Objectives People with chronic disease are at risk of overmedicalisation including overdiagnosis because of their frequent contact with the health care system. People living with HIV (PLWH) have benefited from exceptional efficacy of antiretrovirals with minimal toxicities so that many screening and testing strategies for HIV related conditions can be de-implemented. In developed countries the population of PLWH is aging and multimorbidity remains prevalent requiring shared care between HIV specialists and primary care providers. We explored consumer perspectives on overmedicalisation within a qualitative study of shared care among PLWH.
Method Thirteen semi-structured interviews with PLWH from Northern NSW were conducted by four medical student researchers in February and March 2022. The interview schedule covered access, communication, co-ordination and value within a shared care model. The interviews were coded for concepts related to value and overmedicalisation using NVivo. Latent inductive thematic analysis with a constructivist approach was performed and themes were developed in discussion with experienced qualitative researchers and HIV specialists and social workers.
Results Participants valued holistic, patient-centred care and identified the predominant harm of overmedicalisation as treatment and investigation burden, often driven by poor co-ordination. Overdiagnosis was infrequently recognised meaning health anxiety, consumer expectations and desire for action have the potential to drive future overdiagnosis. However high levels of trust, strong primary care provider relationships and health literacy were potential braking forces on overdiagnosis.
Conclusions Consumer education for PLWH and others with chronic disease may play a critical role in addressing potential overdiagnosis drivers such as patient anxiety and desire for action. Trust and engagement with primary care providers was varied, but has the potential to reduce overmedicalisation. Perspectives from other levels of the healthcare system and other chronic diseases should be sought to comprehensively understand overmedicalisation in chronic disease care.
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