title: Self-management perspectives of heavily comorbid primary care adults.
abstract: OBJECTIVE
  This exploratory study investigated the personal self-management perspectives of a sample of heavily comorbid primary care adults with at least four chronic health conditions. The study was specifically designed to explore the perceived health care needs of adults with numerous comorbid conditions by focusing on their self-management practices and relationships with primary care providers.
  
  
  METHODS
  Midwest academic-based family medicine primary care clinic lacking any formal patient education, case management, or phone follow-up services.
  
  
  METHODS
  A total of 18 heavily comorbid focus group participants described the complexities of their self-management practices and frequently frustrating office visit interactions with primary care providers.
  
  
  RESULTS
  : Four core themes and nine subthemes were identified concerning participants' ongoing self-management practices when attempting to navigate health care delivery systems and interact with providers. Future case management practice and research implications are discussed.
  
  
  CONCLUSIONS
  Case managers have an opportunity to fill the gaps in care for patients with multiple comorbid conditions. The case manager has the potential to address several of the issues identified by the patients in this study by helping comorbid patients develop self-management skills and tailoring supportive primary care interventions to meet individual patient needs.
authors.affiliation: Michigan State University (MSU) College of Nursing, Lansing. MI 48824, USA. Bill.Corser@hc.msu.edu
authors.forename: William
authors.initials: W
authors.lastname: Corser
authors.forename: Katherine
authors.initials: K
authors.lastname: Dontje
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management; D015897:Comorbidity; D003625:Data Collection; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research; D012648:Self Care / Q000379:methods*