'Stuck or unstable' — partnerships between GPs and patients with complex chronic conditions: A qualitative study

Abstract

Background: In chronic care, patient–GP collaboration is essential, but might be challenging if patients have complex health problems because of multimorbidity, psychosocial predicaments, and addiction problems. To understand and manage these challenges, it is important to explore how patients and GPs attempt to collaborate, to maintain and achieve an alliance in order to gain good quality of care. Aim: To explore how dyads of GPs and patients, who GPs deem have complex health problems and difficulties following treatment, perceive and manage challenges in their chronic care partnership. Design & setting: This was a qualitative study from Danish general practice in deprived, rural areas. Method: Semi-structured interviews were conducted with 12 dyads of GPs and patients with doctor-assessed complex chronic conditions and difficulties following treatment. The principles of systematic text condensation were used in the analysis. Results: Overall, the patient–GP collaboration could be characterised as either 'stuck' or 'unstable'. In both types, the challenges were identified as pointless consultations, conflicts about lifestyle, resignation, concealment of information, and hopelessness. These challenges could be managed by solving conflicts, adjusting to the patient’s needs, accommodating the challenges in the relationship, and offering continued emotional support even with unsolved medical problems. Conclusion: Care of patients with complex health problems may present several challenges. In this study, patients and GPs experienced the relational dimension as crucial for collaboration. A robust therapeutic alliance, incorporating the patient’s agenda, offers an essential foundation for enhancing care in individuals with complex health problems.