Background

Multimorbidity̶ the simultaneous occurrence of two or more chronic Non-Communicable Diseases (NCDs) in an individual-is increasing globally and challenging health systems. Although individuals living with multimorbidity face a range of adverse consequences and difficulty in getting optimal health care, the evidence base in understanding the burden and capacity of the health system in managing multimorbidity is sparse in low-and middle-income countries (LMICs). This study aimed at understanding the lived experiences of patients with multimorbidity and perspective of service providers on multimorbidity and its care provision, and perceived capacity of the health system for managing multimorbidity in Bahir Dar City, northwest Ethiopia.

Methods

A facility-based phenomenological study design was conducted in three public and three private health facilities rendering chronic outpatient NCDs care in Bahir Dar City, Ethiopia. Nineteen patient participants with two or more chronic NCDs and nine health care providers (six medical doctors and three nurses) were purposively selected and interviewed using semi-structured in-depth interview guides. Data were collected by trained researchers. Interviews were audio-recorded using digital recorders, stored and transferred to a computer, transcribed verbatim by the data collectors, translated into English and then imported into NVivo V.12 software for data analysis. We employed a six-step inductive thematic framework analysis approach to construct meaning and interpret experiences and perceptions of individual patients and service providers. Codes were identified and categorized into sub-themes, organizing themes and main themes iteratively to identify similarities and differences across themes, and to interpret the themes accordingly.

Results

A total of 19 patient participants (5 Females) and nine health workers (2 females) responded to the interviews. Participants’ age ranged from 39 to79 years for patients and 30 to 50 years for health professionals.  About half (n=9) of the participants had three or more chronic conditions.

The thematic analysis produced two main (global) themes, five organizing themes and 16 sub-themes. Key problems experienced (organizing themes) include dependency, feeling rejected, psychological distress, poor medication adherence and poor quality of care. Poor quality of life and compromised clinical outcomes were the main (global) themes constructed.

Living with multimorbidity poses a huge burden on the physical, psychological, social and sexual health of patients. In addition, patients with multimorbidity are facing financial hardship to access optimal multimorbidity care.  On the other hand, the health system is not appropriately prepared to provide integrated, person-centered and coordinated care for people living with multiple chronic conditions.

Conclusion and recommendations

Multimorbidity poses a huge challenge both for patients and the health system. However, there is lack of personal, social and health system readiness to account for the growing burden. It is recommended that the social fabric and health system must understand and respond to the complex care needs of the patients with multimorbidity. Future research endeavors may need to focus on designing and testing interventions to improve the well-being and health service delivery of patients living with multiple long-term conditions.

Key words

Multimorbidity, health system, qualitative methods, thematic analysis, Ethiopia