title: Generalist solutions to complex problems: generating practice-based evidence--the example of managing multi-morbidity.
abstract: BACKGROUND
  A growing proportion of people are living with long term conditions. The majority have more than one. Dealing with multi-morbidity is a complex problem for health systems: for those designing and implementing healthcare as well as for those providing the evidence informing practice. Yet the concept of multi-morbidity (the presence of >2 diseases) is a product of the design of health care systems which define health care need on the basis of disease status. So does the solution lie in an alternative model of healthcare?
  
  
  CONCLUSIONS
  Strengthening generalist practice has been proposed as part of the solution to tackling multi-morbidity. Generalism is a professional philosophy of practice, deeply known to many practitioners, and described as expertise in whole person medicine. But generalism lacks the evidence base needed by policy makers and planners to support service redesign. The challenge is to fill this practice-research gap in order to critically explore if and when generalist care offers a robust alternative to management of this complex problem. We need practice-based evidence to fill this gap. By recognising generalist practice as a 'complex intervention' (intervening in a complex system), we outline an approach to evaluate impact using action-research principles. We highlight the implications for those who both commission and undertake research in order to tackle this problem.
  
  
  CONCLUSIONS
  Answers to the complex problem of multi-morbidity won't come from doing more of the same. We need to change systems of care, and so the systems for generating evidence to support that care. This paper contributes to that work through outlining a process for generating practice-based evidence of generalist solutions to the complex problem of person-centred care for people with multi-morbidity.
authors.affiliation: University of Liverpool, B122 Waterhouse Buildings, 1-5 Brownlow St, Liverpool L693GL, UK. joanne.reeve@liv.ac.uk
authors.forename: Joanne
authors.initials: J
authors.lastname: Reeve
authors.forename: Tom
authors.initials: T
authors.lastname: Blakeman
authors.forename: George K
authors.initials: GK
authors.lastname: Freeman
authors.forename: Larry A
authors.initials: LA
authors.lastname: Green
authors.forename: Paul A
authors.initials: PA
authors.lastname: James
authors.forename: Peter
authors.initials: P
authors.lastname: Lucassen
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Martin
authors.forename: Joachim P
authors.initials: JP
authors.lastname: Sturmberg
authors.forename: Chris
authors.initials: C
authors.lastname: van Weel
mesh_terms: D002908:Chronic Disease / Q000628:therapy; D015897:Comorbidity; D003266:Continuity of Patient Care; D055317:Evidence-Based Practice; D005260:Female; D058006:General Practice / Q000379:methods* / Q000592:standards; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D010821:Physicians, Family / Q000523:psychology* / Q000706:statistics & numerical data
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