Dynamics of a specialized and complex health care system: Exploring general practitioners' management of multimorbidity.

OBJECTIVE

To explore general practitioners' (GPs') experiences of cooperation with hospital-based physicians regarding multimorbid patients and to identify challenges as well as strategies in managing such challenges. Three medical practices in a provincial town in Denmark.

STUDY DESIGN

A qualitative methodological design was used with explorative data collection among GPs. Participant observation, qualitative interviews and a focus group interview were conducted. Interpretive description was used as the analytical framework. The GPs appreciated cooperating with physicians in optimizing treatment of multimorbid patients. However, three main challenges were experienced: insufficient communication and coordination; unclear divisions of roles and responsibilities; and differences in the way of approaching patients. The GPs navigated these challenges and complexities by taking advantage of their personal relationships and by developing creative and patient-centred ad hoc solutions to difficulties in cross-sectorial cooperation. A hospital initiative to support care for multimorbid patients has not been adopted by the GPs as a preferred strategy.

CONCLUSIONS

The structures of the health care system severely challenged cooperation regarding multimorbid patients; nevertheless, these GPs were aware of the advantages of cooperation, and their mainstay strategy in this involved personalized solutions and flexibility.