Conceptual Development of a Patient-Centered Consultation Framework for Multimorbidity Management in Primary Care (CARESTEP).

Abstract

Multimorbidity management in primary care faces significant challenges, including conflicting disease-specific guidelines, fragmented care, and suboptimal patient engagement. To address these barriers, we introduce the CARESTEP, a patient-centered consultation framework designed to facilitate the management of patients with multimorbidity in primary care. CARESTEP encompasses 8 integrated components, including <b>C</b>omprehensive review, <b>A</b>lternatives, <b>R</b>isk-benefit analysis, <b>E</b>ngagement, <b>S</b>hared decision-making, <b>T</b>eaching, <b>E</b>valuation and <b>P</b>lanning. The framework systematically incorporates biomedical, psychosocial, and functional dimensions to facilitate holistic, individualized care. It emphasizes the need to assess treatment burden, generate feasible therapeutic options, and conduct structured risk-benefit analysis as the foundation for shared decision-making. CARESTEP also promotes tailored patient education, addresses implementation barriers, and fosters sustainable self-management through dynamic follow-up planning. CARESTEP provides a conceptual yet practical framework that explicitly guides primary care physicians through each decision point in complex consultations. We also used several cases to illustrate the key steps of CARESTEP, and further validation of its impact on patient outcomes and cost-effectiveness in diverse settings is warranted.