title: Understanding Clinical Complexity the Hard Way: A Primary Care Journey.
abstract: Ten years ago, complexity was not a term often used in primary care. In the last decade, however, the population seen in primary care has shifted, posing substantial challenges for both primary care providers and health systems. In this essay, I will document the approaches that evolved in an academic family practice environment to address the challenges posed by complex patients typified by multiple concurrent chronic conditions and social determinants challenges. I will describe the research that lead to the creation, implementation and evaluation of an inter-professional model of care and associated outcomes. I will describe how this work subsequently led to the evolution of clinical models and research projects designed to reframe the discourse around complexity as well as move forward on elaborating new policy, clinical and service delivery innovations. I will conclude with some thoughts about what I see as the major challenges in the short and immediate term for research and practice, drawing on 15 years of practice and research experience with complex populations.
authors.affiliation: Professor in the Department of Family and Community Medicine and the Dalla Lana School of Public Health at the University of Toronto. He is also an assistant director of the Lunenfeld Tanenbaum Research Institute in the Sinai Health System and head of the Division of Clinical Public Health at the Dalla Lana School of Public Health at the University of Toronto. He can be reached by e-mail at: ross.upshur@gmail.com.
authors.forename: Ross E G
authors.initials: RE
authors.lastname: Upshur
mesh_terms: D015897:Comorbidity; D019468:Disease Management; D006801:Humans; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods*; D012944:Social Support