Lekha Thoniparambil Ravindranathanpillai, Joseph Linju, Sasidharan Neethu Vasantha, Krishnan Athira, Davies Justine, Gill Paramjit, Greenfield Sheila, Harikrishnan Sivadasanpillai, Thulaseedharan Jissa Vinoda, Valamparampil Mathew Joseph, Manaseki-Holland Semira, Jeemon Panniyammakal
Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.
Front Public Health. 2025 Mar 18;13:1480710. doi: 10.3389/fpubh.2025.1480710. eCollection 2025.
Multiple long-term conditions (MLTCs) are a major public health challenge globally. Complexity in managing MLTCs and their adverse consequences confronts the public healthcare systems in India. However, data from India to understand how to improve capacity to manage multiple chronic conditions are limited. We aimed to explore the challenges healthcare providers (HCPs) face in managing people with MLTCs in a south Indian primary care setting.
Semi-structured interviews were conducted with HCPs in four districts of Kerala, India. Key themes and sub-themes were identified using the Framework method for thematic analysis. We categorized the systemic drivers that influenced management of patients with MLTCs in the government primary care settings as health system, organizational and individual HCPs, and patient-levels.
33 in-depth, semi-structured interviews were conducted. Two main themes with sub-themes were found: multimorbidity preparedness (), multimorbidity care (). Management of MLTCs at primary care was facilitated by the presence of programs for chronic respiratory conditions and depression, perceived value of electronic health records, awareness of HCPs regarding programs and patients' needs. However, several challenges at the health system level including lack of long-term planning, treatment guidelines and combination medicines, leading to fragmentation of care and poor program implementation and uptake by HCPs and patients.
Our study confirms sub-optimal health system preparedness and highlights the challenges for a transitioning primary care for managing people with MLTCs in one of India's states with a well-developed healthcare system. Our results suggest a need for improved planning and re-organization of primary health services with ongoing training support for HCPs.
多种长期病症（MLTCs）是全球主要的公共卫生挑战。管理MLTCs的复杂性及其不良后果给印度的公共医疗系统带来了挑战。然而，来自印度的用于了解如何提高管理多种慢性病能力的数据有限。我们旨在探讨在印度南部初级保健环境中，医疗服务提供者（HCPs）在管理患有MLTCs的患者时所面临的挑战。
对印度喀拉拉邦四个地区的HCPs进行了半结构化访谈。使用主题分析的框架方法确定了关键主题和子主题。我们将影响政府初级保健机构中MLTCs患者管理的系统性驱动因素分为卫生系统、组织和个体HCPs以及患者层面。
进行了33次深入的半结构化访谈。发现了两个主要主题及子主题：多重疾病准备情况（）、多重疾病护理（）。慢性呼吸道疾病和抑郁症项目的存在、电子健康记录的感知价值、HCPs对项目和患者需求的认识，促进了初级保健中MLTCs的管理。然而，卫生系统层面存在若干挑战，包括缺乏长期规划、治疗指南和复方药物，导致护理碎片化以及HCPs和患者对项目的实施和接受情况不佳。
我们的研究证实了卫生系统准备不足，并凸显了在印度一个医疗系统发达的邦，向管理患有MLTCs的患者的转型初级保健所面临的挑战。我们的结果表明，需要改进初级卫生服务的规划和重组，并为HCPs提供持续的培训支持。
