Identifying target groups for person-centred integrated care among multi-morbid populations.

ABSTRACT: Background The growing populations of people with multi-morbidity pose a new challenge to health systems. As multi-morbidity is not a clearly demarcated condition, chronic disease management programs may be unable to meet the needs of persons with multi-morbidity. This requires health systems to shift to more person-centred care models. Developing person-centred care for people with multi-morbidity asks for knowledge about their needs. Methods We conducted four studies (within the EU funded JACHRODIS and ICARE4EU project, and in a recent project funded by the Netherlands MoH) to gain insight in the needs of primary care patients with multi-morbidity. We distinguished subgroups based on their use of health services and quality of life by cluster analyses, and described their medical characteristics and resources (e.g., social support, health literacy, self-management abilities). Next, we predicted adverse outcomes, i.e., a poor quality of life and suboptimal use of services, from patients’ illness perceptions and resources by logistic regression analysis. Results In all studies, we found half of the study sample to report a relatively good quality of life and/or a low use of health services. The other half consists of various subgroups: with a poor QoL (physical and mental or social), a high or suboptimal use of health services or a combination of these outcomes. Adverse outcomes relate to medical characteristics, but also to persons’ perceptions of their conditions and resources. Conclusions Among multi-morbid populations, subgroups of high-need patients can be distinguished based on their medical complexity, illness perceptions and resources (e.g., health literacy, mastery). These subgroups differ in their needs for care and support, and thus require different integrated care arrangements, for instance, horizontal integration of primary care and social care, and/or vertical integration of primary and secondary care services. (aut. ref.