La multimorbilidad vista desde la perspectiva de los profesionales de atención primaria

OBJECTIVE: To explore the perception of primary care health professionals in the Basque Country (Spain) of multiple comorbidities and their influence on clinical practice and the organization of health services. DESIGN: Qualitative study based on interviews, a storytelling workshop and cocreation. SETTING: The autonomous community of the Basque Country. Primary care in the Basque health system. PARTICIPANTS: Fourteen health professionals: 6 specialists in family medicine, 3 hospital specialists (internal medicine, pneumology, and geriatrics), 4 nurses, and 1 community pharmacist. METHODS: A qualitative, exploratory study was carried out, based on a cocreation workshop (12 participants) and 10 interviews with health professionals. The research was performed between February and June 2013. All interviews and the group workshop were audio recorded and some were video recorded. RESULTS: The emerging dominant themes were as follows: a) the challenges posed by multiple comorbidities for a “disease-centered” health system; b) the manifestation of these challenges in daily clinical practice in aspects such as the patient-health professional relationship, clinical decision-making, polypharmacy management, and coordination between healthcare settings; c) the barriers to the appropriate care of these patients: training, decision-making tools, lack of time, etc.; and d) the question of the most appropriate professional competencies and profiles. CONCLUSIONS: The increase in multiple comorbidities is a reality that worries primary care professionals, who express the need for adequate training, decision-making tools and support in daily clinical practice dealing with the most frequent situations and combinations of multiple comorbidities. The most effective approach to these problems requires a shift in the healthcare model toward an integrated view of the patient, a transition from a paternalist approach to a more proactive approach, and the development of healthcare integration.