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Generalist solutions to complex problems: generating practice-based evidence - the example of managing multi-morbidity

Title: Generalist solutions to complex problems: generating practice-based evidence - the example of managing multi-morbidity
Authors: Reeve, J
Blakeman, T
Freeman, GK
Green, LA
James, PA
Lucassen, P
Martin, CM
Sturmberg, JP
Van Weel, C
Item Type: Journal Article
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? Discussion 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. Summary 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.
Issue Date: 7-Aug-2013
Date of Acceptance: 2-Aug-2013
URI: http://hdl.handle.net/10044/1/64414
DOI: https://dx.doi.org/10.1186/1471-2296-14-112
ISSN: 1471-2296
Publisher: BioMed Central
Journal / Book Title: BMC Family Practice
Volume: 14
Issue: 1
Copyright Statement: © 2013 Reeve et al. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Science & Technology
Life Sciences & Biomedicine
Primary Health Care
Medicine, General & Internal
General & Internal Medicine
Primary care
Action research
Chronic Disease
Continuity of Patient Care
Evidence-Based Practice
General Practice
Health Services Needs and Demand
Physicians, Family
1117 Public Health And Health Services
Public Health
Publication Status: Published
Article Number: 112
Online Publication Date: 2013-08-07
Appears in Collections:Faculty of Medicine