چکیده (انگلیسی):

Background:Complex patients are increasingly common in primary care and often have poor clinical outcomes.
Healthcare system barriers to effective care for complex patients have been previously described, but less is known
about the potential impact and meaning of caring for complex patients on a daily basis for primary care providers
(PCPs). Our objective was to describe PCPs’ experiences providing care for complex patients, including their
experiences of health system barriers and facilitators and their strategies to enhance provision of effective care.
Methods:Using a general inductive approach, our qualitative research study was guided by an interpretive
epistemology, or way of knowing. Our method for understanding included semi-structured in-depth interviews
with internal medicine PCPs from two university-based and three community health clinics. We developed an
interview guide, which included questions on PCPs’ experiences, perceived system barriers and facilitators, and
strategies to improve their ability to effectively treat complex patients. To focus interviews on real cases, providers
were asked to bring de-identified clinical notes from patients they considered complex to the interview. Interview
transcripts were coded and analyzed to develop categories from the raw data, which were then conceptualized
into broad themes after team-based discussion.
Results:PCPs (N= 15) described complex patients with multidimensional needs, such as socio-economic, medical,
and mental health. A vision of optimal care emerged from the data, which included coordinating care, preventing
hospitalizations, and developing patient trust. PCPs relied on professional values and individual care strategies to
overcome local and system barriers. Team based approaches were endorsed to improve the management of
complex patients.
Conclusions:Given the barriers to effective care described by PCPs, individual PCP efforts alone are unlikely to
meet the needs of complex patients. To fulfill PCP’s expressed concepts of optimal care, implementation of
effective systemic approaches should be considered.