P.S.S.LEE1, E.A.L.CHEW1, H.L.KOH1, Y.Y.DING2, M.SUBRAMANIAM3, E.S.LEE1, J.VAINGANKAR AJIT3
NHG Polyclinics1, Tan Tock Seng Hospital2, Institute of Mental Health3
Navigating the healthcare system can be particularly challenging for older patients with multimorbidity who are not only affected by their multiple diseases, but also by the treatment burden. This qualitative study sought to elicit the experiences of older patients with multimorbidity when navigating the Singapore healthcare system. The study aimed to identify potential gaps in their care and gather recommendations on how to better support these patients.
Individual in-depth interviews were conducted with purposively sampled older patients with multimorbidity (aged 60 years old and above). Interviews explored patients’ experiences in navigating the healthcare system including scheduling appointments, obtaining medications, and accessing information. These interviews were analysed using thematic analysis.
Data sufficiency was achieved with 20 interviews (13 male; mean age: 74 years old). Patients’ ability to navigate the healthcare system differed depending upon patient-related and healthcare provider-related factors. Patients used strategies such as “fitting in” with system’s demands, “asking for help” to navigate the system, and “negotiating to achieve their own goals” to overcome obstacles encountered during navigation. Suggestions to improve navigation included training to enhance doctors’ understanding of treatment burden and putting more focus on low-literacy and technologically disadvantaged segments of the population.
Our study identified multiple factors that affect older patients with multimorbidity navigating the Singapore healthcare system. While the healthcare system plays an important role to provide efficient system processes and effective patient-doctor communication to reduce older patient’s burden, patients themselves would require resilience and intrinsic capacity to overcome any challenges imposed by the complex healthcare system.