Contributor: Dr. Courtney Field
Summary:
Comorbid patients, those with 2 or more chronic conditions, are increasingly common in primary care and often intimidating to learners. Medical education and clinical guidelines, often focus on individual diseases, and structured approaches or decision-making tools to manage multiple illnesses are lacking. This can lead to learners feeling easily overwhelmed by patients with comorbidities, numerous medications, and often lengthy clinical charts.
Collect, cluster, and coordinate is an approach preceptors can teach learners to help them prepare and manage comorbid patients.
| Collect | -gather the info necessary to understand the issues at hand (review chart prior to appt, explore patients concerns) -collaborative goal-setting (formulate an agenda considering both the patient’s concerns/perspective and your own) -time management – book follow-up to revisit issues -consider other team members that can support patient’s care |
| Cluster | -group like concerns/illness/medications based, such as: a) similar pathophysiology (metabolic, autoimmune) b) medication mechanism of action c) immediate vs active vs inactive concerns -pharmacological and non-pharmacological management strategies -preventative care |
| Coordinate | -managing investigations/referrals -involving other team members (system navigator, dietician) -future monitoring and reminders re: follow-up tasks -follow-up appointments or regularly scheduled appointments |
Learners should be involved in all 3 stages including being aware of hidden administrative systems used to organize care such as sending referrals, managing appointment times, and communicating patient’s results. Include learners in team-based meetings that strategize care coordination and discussions around billing for comorbid patients.
Though patients with comorbidities can be daunting, they highlight the importance of continuity of care and help learners develop strategies for managing complexity.
Links to Resources:
Penner K, Wicklum S, Johnston Aaron, Kelly M. Family medicine teaching strategy for managing patients with comorbidity. Canadian Family Physician. 2023; 69: 443-514. Article: https://www.cfp.ca/content/69/7/507