Implementing Multimorbidity Care Innovations in Three Nova Scotian Primary Care Clinics: A Qualitative Case Study

Background: The increasing global prevalence of multimorbidity poses major challenges for primary healthcare systems because its treatment and prevention require coordinated, patient-centered, and interprofessional models of care. In Nova Scotia, Canada, one response has been the implementation of interprofessional team-based primary healthcare. This study evaluated the implementation of multimorbidity care program components in three interprofessional primary healthcare teams. The aim was to describe programs and identify enablers, barriers, and lessons learned to guide future implementation of similar programs in primary healthcare settings. Methods: A qualitative case study design was used, involving in-depth semi-structured interviews and focus groups with 12 team members across two rural and one urban primary healthcare practices in Nova Scotia, Canada. Data were analyzed using the Consolidated Framework for Implementation Research (CFIR) to explore contextual and organizational factors influencing implementation. Thematic analysis identified common enablers, barriers, and recommendations across the CFIR framework’s domains: Innovation, Outer and Inner Settings, Characteristics of Individuals, and Implementation Processes. Results: Implementation was supported by several enablers, including strong leadership engagement, interprofessional collaboration, and effective use of Information Technology systems that enhanced workflow and communication. Providers reported that team-based care improved job satisfaction and enabled patients to receive more coordinated, accessible care. Community partnerships and blended models of virtual and in-person care also facilitated implementation. However, programs faced multiple barriers, including staffing shortages, limited funding for key roles, high costs and complexity of Electronic Medical Records (EMR), and patient discomfort with virtual care. Additional challenges included limited training, competing provider priorities, and difficulties coordinating across multiple sites. Participants recommended expanding training on EMR systems, increasing funding for navigator roles and infrastructure, streamlining technology, and fostering leadership and team engagement. Conclusions: The implementation of multimorbidity care programs in primary healthcare settings is influenced by both systemic and contextual factors. While interprofessional teamwork, leadership support, and community partnerships are essential enablers, sustainable funding, structured training, and user-friendly technology are critical for program scalability and success. These findings offer actionable guidance for policymakers, healthcare leaders, and researchers seeking to strengthen integrated multimorbidity care, enhance provider satisfaction, and improve patient outcomes in primary healthcare.