GPs' considerations in multimorbidity management: a qualitative study.
BACKGROUND
Scientific evidence on how to manage multimorbidity is limited, but GPs have extensive practical experience with multimorbidity management.


OBJECTIVE
To explore GPs' considerations and main objectives in the management of multimorbidity and  to explore factors influencing their management of multimorbidity.


METHODS
Focus group study of Dutch GPs; with heterogeneity in characteristics such as sex, age and urbanisation.


METHODS
The moderator used an interview guide in conducting  the interviews. Two researchers performed the analysis as an iterative process, based on verbatim transcripts and by applying the technique of constant comparative analysis. Data collection proceeded until saturation was reached.


RESULTS
Five focus groups were conducted  with 25 participating GPs. The main themes concerning multimorbidity management were individualisation, applying an integrated approach, medical considerations placed in perspective, and sharing decision making and responsibility. A personal patient-doctor relationship was considered  a major factor positively influencing the management of multimorbidity. Mental-health problems and interacting conditions were regarded as major barriers in this respect and participants experienced several practical problems. The concept of patient-centredness overarches the participants'  main objectives.


CONCLUSIONS
GPs' main objective in multimorbidity management is applying a patient-centred approach. This approach is welcomed since it counteracts some potential pitfalls of multimorbidity. Further research should include a similar design in a different  setting and should aim at developing best practice in multimorbidity management.
Department of Primary Care and Community Care, Radboud University Nijmegen Medical Centre, The Netherlands. H.Luijks@elg.umcn.nl
Hilde D
HD
Luijks
Maartje J W
MJ
Loeffen
Antoine L
AL
Lagro-Janssen
Chris
C
van Weel
Peter L
PL
Lucassen
Tjard R
TR
Schermer
D002908:Chronic Disease / Q000628:therapy*; D015897:Comorbidity; D005260:Female; D058006:General Practice; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010358:Patient Participation; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D013001:Somatoform Disorders / Q000628:therapy