McGill Primary Health Care Research Network is a practice-based research network that brings together primary care practitioners from member organizations (including Family Medicine Units, integrated academic network clinics, Family Medicine Groups, local community service centers, and other clinical settings) with researchers from the McGill Department of Family Medicine.
The network's starter project evolved from a topic suggested by the clinicians in the group, who wanted to better understand "what do we mean by 'patients with complex care needs,'" that is, patients with a combination of multiple chronic conditions, mental health issues, medication-related problems, and social vulnerability. Specifically, our objective was to identify types and characteristics of patients with complex care needs from the perspective of community-based primary health care professionals.
To answer this question, we conducted a scoping review of the literature, which resulted in 51 included studies from an initial 4405 records. At the same time, we did an exploratory series of case reports using an organization participatory approach. Forty-five primary care practitioners from 10 different clinical sites completed a total of 63 questionnaires using a case that they identified as 'complex'. The questionnaire included checklists health problems, medications, psychosocial and other problems, as well as open-ended questions on the patient's complex care needs.
Of the 63 cases, about 80% had mental health problems, 70% were lacking social support, 68% were taking five or more medications, almost two-thirds had multiple health problems, over half experienced chronic pain, over half were lacking in material resources, such as housing or food, and about 45% were non-adherent to their drug therapy.
Using inductive-deductive thematic analysis, we identified 91 factors associated with complex care needs, which were grouped into 10 dimensions of complexity: socioeconomic; health behaviours; mental health issues; medication issues; poor health status; medical uncertainty; multi-morbidities; communication barriers; lack of agreement (shared understanding) of health problems; lack of access (or inadequate) health care resources. Cases were then grouped into types according to their key dimension of complexity and associated characteristics.
Preliminary results were presented at FMF and NAPCRG, to much interest (see attached). Our final results will be submitted for publication in the near future.
Our poster presentations:
Martello C, Bessière G, Bigras M, Boulet A, Brenner K, Crist E, Duong S, Goulet S, Grad R, Granikov V, Jean-Marie M, Kayal D, Kremer B, Loignon C, McLauchlin LR, Nguyen Q, Omon E, Rosenberg E, Pluye P. What do we mean when we say "this patient is complex"? North American Primary Care Research Group (NAPCRG) Annual Meeting, New York (USA), November 24, 2014. (poster)
Characteristics of Complex Care Needs
Pluye P, Bessière G, Bigras M, Boulet A, Brenner K, Crist E, Duong S, Goulet S, Granikov V, Jean-Marie M, Kayal D, Kremer B, Loignon C, Martello C, McLauchlin LR, Nguyen Q, Omon E, Rosenberg E, Grad R. Characteristics of complex care needs and interventions suited for patients with such needs: A participatory scoping review. North American Primary Care Research Group (NAPCRG) Annual Meeting, New York (USA), November 24, 2014. (poster)