Improving Health Care for Patients with Multimorbidity: A Mixed-Methods Study to Explore the Feasibility and Process of Aligning Scheduled Outpatient Appointments through Collaboration between Medical Specialties

Int J Integr Care. 2022 Mar 1;22(1):17. doi: 10.5334/ijic.6013. eCollection 2022 Jan-Mar.


Background: Many patients with multimorbidity have appointments and parallel trajectories in several outpatient clinics across medical specialties. This organisation may disintegrate care and challenges the navigation of the healthcare system.

Methods: This study explored the feasibility of an intervention targeting patients seen in several outpatient clinics for multiple diseases. The intervention aimed to coordinate outpatient appointments through enhanced collaboration across medical specialties. Feasibility and process were assessed through mixed methods by tracking the intervention through prospectively collected data and through semi-structured interviews with patients and healthcare professionals.

Results: A multidisciplinary outpatient pathway was established as an intervention. Appointments for different medical specialties were scheduled on the same day, information was rapidly transferred to the receiving outpatient clinic, and a multidisciplinary conference resulted in the circulation of a joint summary. In the first year, 20% of eligible patients were enrolled. Appointments were aligned in 15% of patients, and blood samples were reduced by 29%. Overall, intervention components were delivered as intended and seemed acceptable, although the patient selection needed refinement.

Conclusion: It seems feasible to set up an intervention for patients attending several hospital outpatient clinics. Future interventions should focus on selecting patients in greatest need for alignment of appointments.

Keywords: ambulatory care; appointments and schedules; delivery of health care; integrated care; multimorbidity; outpatients.

Grant support

This project was funded by the Novo Nordic Foundation (grant no. NNF18OC0052136), Toyota-Fonden, Denmark and Aarhus University. All authors are independent from the funders, and the funders had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.