Multimorbidity, clinical decision making and health care delivery in New Zealand Primary care: a qualitative study

BACKGROUND: Multimorbidity is a major issue for primary care. We aimed to explore primary care professionals’ accounts of managing multimorbidity and its impact on clinical decision making and regional health care delivery. METHODS: Qualitative interviews with 12 General Practitioners and 4 Primary Care Nurses in New Zealand’s Otago region. Thematic analysis was conducted using the constant comparative method. RESULTS: Primary care professionals encountered challenges in providing care to patients with multimorbidity with respect to both clinical decision making and health care delivery. Clinical decision making occurred in time-limited consultations where the challenges of complexity and inadequacy of single disease guidelines were managed through the use of “satisficing” (care deemed satisfactory and sufficient for a given patient) and sequential consultations utilising relational continuity of care. The New Zealand primary care co-payment funding model was seen as a barrier to the delivery of care as it discourages sequential consultations, a problem only partially addressed through the use of the additional capitation based funding stream of Care Plus. Fragmentation of care also occurred within general practice and across the primary/secondary care interface. CONCLUSIONS: These findings highlight specific New Zealand barriers to the delivery of primary care to patients living with multimorbidity. There is a need to develop, implement and nationally evaluate a revised version of Care Plus that takes account of these barriers. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12875-017-0622-4) contains supplementary material, which is available to authorized users.