Regie bij multimorbiditeit in het ziekenhuis

Objective

To gain insight in medical specialists’ and nurse practitioners’ opinions on multimorbidity and coordination and tailoring of hospital care.

Design

Exploratory mixed-method design.

Method

From August 2018 until January 2019, 35 Dutch medical associations were asked to forward a digital survey with open- and close-ended questions to their members. We used qualitative and quantitative methods to analyze the data. The main themes were identified with inductive, thematic analysis.

Results

There were 554 respondents from 22 associations, 43% of the medical specialist respondents were internist (n=221). The qualitative analysis of the answers regarding what is required in hospital care for patients with multimorbidity resulted in eight themes at the patient’s, professional’s and hospital organization’s level. To the open question about who should take the lead, respondents most often answered the geriatrician or internist, followed by the general practitioner, ‘the care professional who is treating the main problem’, a nurse practitioner/physician assistant and the ‘attending physician of the primary team’. All geriatricians and almost all internists felt they possessed the competencies to take the lead in hospital care for patients with multimorbidity.

Conclusion

Medical specialists’ and nurse practitioners’ diverse ideas about who should take the lead in hospital care for patients with multimorbidity were a noteworthy finding. It is important to start local conversations about how to divide roles and responsibilities regarding the coordination and tailoring of hospital care for patients with multimorbidity.

Conflict of interest and financial support: The project ‘Multimorbidity and coordination and tailoring of care’ was funded by non-profit foundation Quality Funds Medical Specialists. ICMJE forms provided by the authors are available online along with the full text of this article.