Family practitioners' top medical priorities when managing patients with multimorbidity: a cross-sectional study.

BACKGROUND: Managing multiple chronic and acute conditions in patients with multimorbidity requires setting medical priorities. How family practitioners (FPs) rank medical priorities between highly, moderately, or rarely prevalent chronic conditions (CCs) has never been described. The authors hypothesised that there was no relationship between the prevalence of CCs and their medical priority ranking in individual patients with multimorbidity. AIM: To describe FPs' medical priority ranking of conditions relative to their prevalence in patients with multimorbidity. DESIGN & SETTING: This cross-sectional study of 100 FPs in Switzerland included patients with ≥3 CCs on a predefined list of 75 items from the International Classification of Primary Care 2 (ICPC-2); other conditions could be added. FPs ranked all conditions by their medical priority. METHOD: Priority ranking and distribution were calculated for each condition separately and for the top three priorities together. RESULTS: The sample contained 888 patients aged 28-98 years (mean 73), of which 48.2% were male. Included patients had 3-19 conditions (median 7; interquantile range [IQR] 6-9). FPs used 74/75 CCs from the predefined list, of which 27 were highly prevalent (>5%). In total, 336 different conditions were recorded. Highly prevalent CCs were only the top medical priority in 66%, and the first three priorities in 33%, of cases. No correlation was found between prevalence and the ranking of medical priorities. CONCLUSION: FPs faced a great diversity of different conditions in their patients with multimorbidity, with nearly every condition being found at nearly every rank of medical priority, depending on the patient. Medical priority ranking was independent of the prevalence of CCs.

Patterns of patient experience with primary care access in Australia, Canada, New Zealand and Switzerland: a comparative study.

OBJECTIVE: Access to primary care (PC) is vital, but complex to define and compare between settings. We aimed to generate a typology of patients' access patterns across countries using a novel inductive approach. DESIGN: Cross-sectional surveys. SETTING: Australia, Canada, New Zealand and Switzerland between 2012 and 2014 as part of the QUALICO-PC project. PARTICIPANTS: Data were collected from 1306 general practices and 10 000+ patients, with nine patients per practice. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Typology of access. RESULTS: Three axes were retained, explaining 23% of the total variance: (i) 'temporal and geographical access'; (ii) 'frequency of access and unmet healthcare needs'; and (iii) 'affordability and frequency of access'.Based on the three axes, we identified four clusters of patients: (i) patients reporting overall good access to PC; (ii) frequent users with unmet healthcare needs; (iii) under-users with financial barriers; and (iv) users with poor time/geographical access.Better access to PC was experienced in Switzerland and New Zealand, while worst access was reported in Canada, where most of the time and geographical barriers were reported. Most financial barriers were observed in Australia and New Zealand. Frequent users with some level of unmet healthcare needs are prevalent in all four countries. CONCLUSIONS: Four main groups of patients with different patterns of access were identified: (i) good access; (ii) geographical and time barriers; (iii) financial barriers; and (iv) frequent users with unmet healthcare needs. Differences in access between the four countries are substantial.

Defining a typology of primary care practices: a novel approach.

OBJECTIVE: To define a typology of primary care (PC) practices based on a mixed inductive/deductive approach that uses a large number of variables describing organizational and demographic characteristics of practices and a priori hierarchical structuring of the data. DESIGN: Secondary analysis of the Swiss part of the QUALICOPC study using a multiple factor analysis approach incorporating 74 variables hierarchically structured and including information on infrastructures, clinical care, workforces, accessibility and geographic location of PC practices. SETTING: Switzerland. PARTICIPANTS: Two hundred randomly selected PC practices. MAIN OUTCOME MEASURES: Typology of PC practices based on axes identified through the multiple factorial approach. RESULTS: The factorial analysis extracted two uncorrelated axes summarizing 17% of the global variance. The first axis is mainly associated with two dimensions related to the comprehensiveness of services, namely 'clinical care provided' (Pearson's r = 0.73) and 'available infrastructures' (r = 0.78). The second axis is mainly associated with the workforce in the practice such as the number of general practitioners or other health workers (r = 0.69). Swiss PC practices were mapped using these two axes. CONCLUSIONS: This innovative approach allows defining a global typology of PC practices. Based upon Swiss data, two axes were identified to globally describe PC organization: comprehensiveness of services and workforces development. This exploratory study demonstrates a promising way, first to characterize globally one or several PC models that emerge from complex features, second to compare more accurately PC organization between countries and finally to assess how these models might be associated with patients' outcomes.