Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, 2nd floor, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St. London, London, ON, N6A 3K7, Canada.
Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, ingang 42 - verdieping, 5 9000, Ghent, Belgium.
BMC Prim Care. 2022 Mar 30;23(1):62. doi: 10.1186/s12875-022-01670-6.
People with multimorbidity, who may be more vulnerable to certain social determinants of health, often require care by an interprofessional primary healthcare (PHC) team that can tailor their approach to address the multiple and complex needs of this population. This paper describes how the needs of vulnerable patients experiencing multimorbidity are identified and provided care by innovative interprofessional PHC teams during an innovative one-hour consultation, outside of usual care.
This was a descriptive qualitative study. Forty-eight interviews were conducted with 20 allied healthcare professionals: (e.g., social work, pharmacy); 19 physicians (e.g., psychiatry, internal medicine, family medicine); and 9 decision makers. The thematic analysis was iterative using an individual and team approach to identify the main themes and exemplar quotations for illustration.
Participants described patients with multimorbidity who were vulnerable as those experiencing major challenges accessing and navigating the healthcare system. Mental health issues were a major contributor to being vulnerable and often linked to common social determinants of health. Cultural factors were identified as potentially causing patients to be vulnerable. Participants articulated how the collaborative nature of the team generated new ideas and facilitated creative recommendations designed to meet the specific needs of each patient.
This one-time consultation went beyond the assessment of a patient's multimorbidity by including a psycho-social-contextual understanding of vulnerability within the healthcare system. Findings may have important clinical and policy implications in the adoption and implementation of this approach and further assist vulnerable patients with multimorbidity in having their complex needs addressed.
患有多种疾病的患者（他们可能更容易受到某些健康社会决定因素的影响）通常需要由跨专业的初级医疗保健（PHC）团队提供护理，该团队可以根据患者的需求，调整方法，以满足此类人群的多种复杂需求。本文描述了在常规护理之外，创新型的跨专业 PHC 团队如何通过创新的一小时咨询，识别出弱势多病患者的需求，并为其提供护理。
这是一项描述性的定性研究。对 20 名从事辅助医疗保健工作的专业人员（如社会工作者、药剂师）、19 名医生（如精神病学、内科、家庭医学）和 9 名决策者进行了 48 次访谈。采用个体和团队的方法进行主题分析，以确定主要主题和说明性示例引文。
参与者描述了那些在获取和使用医疗保健系统方面面临重大挑战的患有多种疾病的弱势患者。心理健康问题是导致弱势的主要原因，通常与常见的健康社会决定因素有关。文化因素被认为可能导致患者变得脆弱。参与者阐述了团队的协作性质如何产生新的想法，并促进了创造性的建议，旨在满足每个患者的具体需求。
这种一次性咨询不仅评估了患者的多种疾病，还包括了对医疗保健系统中脆弱性的心理-社会-背景的理解。这些发现可能对采用和实施这种方法具有重要的临床和政策意义，并进一步帮助患有多种疾病的弱势患者解决其复杂的需求。
