Abstract
BACKGROUND: Over one-quarter of adults have multimorbidity. Patients with multimorbidity are more likely to struggle to afford their care than patients without multimorbidity, but their experiences with financial strain have not been fully described. OBJECTIVE: We qualitatively explored the lived experiences of adults with multimorbidity to develop a framework describing financial strain in this patient population. DESIGN: Using semi-structured interviews, we asked participants to describe scenarios causing financial strain, any exacerbating or alleviating factors, and emotional/behavioral responses. PARTICIPANTS: Adults who had ≥ 2 of 5 pre-defined chronic conditions (heart failure, coronary artery disease, diabetes, chronic obstructive pulmonary disease, hypertension), took ≥ 5 medications, and received care at a safety-net primary care clinic. MEASUREMENTS: We analyzed transcripts using rapid qualitative analysis. RESULTS: Among 13 participants, age was 42-68 years, 7 were female, 7 had self-reported Black race, and 9 were enrolled in Medicaid. On average, participants had 3/5 pre-defined chronic conditions and were prescribed 10 medications. Financial strain was driven by complex cycles of chronic disease stability and exacerbations, high medical costs (e.g., medications), non-medical costs (e.g., transportation), and low financial reserve (e.g., income loss due to hospitalizations). Participants felt they had to prioritize certain health conditions over others due to cost. Protective factors included caregiver support, financial assistance programs, and assistance from community organizations. Responses to financial strain included rationing care and borrowing money, which negatively impacted disease control and credit scores. LIMITATIONS: All interviews were conducted at a single site. CONCLUSION: Financial strain in multimorbidity stems from a complex interplay between individual, health system, and community factors, some of which may not be ascertained in routine interactions with primary care providers.