title: Primary care physician insights into a typology of the complex patient in primary care.
abstract: OBJECTIVE
  Primary care physicians play unique roles caring for complex patients, often acting as the hub for their care and coordinating care among specialists. To inform the clinical application of new models of care for complex patients, we sought to understand how these physicians conceptualize patient complexity and to develop a corresponding typology.
  
  
  METHODS
  We conducted qualitative in-depth interviews with internal medicine primary care physicians from 5 clinics associated with a university hospital and a community health hospital. We used systematic nonprobabilistic sampling to achieve an even distribution of sex, years in practice, and type of practice. The interviews were analyzed using a team-based participatory general inductive approach.
  
  
  RESULTS
  The 15 physicians in this study endorsed a multidimensional concept of patient complexity. The physicians perceived patients to be complex if they had an exacerbating factor-a medical illness, mental illness, socioeconomic challenge, or behavior or trait (or some combination thereof)-that complicated care for chronic medical illnesses.
  
  
  CONCLUSIONS
  This perspective of primary care physicians caring for complex patients can help refine models of complexity to design interventions or models of care that improve outcomes for these patients.
authors.affiliation: University of Colorado, Division of General Internal Medicine, Aurora, Colorado Danielle.loeb@ucdenver.edu.
authors.forename: Danielle F
authors.initials: DF
authors.lastname: Loeb
authors.affiliation: University of Colorado, Division of General Internal Medicine, Aurora, Colorado Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
authors.forename: Ingrid A
authors.initials: IA
authors.lastname: Binswanger
authors.affiliation: University of Colorado, Division of General Internal Medicine, Aurora, Colorado.
authors.forename: Carey
authors.initials: C
authors.lastname: Candrian
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado University of Colorado, Department of Family Medicine, Aurora, Colorado.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bayliss
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010465:Perception; D058007:Physicians, Primary Care / Q000523:psychology*; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research
keywords: chronic care; comorbidity/multimorbidity; key informant/depth interviewing; mental health; practice-based research; primary care issues; qualitative methods; social factors in health and health care