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Research ArticleOriginal Research

Primary Care Physician Insights Into a Typology of the Complex Patient in Primary Care

Danielle F. Loeb, Ingrid A. Binswanger, Carey Candrian and Elizabeth A. Bayliss
The Annals of Family Medicine September 2015, 13 (5) 451-455; DOI: https://doi.org/10.1370/afm.1840
Danielle F. Loeb
1University of Colorado, Division of General Internal Medicine, Aurora, Colorado
MD
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  • For correspondence: Danielle.loeb@ucdenver.edu
Ingrid A. Binswanger
1University of Colorado, Division of General Internal Medicine, Aurora, Colorado
2Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
MD, MPH
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Carey Candrian
1University of Colorado, Division of General Internal Medicine, Aurora, Colorado
PhD
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Elizabeth A. Bayliss
2Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
3University of Colorado, Department of Family Medicine, Aurora, Colorado
MD, MSPH
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    Typology of complex patients.

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    Table 1

    Physician Characteristics (N = 15)

    CharacteristicValue
    Age, mean (range) [median], y38 (29–52) [38]
    Female, No. (%)9 (60)
    Race/ethnicity, No. (%)
     White non-Hispanic12 (80)
     Asian2 (13)
     White Hispanic1 (7)
    Clinic type: community health (vs university), No. (%)7 (47)
    Time since residency completion, mean (range) [median], y8 (<1–24) [7]
    Time in primary care practice, mean (range) [median], y7 (<1–24) [11]

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  • The Article in Brief

    Primary Care Physician Insights Into a Typology of the Complex Patient in Primary Care

    Danielle F. Loeb , and colleagues

    Background New models of patient complexity have been developed, but it is not known if primary care physicians' (PCPs) perceptions of complexity are consistent with these models. This study set out to understand how PCPs conceptualize patient complexity.

    What This Study Found In-depth interviews with 15 primary care physicians from two university clinics and three community health centers revealed a multidimensional concept of patient complexity. The physicians perceived patients to be complex if they had one or more exacerbating factors--a medical illness, mental illness, socioeconomic challenge or behavior or trait--that complicated care for chronic medical illnesses. Most of the physicians broadly defined complex patients as those who did not easily fit into guidelines or algorithms.

    Implications

    • The authors suggest that insights offered by physicians in this study integrate well into two recently proposed conceptual models: AHRQ's Multiple Chronic Conditions Research Network model and a model based on comorbidity interrelatedness developed by Zulman et al.
    • The perspectives offered by physicians in this study can help refine existing models of complexity and better inform the organization of care for complex patients, according to the authors.
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The Annals of Family Medicine: 13 (5)
The Annals of Family Medicine: 13 (5)
Vol. 13, Issue 5
September/October 2015
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Primary Care Physician Insights Into a Typology of the Complex Patient in Primary Care
Danielle F. Loeb, Ingrid A. Binswanger, Carey Candrian, Elizabeth A. Bayliss
The Annals of Family Medicine Sep 2015, 13 (5) 451-455; DOI: 10.1370/afm.1840

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Primary Care Physician Insights Into a Typology of the Complex Patient in Primary Care
Danielle F. Loeb, Ingrid A. Binswanger, Carey Candrian, Elizabeth A. Bayliss
The Annals of Family Medicine Sep 2015, 13 (5) 451-455; DOI: 10.1370/afm.1840
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Subjects

  • Domains of illness & health:
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