Extended Consultations as a Trial Intervention in General Practice: Experiences of Patients with Complex Multimorbidities

Rosa Fryd,1– 4 Barbara Ann Barrett,1,4,5 Sanne Lykke Lundstrøm,1,6 Anne Frølich,1,5 Iben Charlotte Aamann1,4,5,7 1Innovation and Research Centre for Multimorbidity, NSR Hospital, Slagelse, Denmark; 2Section for Global Health, Department of Public Health, Copenhagen University, Copenhagen, Denmark; 3Department of Quality, Nordsjællands Hospital, Hillerød, Denmark; 4Section for Critical Health Studies, Institute for People and Technology, Roskilde University, Roskilde, Denmark; 5Centre for General Practice, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; 6Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark; 7University College Copenhagen, Institute of Social Work, Copenhagen, DenmarkCorrespondence: Rosa Fryd, Innovation and Research Centre for Multimorbidity, NSR Hospital, Region Zealand, Slagelse, 4200, Denmark, Email rosafryd@outlook.dkBackground: Multimorbidity poses significant challenges for healthcare systems worldwide, particularly for patients with complex multimorbidity (CMM). The Complex Intervention for Multimorbidity version 2 (CIM2) was designed to enhance integrated patient-centered care.Aim: This qualitative study aimed to explore patients’ experiences with the CIM2 intervention, focusing on their perceptions of extended consultations and identifying factors that influenced their experiences, which were either beneficial or challenging.Methods: This is a qualitative evaluation conducted as a part of the CIM2 intervention, drawing on data from 13 semi-structured interviews with patients with CMM. Eight of the interviews included the patients’ spouses. The interviews were analyzed using thematic analysis.Results: Three patients found the extension beneficial, appreciating the increased time for discussions and feeling genuinely heard by their GPs. Two patients perceived partial benefit, valuing the extra time but finding the consultation similar to regular appointments. However, six patients experienced no benefit, citing unclear communication about the consultation purpose, a lack of continuity when seen by an unfamiliar GP, and superficial interactions despite the extended time. Two patients did not recall attending the extended consultations.Discussion: Although some patients appreciated the extra time and personalized attention, others found the consultations confusing, superficial, or indistinguishable from regular visits. Crucial factors influencing benefits included clear communication about the consultation’s purpose, being heard and understood, and continuity with familiar GPs. Notably, those with the most fragmented care and highest treatment burden often derived the least benefit. These findings underscore the importance of better communication, preparation, and continuity.Conclusion: Although some patients with complex multimorbidity valued extended consultation time, time alone proved insufficient to ensure meaningful care experiences. Better communication regarding the purpose of the consultation and patient preparation was essential to improving the overall quality and relevance of the encounter.