Primary Care Providers' Experiences Caring for Complex Patients in Primary Care

Danielle F. Loeb; Elizabeth A. Bayliss; Carey Candrian; Frank V. deGruy; Ingrid A. Binswanger


BMC Fam Pract. 2016;17(34) 

In This Article


Readers should generalize these findings with caution. First, all participants were affiliated with a single university in the Rocky Mountain region, but worked diverse settings, including an academic medical center and urban, community health centers. These clinical sites were chosen because of their concentration of complex patient populations. Second, the providers in this study were relatively young and most had been in practice for less than 10 years. Physicians in practice for longer may develop greater skills for managing complex patients. Third, four of the five researchers who conducted this study were PCPs. Thus, the analysis was likely influenced by their own professional roles, which may have informed a rich understanding and generative discussion of meaning regarding the care of complex patients.[24] Lastly, we used the term "complex patients" in materials with participants because it is commonly used in the United States when referring to patients with multiple chronic conditions. However, we have some concern that this term can have a pejorative connotation. AHRQ has more recently been using the term "patients with complex care needs". Other commonly used terms include multimorbidity and multiple chronic conditions.

Our study identified core struggles in the daily practice of managing complex patients. PCP reliance on professional values and individual strategies to manage systemic challenges may not necessarily produce optimal care and may contribute to PCP burnout. It remains to be shown whether these barriers to optimal care can be reduced with new models of care.