Care pathways for older multimorbid patients: lessons learned from 16 clinical sites in 3 Countries

BACKGROUND: The fact that multimorbid and vulnerable patients need improved care coordination is well known. However, current healthcare system is still mainly single-disease oriented and as a result, coexisting morbidities are often under-evaluated and under managed leading to inappropriate care, inefficiencies, duplication and poor quality of care. We also know that different strategies have been developed to manage older multimorbid patients and varies from one country to the other. We therefore aimed to describe the care pathway for older, multimorbid cancer patients to understand current practices and shed light on the care pathways currently followed by the 16 clinical sites in 3 Countries that are participating to a EU funded research project. METHODS: Semi-structured interviews were conducted in each site with key, relevant stakeholders (e.g., oncologists, geriatrician, nurses). An interview outline was drafted and followed systematically, to collect coherent responses across centres. Overall, 39 interviews were conducted. Evidence of the interviews were processed under several dimensions, including but not limited to organizational context, health care professionals involved, multidisciplinarity, spaces and organization of the activities. RESULTS: The analyses highlighted high variability in the process of care of older multimorbid patients across countries and centres. In particular, the organizational context in which each site is embedded affects its operating conditions and there are at least three dimensions that affect the delivery of patient care: a) the scope of the services offered by each clinical site within the care pathway; b) the relationships between health care professionals, including access to specialist knowledge; c) the tools available to ensure integration between the different professionals in the different stages of the care pathway. GERONTE is funded by the Horizon 2020 research and innovation programme under grant agreement No 945218. KEY MESSAGES: • Multimorbid patients need improved care coordination but current healthcare system is still mainly single-disese oriented. • Delivery of patient care is affected by the scope of the services offered by each hospital, the relationship between professionals and the operational tools available.