Patients with multimorbidity and their experiences with the healthcare process: a scoping review

Maartje J van der Aa, Jennifer R van den Broeke, Karien Stronks, Thomas Plochg, Maartje J van der Aa, Jennifer R van den Broeke, Karien Stronks, Thomas Plochg

Abstract

Background: The number of patients with multimorbidity (two or more conditions) is increasing. Observational research has shown that having multiple health problems is associated with poorer outcomes in terms of health, quality of care, and costs. Thus, it is imperative to understand how patients with multimorbidity experience their healthcare process. Insight into patient experiences can be used to tailor healthcare provision specifically to the needs of patients with multimorbidity.

Objective: To synthesize self-reported experiences with the healthcare process of patients with multimorbidity, and identify overarching themes.

Design: A scoping literature review that evaluates both qualitative and quantitative studies published in PubMed, Embase, MEDLINE, and PsycINFO. No restrictions were applied to healthcare setting or year of publication. Studies were included if they reported experiences with the healthcare process of patients with multimorbidity. Patient experiences were extracted and subjected to thematic analysis (interpretative), which revealed overarching themes by mapping their interrelatedness.

Results: Overall, 22 empirical studies reported experiences of patients with multimorbidity. Thematic analysis identified 12 themes within these studies. The key overarching theme was the experience of a lack of holistic care. Patients also experienced insufficient guidance from healthcare providers. Patients also perceived system-related issues such as problems stemming from poor professional-to-professional communication.

Conclusions: Patients with multimorbidity experience a range of system- and professional-related issues with healthcare delivery. This overview illustrates the diversity of aspects that should be considered in designing healthcare services for patients with multimorbidity.

Keywords: Multimorbidity; delivery of healthcare; healthcare system; patient experience; professional-patient relation; scoping review.

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flowchart of study selection.
Figure 2
Figure 2
Self-reported experiences of patients with multimorbidity (MM) with their healthcare process (synthesizing qualitative and quantitative evidence).
Figure 3
Figure 3
Overview of self-reported experiences of patients with multimorbidity (MM) and their interrelatedness (when mentioned by three or more sources). Source numbers correspond to literature provided in the reference list of this article. Weight of the lines framing the text boxes (categories) indicates the number of sources mentioning that experience. Weight of the connecting lines indicates the number of sources that mentioned the link.

