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

Reeve J, Blakeman T, Freeman GK, Green LA, James PA, Lucassen P, Martin CM, Sturmberg JP, van Weel C - BMC Fam Pract (2013)

Bottom Line: 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Liverpool, B122 Waterhouse Buildings, 1-5 Brownlow St, Liverpool L693GL, UK. joanne.reeve@liv.ac.uk

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.

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The generalism in action framework.
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Figure 2: The generalism in action framework.

Mentions: Drawing on these principles of action research, we present the Generalism in Action (GIA) framework as a change model to describe, deliver and evaluate expert generalist practice. The framework focuses on developing and evaluating generalist solutions to health care problems within a given context. It supports the user in asking ‘(how) can an expert generalist approach enhance person-centred primary care within the context of particular area or problem?’ It can therefore be used to critically enhance and evaluate EGP for the care of people with multi-morbidity (Figure 2).


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

Reeve J, Blakeman T, Freeman GK, Green LA, James PA, Lucassen P, Martin CM, Sturmberg JP, van Weel C - BMC Fam Pract (2013)

The generalism in action framework.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750615&req=5

Figure 2: The generalism in action framework.
Mentions: Drawing on these principles of action research, we present the Generalism in Action (GIA) framework as a change model to describe, deliver and evaluate expert generalist practice. The framework focuses on developing and evaluating generalist solutions to health care problems within a given context. It supports the user in asking ‘(how) can an expert generalist approach enhance person-centred primary care within the context of particular area or problem?’ It can therefore be used to critically enhance and evaluate EGP for the care of people with multi-morbidity (Figure 2).

Bottom Line: 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Liverpool, B122 Waterhouse Buildings, 1-5 Brownlow St, Liverpool L693GL, UK. joanne.reeve@liv.ac.uk

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.

Show MeSH
Related in: MedlinePlus