Table 2 Evaluation findings: outcomes of implementation

1. Acceptability: participants were motivated to incorporate the proposed changes regarding the MPCM in their practices and considered them appropriate within the care system, validating the implementation of the strategy.

2. Adoption: collected evidence indicates high levels MPCM integration in the health teams, involving the expected different activities for the care of users, following the guidelines provided according to the risk stratification (high, moderate and low complexity).

3. Relevance: the perception regarding this outcome of implementation was positive, indicating that MPCM is important to improve care for users with multimorbidity. In addition, positive health and quality of life results for the target population were identified.

4. Feasibility: although participants revealed the possibility of carrying out the changes proposed by MPCM, some differences were identified according to each local reality. Elements that conditioned the viability of MPCM implementation are primarily of an organizational nature, among which the following stand out: (A) modifications in performance to carry out comprehensive patient control, (B) changes in the scheduling system to carry out continuity of care by the head team, (C) an efficient registration system that facilitates the entry of integrated and non-fractioned information by pathology, and (D) protected time to perform associated tasks for the implementing leaders; they considered it advisable to use between 9 and 11 h a week for this function. These organizational elements were modified in a different way by each CESFAM.

5. Fidelity: the information collected shows a correct implementation of the core elements of MPCM, according to the original guidelines. This is more accurate for high-risk users where MPCM has been fully implemented. Health professionals involved in actions and activities aimed at medium and low complexity considered that they are still in the process of incorporation. They indicate that the high demand for patients and the modification of certain organizational conditions (induction plan, higher yields, changes in schedules, training of personnel, as well as spaces for dissemination and follow-up with those involved) are fundamental for the consolidation of MPCM.

6. Cost: there is a call to maintain the resources, both financial and human, considered in the pilot stage of the Strategy, to be able to continue progressing in the implementation of MPCM. The most relevant identified resources were the transition nurse and support staff for the clinical management of patients, as well as specific materials such as cell phones, among others.

7. Coverage: a good level of population scope of the intervention was achieved. Initially with high risk and then with moderate and low risk patients. Progressively, this coverage was greater. However, as the population outreach broadens, significant challenges arise to ensure fidelity in the implementation of the intervention.

8. Sustainability: participants report a successful institutionalization of MPCM, as it has been established within the pilot CESFAMs. Main mentioned changes are aimed at: (A) comprehensive patient care, (B) delivery of support for individual and group self-management (pre-pandemic), as well as (C) case management, and (D) participation and shared responsibility visualized in the agreed plans and its continuous updating. These changes are mainly consolidated in the attention to highly complex users. Regarding moderate and low complexity, this sustainability process has made great progress that has generated results, but the need to continue with training and dissemination actions.