References

    1. Anderson G. For 50 years OECD countries have continually adapted to changing burdens of disease; the latest challenge is people with multiple chronic conditions. Paris: OECD Publishing; 2011.
    1. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43. .
    1. Jones DS, Podolsky SH, Greene JA. The burden of disease and the changing task of medicine. N Engl J Med. 2012;366(25):2333–8. .
    1. Wright S, Verouhis D, Gamble G, Swedberg K, Sharpe N, Doughty R. Factors influencing the length of hospital stay of patients with heart failure. Eur J Heart Fail. 2003;5(2):201–9. .
    1. Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002;162(20):2269–76. .
    1. Lehnert T, Heider D, Leicht H, Heinrich S, Corrieri S, Luppa M, et al. Review: health care utilization and costs of elderly persons with multiple chronic conditions. Med Care Res Rev. 2011;68(4):387–420. .
    1. Bahler C, Huber CA, Brungger B, Reich O. Multimorbidity, health care utilization and costs in an elderly community-dwelling population: a claims data based observational study. BMC Health Serv Res. 2015;15(1):23. .
    1. Orueta JF, García-Álvarez A, García-Goñi M, Paolucci F, Nuño-Solinís R. Prevalence and costs of multimorbidity by deprivation levels in the Basque country: a population based study using health administrative databases. PLoS One. 2014;9(2):e89787. .
    1. Schnitzer S, Kuhlmey A, Adolph H, Holzhausen J, Schenk L. Complaints as indicators of health care shortcomings: which groups of patients are affected? Int J Qual Health Care. 2012;24(5):476–82. .
    1. Zulman DM, Asch SM, Martins SB, Kerr EA, Hoffman BB, Goldstein MK. Quality of care for patients with multiple chronic conditions: the role of comorbidity interrelatedness. J Gen Intern Med. 2014;29(3):529–37. .
    1. Lupari M, Coates V, Adamson G, Crealey GE. ‘We’re just not getting it right’–how should we provide care to the older person with multi-morbid chronic conditions? J Clin Nurs. 2011;20(9-10):1225–35. .
    1. Sarnak DO, Ryan J. How high-need patients experiences the health care system in nine countries. Issue Brief Commonwealth Fund. 2016;1:1–14. .
    1. Axelsson R, Axelsson SB, Gustafsson J, Seemann J. Organizing integrated care in a university hospital: application of a conceptual framework. Int J Integr Care. 2014;14:e019. .
    1. Daudt HM, van Mossel C, Scott S. Enhancing the scoping study methodology: a large, inter-professional team’s experience with Arksey and O’Malley’s framework. BMC Med Res Methodol. 2013;13(1):48. .
    1. Boyatzis RE. Transforming qualitative information. Thematic analysis and code development. Thousand Oaks, CA: SAGE Publications; 1998.
    1. Dixon-Woods M, Agarwal S, Jones D, Young B, Sutton A. Synthesising qualitative and quantitative evidence: a review of possible methods. J Health Serv Res Policy. 2005;10(1):45–53. .
    1. Cowie L, Morgan M, White P, Gulliford M. Experience of continuity of care of patients with multiple long-term conditions in England. J Health Serv Res Policy. 2009;14(2):82–7. .
    1. Noël PH, Chris Frueh B, Larme AC, Pugh JA. Collaborative care needs and preferences of primary care patients with multimorbidity. Health Expect. 2005;8(1):54–63. .
    1. Williams A. Patients with comorbidities: perceptions of acute care services. J Adv Nurs. 2004;46(1):13–22. .
    1. Adeniji C, Kenning C, Coventry PA, Bower P. What are the core predictors of ‘hassles’ among patients with multimorbidity in primary care? A cross sectional study. BMC Health Serv Res. 2015;15:255. .
    1. Bayliss EA, Edwards AE, Steiner JF, Main DS. Processes of care desired by elderly patients with multimorbidities. Fam Pract. 2008;25(4):287–93. .
    1. Boult C, Reider L, Frey K, Left B, Boyd CM, Wolff JL, et al. Early effects of “Guided Care” on the quality of health care for multimorbid older persons: a cluster-randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2008;63(3):321–7. .
    1. Burgers JS, Voerman GE, Grol R, Faber MJ, Schneider EC. Quality and coordination of care for patients with multiple conditions: results from an international survey of patient experience. Eval Health Prof. 2010;33(3):343–64. .
    1. Fung CH, Setodji CM, Kung F-Y, Keesey J, Asch SM, Adams J, et al. The relationship between multimorbidity and patients’ ratings of communication. J Gen Intern Med. 2008;23(6):788–93. .
    1. Gallagher N, MacFarlane A, Murphy AW, Freeman GK, Glynn LG, Bradley CP. Service users’ and caregivers’ perspectives on continuity of care in out-of-hours primary care. Qual Health Res. 2013;23(3):407–21. .
