title: Processes of care desired by elderly patients with multimorbidities.
abstract: BACKGROUND
  Most recommended care for chronic diseases is based on the research of single conditions. There is limited information on 'best' processes of care for persons with multiple morbidities. Our objective was to explore processes of care desired by elderly patients who have multimorbidities that may present competing demands for patients and providers.
  
  
  METHODS
  Qualitative investigation using one-on-one interviews of 26 community-dwelling HMO members aged 65-84 (50% male) who had, at a minimum, the combined conditions of diabetes, depression and osteoarthritis. Participants were chosen from a stratified random sample to have a range of 4-16 chronic medical conditions.
  
  
  RESULTS
  Participants' desired processes of care included: the need for convenient access to providers (telephone, internet or in person), clear communication of individualized care plans, support from a single coordinator of care who could help prioritize their competing demands and continuity of relationships. They also desired providers who would listen to and acknowledge their needs, appreciate that these' needs were unique and fluctuating and have a caring attitude.
  
  
  CONCLUSIONS
  These respondents describe an ideal process of care that is patient centered and individualized and that supports their unique constellations of problems, shifting priorities and multidimensional decision making. Individual and ongoing care coordination managed by a primary contact person may meet some of these needs. Achieving these goals will require developing efficient methods of assessing patient care needs and flexible care management support systems that can respond to patients' needs for different levels of support at different times.
authors.affiliation: Kaiser Permanente Institute for Health Research, Denver, CO 80237-8066, USA. elizabeth.bayliss@kp.org
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bayliss
authors.forename: Allison E
authors.initials: AE
authors.lastname: Edwards
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Main
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015897:Comorbidity; D003863:Depression / Q000628:therapy; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D005853:Geriatrics / Q000379:methods*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006299:Health Services for the Aged; D006801:Humans; D008297:Male; D010003:Osteoarthritis / Q000628:therapy; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D012648:Self Care