Envisaging a new model of care for complex multimorbidity in primary care

Posted by on 1 February 2023

Tags: HOPE Foundation scholar, primary care, clinic led integrated care, CLIC, self-management, patient centred model of care, holistic

Summary of Research - December 2022

by Anna Askerud, University of Otago

This thesis, due to be submitted in June 2023 presents a process evaluation of the Clinic Led Integrated Care (CLIC) model of primary care implemented in the southern district of Aotearoa, New Zealand between 2018 and 2022. Four case study practices are examined with interviews and participant observations conducted in two visits by the researcher over a period of two years.  Additionally, results from a self-report survey (Partners in Health) are analysed to provide a longitudinal health consumer perspective.

The following article was recently published by The Conversation and reprinted in the Otago Daily Times on 29 November 2022. This provides a brief summary of the findings.

Askerud, A. (2022). Healthcare for New Zealanders with multiple chronic conditions needs ‘radical rethinking’ – here’s what should happen.  Published in The Conversation 18 November 2022 and reprinted in the Otago Daily Times 24 November 2022.

CLIC was envisaged to be a holistic and patient centred model of care to support self-management and provided personalised care planning, acute care planning and advanced care plans. Integrated care and shared health records were other strategies to provide more joined up healthcare for patients in general practice. Although it was slow to gain traction, CLIC generally worked well for those who were engaged in their general practice and had the capability and resources to take up the support that CLIC offered.

This research has revealed that there was minimal consideration of the personal resources required for all people to engage in CLIC, or an understanding of the lack of funding in primary care to address poverty and those negatively affected by the social determinants of health. Despite the increasing prevalence of multi-morbidity, the growing ageing population, and the lack of success in addressing the negative impact of the socioeconomic and cultural determinants of health, the organisation of general practice, and how it connects with the rest of the health system, remains largely unchanged.

The thesis provides a framework for a successful model of long-term conditions primary which encompasses an understanding of complexity and capability and the importance of educating and supporting health professionals and patients to ensure there is a shared vision of care. Transitioning to a primary health care system more suited to the needs of people with multimorbidity will require strong leadership and good communication and a willingness from all areas of the health system to provide an integrated system which encompasses an effective shared electronic health record. The key gain from such a radical redesign will be a more equitable health system focused on a broader range of health needs.