    1. Grundberg A, Ebbeskog B, Gustafsson SA, Religa D. Mental health-promoting dialogues from the perspective of community-dwelling seniors with multimorbidity. J Multidiscip Healthc. 2014;7:189–99. .
    1. Kjeken I, Dagfinrud H, Mowinckel P, Uhlig T, Kvien TK, Finset A. Rheumatology care: involvement in medical decisions, received information, satisfaction with care, and unmet health care needs in patients with rheumatoid arthritis and ankylosing spondylitis. Arthritis Care Res. 2006;55(3):394–401. .
    1. Maneze D, Dennis S, Chen HY, Taggart J, Vagholkar S, Bunker J, et al. Multidisciplinary care: experience of patients with complex needs. Aust J Prim Health. 2012;20(1):20–6. .
    1. Nicolaije KAH, Husson O, Ezendam NPM, Vos MC, Kruitwagen RFPM, Lybeert MLM, et al. Endometrial cancer survivors are unsatisfied with received information about diagnosis, treatment and follow-up: a study from the population-based PROFILES registry. Patient Educ Couns. 2012;88(3):427–35. .
    1. Oerlemans S, Husson O, Mols F, Poortmans P, Roerdink H, Daniels LA, et al. Perceived information provision and satisfaction among lymphoma and multiple myeloma survivors—results from a Dutch population-based study. Ann Hematol. 2012;91(10):1587–95. .
    1. Paddison CA, Saunders CL, Abel GA, Payne RA, Adler AI, Graffy JP, et al. How do people with diabetes describe their experiences in primary care? Evidence from 85,760 patients with self-reported diabetes from the English General Practice Patient Survey. Diabetes Care. 2015;38(3):469–75. .
    1. Penn PE, Brooks AJ, Worsham BD. Treatment concerns of women with co-occurring serious mental illness and substance abuse disorders. J Psychoactive Drugs. 2002;34(4):355–62. .
    1. Rincón-Gómez M, Bernabeu-Wittel M, Bohórquez-Colombo P, Moreno-Gaviño L, Cassani-Garza M, Ortiz-Camúñez M-Á, et al. Perceived quality of healthcare in a multicenter, community-based population of polypathological patients. Arch Gerontol Geriatr. 2011;52(2):142–6. .
    1. Shadmi E, Boyd CM, Hsiao CJ, Sylvia M, Schuster AB, Boult C. Morbidity and older persons’ perceptions of the quality of their primary care. J Am Geriatr Soc. 2006;54(2):330–4. .
    1. Sperling C, Sandager M, Jensen H, Lehmann Knudsen J. Current organisation of follow-up does not meet cancer patients’ needs. Dan Med J. 2014;61(6):A4855. Available from: [Last accessed Dec 12, 2016]
    1. Urbanoski K, Cairney J, Bassani D, Rush B. Perceived unmet need for mental health care for Canadians with co-occurring mental and substance use disorders. Psychiatr Serv. 2008;59(3):283–9. .
    1. Whitson HE, Steinhauser K, Ammarell N, Whitaker D, Cousins SW, Ansah D, et al. Categorizing the effect of comorbidity: a qualitative study of individuals’ experiences in a low-vision rehabilitation program. J Am Geriatr Soc. 2011;59(10):1802–9. .
    1. Williams A, Dunning T, Manias E. Continuity of care and general wellbeing of patients with comorbidities requiring joint replacement. J Adv Nurs. 2007;57(3):244–56. .
    1. Orrock PJ. The patient experience of osteopathic healthcare. Man Ther. 2016;22:131–7. .
    1. Plochg T. Reconfiguring health professionalism towards addressing multimorbidity. Q Eur Observatory Health Systems and Policies. 2013;19(2):24–7. Available from: [Last accessed Dec 12, 2016]
    1. Starfield B. Point: the changing nature of disease: implications for health services. Med Care. 2011;49(11):971–2. .
    1. Roland M, Paddison C. Better management of patients with multimorbidity. BMJ. 2013;346:f2510. .
    1. Haslam D. “You’re an expert in me”: the role of the generalist doctor in the management of patients with multimorbidity. J Comorbidity. 2015;5(1):132–4. .
    1. Anderson R, Barbara A, Feldman S. What patients want: a content analysis of key qualities that influence patient satisfaction. J Med Pract Manage. 2007;22(5):255–61. Available from: [Last accessed Dec 12, 2016]
    1. Hewitson P, Skew A, Graham C, Jenkinson C, Coulter A. People with limiting long-term conditions report poorer experiences and more problems with hospital care. BMC Health Serv Res. 2014;14(1):33. .
    1. Zulman DM, Kerr EA, Hofer TP, Heisler M, Zikmund-Fisher BJ. Patient-provider concordance in the prioritization of health conditions among hypertensive diabetes patients. J Gen Intern Med. 2010;25(5):408–14. .

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere