Relying on Trust: A Qualitative Study on Home-Dwelling Older Adults' Experiences and Preferences With Multimorbidity Management in Municipal Healthcare Assessments

IF 3.2 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Expectations Pub Date : 2025-09-24 DOI:10.1111/hex.70445

Turid R. Aarønes, Kristin Taraldsen, Linda A. H. Kvæl

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引用次数: 0

Abstract

Background

Older adults with multimorbidity present a unique challenge to municipal healthcare due to the complexity of managing multiple health conditions simultaneously. Addressing multimorbidity, especially in older adults, requires an integrated, holistic approach focused on person-centred healthcare and patient participation. Multidimensional assessments in municipal healthcare, which consider physical, psychological, and social factors, are essential to understanding and managing these complex health conditions. Additionally, trust in the system's reliability and in staff competency is crucial for ensuring quality care.

Aim

The aim of this study was to explore the experiences and preferences of older adults with assessments in the management of multimorbidity within municipal healthcare.

Methods

Qualitative data were obtained through semi-structured individual interviews with 12 home-dwelling older adults with multimorbidity from three Norwegian municipalities. The participants were aged 67–92, with an average of five chronic conditions. Interviews were conducted face-to-face in participants' homes between February 2023 and February 2024. Interviews were transcribed and analysed using reflexive thematic analysis.

Results

We identified three main themes: nurturing trust and security through professional competence and assessment skills, navigating vulnerability and dependence in healthcare systems, and the impact of patient participation on assessment outcomes. The results emphasise the importance of competence, trust, autonomy, collaboration, and effective communication both in clinical interactions between health professionals and patients and as a system approach in the management of multimorbidity.

Conclusions

Older adults with multimorbidity valued professional competence and effective communication in their healthcare assessments, as these fostered personal and system trust, as well as a sense of security. Participants also highlighted the importance of their involvement in treatment decisions and the need for a coordinated, person-centred approach to manage their complex health conditions. Our findings underscore the necessity of enhancing healthcare professionals' communication skills, improving information flow, and actively involving patients in assessment and management processes to better support home-dwelling older adults with multimorbidity in municipal healthcare.

Patient and/or Public Contribution

This study builds on a recent James Lind Alliance process, which highlighted improving communication with frail older adults as a key area in the management of multimorbidity and one highly relevant to our aim. A reference group, including a user representative, a healthcare professional, and a professor, contributed to the development of the interview guide and formulation of the study aim and provided input on the results. Additionally, the reference group discussed the implications of the findings, contributed on strategies for dissemination, and promoted the integration of the perspectives and priorities of older adults with multimorbidity throughout the research process.

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依赖信任：城市医疗评估中居家老年人多病管理经验与偏好的质性研究。

背景：由于同时管理多种健康状况的复杂性，患有多种疾病的老年人对市政卫生保健提出了独特的挑战。解决多病问题，特别是老年人的多病问题，需要采取一种以人为中心的保健和患者参与为重点的综合综合办法。市政卫生保健的多维评估考虑了身体、心理和社会因素，对于理解和管理这些复杂的健康状况至关重要。此外，对系统可靠性和工作人员能力的信任对于确保优质护理至关重要。目的：本研究的目的是探讨老年人的经验和偏好评估管理的多病在市政卫生保健。方法：通过半结构化的个人访谈获得定性数据，访谈对象为来自挪威三个城市的12名患有多种疾病的居家老年人。参与者的年龄在67-92岁之间，平均有五种慢性病。访谈于2023年2月至2024年2月在参与者家中进行。访谈记录和分析使用反身性主题分析。结果：我们确定了三个主要主题：通过专业能力和评估技能培养信任和安全，导航医疗保健系统中的脆弱性和依赖性，以及患者参与对评估结果的影响。研究结果强调了能力、信任、自主、协作和有效沟通的重要性，无论是在卫生专业人员和患者之间的临床互动中，还是在多病管理中作为一种系统方法。结论：具有多重疾病的老年人在健康评估中重视专业能力和有效的沟通，因为这些培养了个人和系统的信任以及安全感。与会者还强调了他们参与治疗决定的重要性，以及需要采取协调一致的、以人为本的办法来管理其复杂的健康状况。我们的研究结果强调了提高医疗保健专业人员的沟通技巧，改善信息流，并积极让患者参与评估和管理过程的必要性，以更好地支持城市医疗保健中患有多种疾病的居家老年人。患者和/或公众贡献：本研究建立在最近James Lind联盟进程的基础上，该进程强调改善与体弱老年人的沟通是多病管理的关键领域，也是与我们的目标高度相关的领域。包括一名用户代表、一名医疗保健专业人员和一名教授在内的一个参考小组为制定访谈指南和制定研究目标作出了贡献，并就研究结果提供了意见。此外，参考小组讨论了研究结果的意义，制定了传播策略，并在整个研究过程中促进了对多病老年人的观点和优先事项的整合。

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来源期刊

Health Expectations 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.20

自引率

9.40%

发文量

251

审稿时长

>12 weeks

期刊介绍： Health Expectations promotes critical thinking and informed debate about all aspects of patient and public involvement and engagement (PPIE) in health and social care, health policy and health services research including: • Person-centred care and quality improvement • Patients'' participation in decisions about disease prevention and management • Public perceptions of health services • Citizen involvement in health care policy making and priority-setting • Methods for monitoring and evaluating participation • Empowerment and consumerism • Patients'' role in safety and quality • Patient and public role in health services research • Co-production (researchers working with patients and the public) of research, health care and policy Health Expectations is a quarterly, peer-reviewed journal publishing original research, review articles and critical commentaries. It includes papers which clarify concepts, develop theories, and critically analyse and evaluate specific policies and practices. The Journal provides an inter-disciplinary and international forum in which researchers (including PPIE researchers) from a range of backgrounds and expertise can present their work to other researchers, policy-makers, health care professionals, managers, patients and consumer advocates.