GPs’ perspectives on the management of patients with multimorbidity: systematic review and synthesis of qualitative research

Abstract

Objective: To synthesise the existing publishedud literature on the perceptions of general practitionersud (GPs) or their equivalent on the clinical management ofud multimorbidity and determine targets for future researchud that aims to improve clinical care in multimorbidity.ud Design: Systematic review and metaethnographicud synthesis of primary studies that used qualitativeud methods to explore GPs’ experiences of clinicalud management of multimorbidity or multiple chronicud diseases.ud Data sources: EMBASE, MEDLINE, CINAHL, PsycInfo,ud Academic Search Complete, SocIndex, Social Scienceud Full Text and digital theses/online libraries (databaseud inception to September 2012) to identify literature usingud qualitative methods (focus groups or interviews).ud Review methods: The 7-step metaethnographicud approach described by Noblit and Hare, which involvesud cross-interpretation between studies while preserving theud context of the primary data.ud Results: Of 1805 articles identified, 37 were reviewed inud detail and 10 were included, using a total of 275 GPs in 7ud different countries. Four areas of difficulty specific to theud management of multimorbidity emerged from theseud papers: disorganisation and fragmentation of healthcare;ud the inadequacy of guidelines and evidence-basedud medicine; challenges in delivering patient-centred care;ud and barriers to shared decision-making. A ‘line ofud argument’ was drawn which described GPs’ sense ofud isolation in decision-making for multimorbid patients.ud Conclusions: This systematic review shows that theud problem areas for GPs in the management ofud multimorbidity may be classified into four domains.ud There will be no ‘one size fits all’ intervention forud multimorbidity but these domains may be useful targetsud to guide the development of interventions that will assistud and improve the provision of care to multimorbidud patients.To synthesise the existing published literature on the perceptions of general practitioners (GPs) or their equivalent on the clinical management of multimorbidity and determine targets for future research that aims to improve clinical care in multimorbidity.Systematic review and metaethnographic synthesis of primary studies that used qualitative methods to explore GPs' experiences of clinical management of multimorbidity or multiple chronic diseases.EMBASE, MEDLINE, CINAHL, PsycInfo, Academic Search Complete, SocIndex, Social Science Full Text and digital theses/online libraries (database inception to September 2012) to identify literature using qualitative methods (focus groups or interviews).The 7-step metaethnographic approach described by Noblit and Hare, which involves cross-interpretation between studies while preserving the context of the primary data.Of 1805 articles identified, 37 were reviewed in detail and 10 were included, using a total of 275 GPs in 7 different countries. Four areas of difficulty specific to the management of multimorbidity emerged from these papers: disorganisation and fragmentation of healthcare; the inadequacy of guidelines and evidence-based medicine; challenges in delivering patient-centred care; and barriers to shared decision-making. A 'line of argument' was drawn which described GPs' sense of isolation in decision-making for multimorbid patients.This systematic review shows that the problem areas for GPs in the management of multimorbidity may be classified into four domains. There will be no 'one size fits all' intervention for multimorbidity but these domains may be useful targets to guide the development of interventions that will assist and improve the provision of care to multimorbid patients