title: Reasons for disagreement regarding illnesses between older patients with multimorbidity and their GPs - a qualitative study.
abstract: BACKGROUND
  Chronic conditions are the most common themes in doctor-patient communication, especially for older patients with multimorbidity and their GPs. Former quantitative studies identified a variety of socio-demographic and health-related factors which were associated with the (dis-)agreement between medical records and patient self-reported diseases. The aim of this qualitative study was to identify reasons for disagreement regarding illnesses between patients and their GPs.
  
  
  METHODS
  We conducted three focus groups with GPs (n = 15) and three focus groups with multimorbid patients aged 65 to 85 (n = 21). The participants were recruited from the MultiCare Cohort Study. Focus groups were audiotaped and transcribed verbatim. The transcripts of the focus groups were analysed using the qualitative content analysis according to Mayring. Categories were determined deductively and inductively.
  
  
  RESULTS
  The analysis revealed seven themes concerning reasons for disagreement regarding illnesses between patients and their GPs: problems with communication and cooperation between health care professionals, disease management by the GP and the patient, the documentation behaviour of the GP, communication challenges between GP and patient, differences in the understanding of a disease between GP and patient, the prioritization and rating of diseases by GP and patient and obliviousness, repression and avoidance by the patient.
  
  
  CONCLUSIONS
  For older patients with multimorbidity, our study demonstrated that there is a need to enhance the cooperation between GPs, specialists and outpatient care, a demand to improve doctor-patient communication and a need for interventions to increase patients' knowledge of diseases.
authors.affiliation: Department of Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. h.hansen@uke.de.
authors.forename: Heike
authors.initials: H
authors.lastname: Hansen
authors.affiliation: Department of Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. n.pohontsch@uke.de.
authors.forename: Nadine
authors.initials: N
authors.lastname: Pohontsch
authors.affiliation: Department of Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. bussche@uke.de.
authors.forename: Hendrik
authors.initials: H
authors.lastname: van den Bussche
authors.affiliation: Department of Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. m.scherer@uke.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Scherer
authors.affiliation: Department of Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. in.schaefer@uke.de.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Schäfer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002908:Chronic Disease / Q000523:psychology / Q000628:therapy; D003144:Communication Barriers; D015897:Comorbidity; D019468:Disease Management; D005260:Female; D017144:Focus Groups; D058005:General Practitioners / Q000523:psychology*; D005858:Germany; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008501:Medical Records, Problem-Oriented / Q000706:statistics & numerical data*; D008875:Middle Aged; D057240:Patient Preference; D010817:Physician-Patient Relations; D036301:Qualitative Research; D057566:Self Report