puget Sound Health Care SystemNicole L. Johnson - Center for Access & Delivery Research and Evaluation (CADRE), VA Iowa City Health Care SystemElizabeth Wirtz - Iowa City VA Health Care SystemJames D. Ralston - Kaiser Permanente Washington Health Research InstituteAnn-Marie Rosland - University of Pittsburgh School of MedicineKarin Nelson - University of WashingtonGeorge Sayre - VA Puget Sound Health Care System
- Resource Type
- Journal article
- Publication Details
- Journal of general internal medicine : JGIM, Vol.37(16), pp.4189-4196
- Publisher
- Springer International Publishing
- DOI
- 10.1007/s11606-022-07533-1
- PMID
- 35606644
- PMCID
- PMC9126696
- ISSN
- 0884-8734
- eISSN
- 1525-1497
- Grant note
- U.S. Department of Veterans Affairs (http://dx.doi.org/10.13039/100000738) K12HS026369 / Agency for Healthcare Research and Quality (http://dx.doi.org/10.13039/100000133)
- Language
- English
- Date published
- 12/01/2022
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984627253402771
Metrics
6 Record Views