Chronic illness care as a balancing act. A qualitative study.

OBJECTIVE: Current health care reforms aim to assist general practitioners in providing chronic illness care. This study investigates GPs' models of care including their role and responsibilities and their delivery of care models. METHODS: Sixteen GPs, as key informants representing diverse backgrounds, were interviewed about their general chronic illness care and responses to case vignettes. Thematic analysis was based upon the categorizing of GP interviews. RESULTS: The key responsibility in GP models of care was to address the presenting problem and to manage disease and treatment. Models encompassed providing preventive and psychosocial care; and care coordination, but in relation to need as time permitted. Experience and education, rather than reforms and incentives shaped care models. While patient-centredness was a universal theme, gender and location influenced its implementation. Care delivery was an individualized balance of patient needs with other pressures over a series of consultations. DISCUSSION: General practitioners balance models of care with organisational and resource constraints in everyday consultations. Consistent common models of care are subjected to a wide range of influences and translated into varied modes of service delivery and presumably patient outcomes. CONCLUSION: Reforms to improve outcomes for people with chronic illness must address GP care models and adaptive balancing of needs and resources and recognise internal and external constraints that encroach upon patient centred comprehensive care. Policymakers need to research and consult in order that reforms can realistically facilitate care.