Envisaging better care for patients with complex multimorbidity in Aotearoa New Zealand
Anna Askerud
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Abstract
Client-Led Integrated Care (CLIC) was implemented in general practices between 2018 and 2022 in the Southern region of New Zealand. It was envisaged to be an equitable, holistic and patient-centred inter-disciplinary framework of care for those with multiple long-term conditions; usually called multimorbidity.
This process evaluation aimed to determine whether CLIC supported self-management ability and assessed its alignment with current priorities for multimorbidity management.
Mixed methods were used across four purposively selected general practices. At each practice interviews were undertaken together with participant observation over 3 years. This was followed by analysis of annual self-report surveys.
CLIC worked well for those patients who were engaged, but the implementation provided minimal consideration of the resources required for everyone to receive culturally competent integrated care. Staff reported structural difficulties and wondered if the right patients were targeted.
CLIC did not address the needs of all participants, nor did it target those with the most ability to benefit. In all practices, despite increasing rates of multimorbidity and social complexity during a pandemic, the organisation of general practice and how it connected with the health system remained unchanged. Transitioning to a general practice system for complex multimorbidity will require changes in funding, strong leadership and clear communication. It requires all areas of the health system to provide an integrated health and social care system that is culturally competent and engages those most vulnerable in our community.
Keywords: ageing, chronic disease management, equity, general practitioners, health literacy, health systems, models of care, primary health care, workforce.
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