Patient experiences with person-centred and integrated chronic care, focusing on patients with low socioeconomic status: a qualitative study

Background: effectiveness of single disease management programs (DMP) in general practice may be limited for patients with low socioeconomic status (SES), as DMPs insufficiently take into account the specific problems and needs of this population. A Person-Centred Integrated Care (PC-IC) approach focusing on patient’s needs could address these problems. Aim: to explore experiences of patients with (multiple) chronic diseases with regard to the acceptability of a general practice-based PC-IC approach, with a focus on patients with low SES, and to establish which modifications are needed to tailor the approach to this group. Design and setting: in 2021, a 6 month feasibility study in seven general practices in the Netherlands was carried out. The healthcare professionals provided care based on a PC-IC approach to patients with diabetes, chronic respiratory diseases and/or cardiovascular disorders. Method: a qualitative study using focus group discussions, in-depth interviews, and semi-structured telephone interviews in a combined total of 46 patients with chronic diseases and multimorbidity, including 31 patients with low SES. Results: an overall positive experience of participants with the PC-IC approach was observed. Discussing their health made patients feel being taken more seriously, and provided the opportunity to discuss their life and health concerns. Recommended adaptations of the PC-IC approach for patients with low SES include creating comprehensible materials and offering communication training for healthcare professionals. Conclusion: the PC-IC approach seems helpful for chronic disease patients, provided that it is tailored to their skills and abilities. Several modifications for patients with low SES were suggested.