title: Patients with comorbidities: perceptions of acute care services.
abstract: BACKGROUND
  Advances in medical science and improved lifestyles have reduced mortality rates in Australia and most Western countries. As a result, there is an ageing population with a concomitant growth in the number of people living with chronic illnesses. Indeed, a significant number of people will experience multiple chronic illnesses (comorbidities) and may require admission to hospital for acute care that is superimposed on their chronic illnesses.
  
  
  OBJECTIVE
  The aim of this study was to investigate perceptions of quality of care by patients experiencing comorbidities who required an acute hospital stay.
  
  
  METHODS
  A qualitative descriptive design was adopted, informed by Colaizzi's phenomenological method. Single semi-structured interviews were conducted with 12 patients within 14 days of being discharged home after an acute illness episode.
  
  
  RESULTS
  Data analysis revealed three themes: poor continuity of care for comorbidities, the inevitability of something going wrong during acute care and chronic conditions persisting after discharge. Combinations of chronic illnesses and treatments affected these patients' experiences of acute care and recovery postdischarge. Medicalized conceptualizations of comorbidity failed to capture the underlying health care needs of these patients. Limitations. No generalizations can be drawn because the findings and conclusions were derived from a purposive sample of patients who agreed to participate.
  
  
  CONCLUSIONS
  These findings have implications for a comprehensive and co-ordinated approach to this group of patients, and inform the body of nursing knowledge about how patients with comorbidities experience nursing care.
authors.affiliation: School of Postgraduate Nursing, University of Melbourne, Carlton, Victoria, Australia. afw@unimelb.edu.au
authors.forename: Allison
authors.initials: A
authors.lastname: Williams
mesh_terms: D000208:Acute Disease / Q000523:psychology / Q000628:therapy*; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D015897:Comorbidity; D003266:Continuity of Patient Care; D005260:Female; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011157:Population Dynamics; D011787:Quality of Health Care