Healthcare providers' perspectives on the organization of health services to manage people with multiple long-term conditions in primary care settings in Kerala, India: a qualitative exploratory study.

Background: Multiple long-term conditions (MLTCs) are a major public health challenge globally. Complexity in managing MLTCs and their adverse consequences confronts the public healthcare systems in India. However, data from India to understand how to improve capacity to manage multiple chronic conditions are limited. We aimed to explore the challenges healthcare providers (HCPs) face in managing people with MLTCs in a south Indian primary care setting. Methods: Semi-structured interviews were conducted with HCPs in four districts of Kerala, India. Key themes and sub-themes were identified using the Framework method for thematic analysis. We categorized the systemic drivers that influenced management of patients with MLTCs in the government primary care settings as health system, organizational and individual HCPs, and patient-levels. Results: 33 in-depth, semi-structured interviews were conducted. Two main themes with sub-themes were found: multimorbidity preparedness ( Conclusion: Our study confirms sub-optimal health system preparedness and highlights the challenges for a transitioning primary care for managing people with MLTCs in one of India's states with a well-developed healthcare system. Our results suggest a need for improved planning and re-organization of primary health services with ongoing training support for HCPs.