"Improving Care for Patients with Complex Multimorbidity. GPs’ and patients’ experience of a new Care Model (CIM2) in General Practice"

Background: Multimorbidity (≧2 chronic conditions) is a growing global health concern challenging the organization of high-quality integrated care. Patients with complex multimorbidity (CMM), i.e. a combination of multiple chronic conditions, polypharmacy, and low socio-economic status (SES), require a comprehensive, patient-centered approach to care management. The organization of healthcare services for this patient population remains a critical challenge.

We developed the Complex Intervention for Multimorbidity (CIM) care model, based on a systematic review (1) and results from qualitative studies (2), and tested it a feasibility study (3) to address the specific needs of patients with CMM. Results demonstrated the model's potential to improve patient outcomes and healthcare utilization and we refined it into A new Care Model for patients with complicated Multimorbidity (CIM2), a more comprehensive and tailored intervention including teaching of health professionals and an extended overview consultation (EOC) (45 min.) aiming to get an overview of the patient's diagnoses, symptoms, medication, and to identify the patient's main problems, needs, goals and preferences.

The CIM2 model aims to reduce the patient's treatment burden, minimize the number of outpatient appointments or replace outpatient visits with appointments in general practice, adjust patient's medication list if relevant, and refer the patient to a rehabilitation program at the community health center, if the patient was motivated. 

The CIM2 was tested in a pilot randomized controlled trial (RCT) study involving 375 patients and 14 general practices in socially deprived areas in two regions, half the Danish population. A qualitative follow up study was conducted among general practitioners (GPs), patients, and health professionals in municipality and hospital.

Aim: To investigate GPs’ and patients’ experience of benefits and challenges of the CIM2 model for improving the quality of care and outcomes for patients with CMM.

Approach:  Semi-structured interviews with 8 GPs and 15 patients with CMM, and one focus group interview with GPs and professionals from municipality and hospitals.

Results: Identified benefits and challenges were experienced differently by GPs, as well as by patients. GPs generally found it beneficial that the EOC provided an overview of patients with complex medical histories, of medication, of possible adjustments of medicine, appointments and referrals, and a better knowledge of their patients. Patients generally felt seen and heard and felt things were under control. Not all patients were able to distinguish the EOC, or its elements, from other consultations. GPs identified favorable opportunities to utilize the EOC for patient groups beyond those included in the study.

Implications: Insights into user perspectives – GPs and patients - are essential for sustainable, successful implementation of new organizational models in integrated care for patients with CMM, especially results from a study in deprived areas. The qualitative results will contribute to a holistic perspective on the improvement of integrated care for patients with CMM.

The model was experimentally incorporated in the Agreement between Danish Regions and The Danish Organization of General Practitioners for 2022-2024 and tested in non-deprived areas. Next step is joining results to strengthen a potential national implementation of the CIM2 model.