Extended Consultations as a Trial Intervention in General Practice: Experiences of Patients with Complex Multimorbidities.

BACKGROUND

Multimorbidity poses significant challenges for healthcare systems worldwide, particularly for patients with complex multimorbidity (CMM). The Complex Intervention for Multimorbidity version 2 (CIM2) was designed to enhance integrated patient-centered care.

AIM: This qualitative study aimed to explore patients' experiences with the CIM2 intervention, focusing on their perceptions of extended consultations and identifying factors that influenced their experiences, which were either beneficial or challenging.

METHODS

This is a qualitative evaluation conducted as a part of the CIM2 intervention, drawing on data from 13 semi-structured interviews with patients with CMM. Eight of the interviews included the patients' spouses. The interviews were analyzed using thematic analysis.

RESULTS

Three patients found the extension beneficial, appreciating the increased time for discussions and feeling genuinely heard by their GPs. Two patients perceived partial benefit, valuing the extra time but finding the consultation similar to regular appointments. However, six patients experienced no benefit, citing unclear communication about the consultation purpose, a lack of continuity when seen by an unfamiliar GP, and superficial interactions despite the extended time. Two patients did not recall attending the extended consultations.

DISCUSSION: Although some patients appreciated the extra time and personalized attention, others found the consultations confusing, superficial, or indistinguishable from regular visits. Crucial factors influencing benefits included clear communication about the consultation's purpose, being heard and understood, and continuity with familiar GPs. Notably, those with the most fragmented care and highest treatment burden often derived the least benefit. These findings underscore the importance of better communication, preparation, and continuity.

CONCLUSION

Although some patients with complex multimorbidity valued extended consultation time, time alone proved insufficient to ensure meaningful care experiences. Better communication regarding the purpose of the consultation and patient preparation was essential to improving the overall quality and relevance of the encounter.