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Generalist solutions to complex problems : generating practice-based evidence : the example of managing multi-morbidity
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Reeve, Joanne L., Blakeman, Tom, Freeman, George K., Green, Larry A., James, Paul A., Lucassen, Peter, Martin, Carmel M., Sturmberg, Joachim P. and Weel, C. van (Chris van) (2013) Generalist solutions to complex problems : generating practice-based evidence : the example of managing multi-morbidity. BMC Family Practice, Volume 14 (Number 1). Article number 112. doi:10.1186/1471-2296-14-112 ISSN 1471-2296.
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Official URL: http://dx.doi.org/10.1186/1471-2296-14-112
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.
Item Type: | Journal Article | ||||||||
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Subjects: | R Medicine > R Medicine (General) | ||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Physicians (General practice), Primary care (Medicine), Chronic diseases -- Treatment | ||||||||
Journal or Publication Title: | BMC Family Practice | ||||||||
Publisher: | BioMed Central Ltd. | ||||||||
ISSN: | 1471-2296 | ||||||||
Official Date: | 7 August 2013 | ||||||||
Dates: |
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Volume: | Volume 14 | ||||||||
Number: | Number 1 | ||||||||
Article Number: | Article number 112 | ||||||||
DOI: | 10.1186/1471-2296-14-112 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||
Date of first compliant deposit: | 29 December 2015 | ||||||||
Date of first compliant Open Access: | 29 December 2015 |
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