Understanding the processes behind the decisions – GPs and complex multimorbidity decision making
Open Access
- 28 June 2022
- journal article
- editorial
- Published by Springer Science and Business Media LLC in BMC Primary Care
- Vol. 23 (1), 1-5
- https://doi.org/10.1186/s12875-022-01781-0
Abstract
Complex multimorbidity, defined either as three or more chronic conditions affecting three or more different body systems or by the patients General Practitioner (GPs), is associated with various adverse outcomes. Understanding how GPs reach decisions for this complex group of patients is currently under-researched, with potential implications for health systems and service delivery. Schuttner and colleagues, through a qualitative approach, reported that internal factors of individuals (decisions tailored to patients; Primary Care Physician (PCP) consultation style; care planning towards an agreed goal of care), external factors within the environment or context of encounter (patient access to healthcare; organizational structures acting as barriers), and relationship-based factors (collaborative care planning; decisions within a dynamic patient clinician relationship) all influence care planning decisions. There are other important findings which have broader relevance to the literature such as the ongoing separation of physical and mental health which persist even within integrated care systems, GPs continue to prioritize continuity of care and that organizational barriers are reported as factors in clinician decision-making for patients. More broadly, the work has proved valuable in extending previously reported findings surrounding care coordination, and limitation of current guidelines for patients with complex multimorbidity. Work-load in general practice is increasing due to an ageing population, increasing prevalence of multimorbidity and polypharmacy, and transfer of clinical activities from secondary to primary care. The future for GPs is more complexity in the clinic room, understanding how GPs make decisions and how this can be supported is crucial for the sustainability for general practice.Keywords
This publication has 31 references indexed in Scilit:
- The influence of socioeconomic deprivation on multimorbidity at different ages: a cross-sectional studyBritish Journal of General Practice, 2014
- Costs Associated With Multimorbidity Among VA PatientsMedical Care, 2014
- GPs’ perspectives on the management of patients with multimorbidity: systematic review and synthesis of qualitative researchBMJ Open, 2013
- The effect of physical multimorbidity, mental health conditions and socioeconomic deprivation on unplanned admissions to hospital: a retrospective cohort studyCMAJ : Canadian Medical Association Journal, 2013
- Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional studyThe Lancet, 2012
- Multimorbidity, service organization and clinical decision making in primary care: a qualitative studyFamily Practice, 2011
- The Relationship of Medical Comorbidity and Depression in Older, Primary Care PatientsPsychosomatics, 2006
- Comorbidity and the Use of Primary Care and Specialist Care in the ElderlyAnnals of Family Medicine, 2005
- Learning from malpractice claims about negligent, adverse events in primary care in the United StatesQuality and Safety in Health Care, 2004
- Continuity of care: a multidisciplinary reviewBMJ, 2003