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

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.