For a study, the researchers sought to identify characteristics that influence primary care physician decision-making while planning treatment for complicated patients with multimorbidity in a team-based, patient-centered medical home environment in the Veterans Health Administration’s (VHA) integrated healthcare system. A qualitative study was performed that included semi-structured telephone interviews with PCPs who worked at VHA clinics for more than 40% of their time. Discussions took place between April and July of 2020. Deductive and inductive thematic analyses were used to examine the content. Interviews were conducted with 23 physicians, most of whom were MDs (n=21) and worked in hospital-affiliated clinics (n=14) within the VHA’s nationwide clinic network. Internal, environmental, and relationship-based components were discovered, with developed subthemes explaining elements influencing decision-making for complicated multimorbid patients. Physicians described tailoring decisions to individual patients, making decisions by a foundational internal style or habit, working toward an overarching goal for care, assessing the impact of patient access and resources on care plans, deciding within organizational boundaries, cooperating on care plans with their care team, and the effect of their feelings and connect with the patient on their decisions. PCPs at the VHA described how internal, external, and relationship-based factors influenced their care planning for high-risk and complex comorbidities. The results indicate that physicians used strategies like delegation of follow-up within multidisciplinary care teams, optimizing visit time vs frequency, and deliberate investment in patient-centered relationship-building to gain buy-in to care plans to effectively conduct care planning for complex patients in a medical home setting.
Source:bmcprimcare.biomedcentral.com/articles/10.1186/s12875-022-01633-x
