What makes patients in primary care complex? A scoping review combined with a focus group analysis

Abstract

Background: Consultations can be challenging because of patient complexity, affecting care quality. Patient complexity involves factors related to the patient, healthcare professional, organization, and healthcare system. A comprehensive overview of these factors and their significance to healthcare providers is lacking. The aim of this study was to create a literature overview and to examine how the results relate to the experiences of primary care providers. Methods: The PubMed, Embase and Cochrane databases were searched (2018–2023) to conduct a scoping review. In addition, a focus group was organized with healthcare providers from general practices (a) to discuss the results of the review, and (b) to explore its meaning in daily consultation, based on the real-life patient cases they presented. Results: The review (171 unique studies) mainly revealed patient-related factors (medical, social and behavioural aspects). Complexity arises when multiple aspects are present and mutually interact. Factors related to the expertise of healthcare professionals, the organization (care coordination) and the system (availability of resources, navigation problems) were also identified. The focus group recognized the factors that influenced patient complexity and their interdependence. They noted a need for support in identifying and treating the patient population in question across disciplines. Conclusions: A comprehensive overview of factors influencing patient complexity at four different levels (patient, professional, organization, system) is provided. The primary care providers suggested disseminating these results to customize treatment to the needs of patients, which is likely to require coordination across disciplines and integrated care.