title: Primary care practitioner and patient understanding of the concepts of multimorbidity and self-management: A qualitative study.
abstract: OBJECTIVE
  The aim of this article is to offer insight into how professionals and patients understand and experience multimorbidity and how these accounts differ, and how they affect attitudes and engagement with self-management.
  
  
  METHODS
  Semi-structured interviews with 20 primary healthcare practitioners and 20 patients with at least 2 long-term conditions (including coronary heart disease, diabetes, osteoarthritis, chronic obstructive pulmonary disease and depression). Thematic analysis was used, and themes were identified using an open-coding method.
  
  
  RESULTS
  Practitioners associated multimorbidity with complexity and uncertainty in the clinic, leading to emotional strain and 'heart sink'. Patient accounts differed. Some described multimorbidity as problematic when it exacerbated their symptoms and caused emotional and psychological strain. Others did not perceive multimorbidity as problematic. Self-management was seen by practitioners and patients to be a key element of managing multiple conditions, but drivers for prompting and engaging in self-management differed between patients and practitioners.
  
  
  CONCLUSIONS
  This study suggests that recommendations for clinical practice for multimorbid patients should take into account the gap in perceptions between practitioner and patients about experiences of multimorbidity. Not least, practice would need to reflect the tension between practitioners' and patients' accounts about the role and benefits of self-management in the presence of multimorbidity.
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Kenning
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Fisher
authors.affiliation: Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK; School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
authors.forename: Penny
authors.initials: P
authors.lastname: Bee
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
authors.affiliation: Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK; NIHR Collaboration for Applied Health Research and Care for Greater Manchester (GM-CLAHRC), University of Manchester, Manchester, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Coventry
keywords: Multimorbidity; patient views; practitioner views; primary care; self-management