Supporting those with a Multimorbidity. A Qualitative Study on the Perspectives of Healthcare Professionals who Provide Care to Individuals with Type 2 Diabetes and Cardiovascular Disease, 2023-2024

Type 2 Diabetes and cardiovascular disease frequently co-exist as multimorbid conditions due to their shared pathophysiological mechanisms and overlapping treatment needs. Effective management requires coordinated patient centred care, however there is limited qualitative accounts understanding how support is provided to those who live with T2D and CVD collectively. Thus, the present study aims to bridge the gap by providing in depth explorations of practitioner’s perception and practices regarding the management of these conditions. Thirteen community practitioners and three hospital-based clinicians were recruited, and raw data was analysed using Reflexive Thematic Analysis. Three core themes and six sub themes were generated: first, current care, second, structural challenges, and third, psychological perceptions of multimorbidity. Importantly, the data demonstrated inconsistencies in how healthcare professionals conveyed risk information, with some suggesting the monitoring of biological complications alone is sufficient for managing morbidity. Further, multifaceted barriers within the structure of care and lack of cohesion between teams highlighted how support is not always optimised for those living with complex needs. Moreover, psychological issues were recognised by all healthcare professionals, however most lacked confidence providing this sort of support, and several commented on the lack of suitable services for those mentally struggling with chronic health conditions. This study underscores the need for improved communication and a more integrated approach to care, however until complex systemic issues are resolved multimorbidity management will remain minimal.<p>Type 2 Diabetes and cardiovascular disease frequently co-exist as multimorbid conditions due to their shared pathophysiological mechanisms and overlapping treatment needs. Effective management requires coordinated patient centred care, however there is limited qualitative accounts understanding how support is provided to those who live with T2D and CVD collectively. Thus, the present study aims to bridge the gap by providing in depth explorations of practitioner’s perception and practices regarding the management of these conditions. Thirteen community practitioners and three hospital-based clinicians were recruited, and raw data was analysed using Reflexive Thematic Analysis. Three core themes and six sub themes were generated: first, current care, second, structural challenges, and third, psychological perceptions of multimorbidity. Importantly, the data demonstrated inconsistencies in how healthcare professionals conveyed risk information, with some suggesting the monitoring of biological complications alone is sufficient for managing morbidity. Further, multifaceted barriers within the structure of care and lack of cohesion between teams highlighted how support is not always optimised for those living with complex needs. Moreover, psychological issues were recognised by all healthcare professionals, however most lacked confidence providing this sort of support, and several commented on the lack of suitable services for those mentally struggling with chronic health conditions. This study underscores the need for improved communication and a more integrated approach to care, however until complex systemic issues are resolved multimorbidity management will remain minimal.</p>2型糖尿病（Type 2 Diabetes, T2D）与心血管疾病（cardiovascular disease, CVD）因共享病理生理机制、治疗需求重叠，常以共病状态共同存在。有效的疾病管理需要协同的以患者为中心的照护（patient centred care），但目前针对两类疾病共患人群的支持提供方式的质性研究尚较为匮乏。 因此，本研究旨在填补这一研究空白，深入探索临床从业者针对两类疾病共患管理的认知与实践。本研究招募了13名社区从业者与3名医院临床医师，并采用反思性主题分析（Reflexive Thematic Analysis）对原始数据进行分析。 最终生成3个核心主题与6个次级主题：其一为当前照护现状，其二为结构性挑战，其三为共病的心理认知。值得注意的是，数据显示医护人员在风险信息传递方面存在不一致，部分人员认为仅需监测生物学并发症即可满足共病管理需求。此外，照护体系内存在多维度壁垒，且团队间缺乏协同性，这表明针对存在复杂健康需求的人群，支持服务往往未能得到最优配置。进一步而言，所有医护人员均意识到心理问题的存在，但多数人在提供此类支持时缺乏信心，另有部分从业者提及，针对因慢性疾病承受心理困扰的人群，缺乏适配的服务资源。本研究凸显了优化沟通、采用更整合式照护方案的必要性，但若复杂的系统性问题未能得到解决，共病管理的质量仍将处于较低水平。