Finding common ground : patient-centered care and self-management support of multimorbidity in primary health care

Abstract: Background: Patient-centered care is associated with improved health outcomes and increased care satisfaction and is a target for health care internationally. An important component of patient-centered care is patient-centered communication, which aims to involve patients in their care. Nevertheless, recent national and international surveys have found shortcomings in involving patients in their care. This is especially true for older patients with chronic diseases. As populations age, an increasing number of patients have multimorbidity (i.e., two or more chronic diseases). However, health care is still organized around single diseases. Selfmanagement can be burdensome for these patients because of functional impairment, polypharmacy, and contradictory information from multiple health care professionals. There is evidence that self-management support improves outcomes for patients with single chronic diseases, but such evidence is lacking for patients with multimorbidity. The aim of this licentiate thesis was to explore perceptions of professional-patient interactions and perspectives on how to improve self-management support for patients with multimorbidity in primary health care. Methods: Exploratory designs were used to investigate health care professionals’, patients’, and family caregivers’ perspectives on patient-provider interactions and self-management support. Study I was a cross-sectional questionnaire study about patient-centeredness in primary health care consultations in northern Stockholm. The study included 596 participants: 298 pairs of patients and health care professionals (physicians, registered nurses, and physiotherapists). Study II was a mixed-method qualitative study about self-management support for patients with multimorbidity that included 42 participants. It used focus groups and in-depth interviews with health care professionals and patients in central Sweden. It also included in-depth interviews with registered nurses, patients, and family caregivers from a rural region in southern Sweden where telemedicine was used to support patients. The results were analyzed with content analysis. Results: The main finding of the two studies was that the perspectives of both health care professionals and patients need to be acknowledged to find common ground in primary health care consultations. Study I showed that most patients had expressed their own ideas in consultations, but only a minority had expressed their concerns. Although patients were satisfied with the consultations overall, the health care professionals tended to believe that patients were less satisfied than the patients reported they were. In Study II, the main theme that emerged was “Standing on common ground enables individualized support.” This theme was supported by four categories. Conclusions: The main conclusion of this thesis was that it is important to find common ground between the patients’ and health care professionals’ agendas and goals in consultations. Finding common ground through patient-centered communication could reduce misperceptions of patients’ experiences (Study I) and enable individualized support for self-management (Study II). A trustful relationship between the health care professional and patient could facilitate patient-centered communication.