title: How do general practitioners recognize the definition of multimorbidity? A European qualitative study.
abstract: BACKGROUND
  Multimorbidity is a challenging concept for general practice. An EGPRN working group has published a comprehensive definition of the concept of multimorbidity. As multimorbidity could be a way to explore complexity in general practice, it was of importance to explore whether European general practitioners (GPs) recognize this concept and whether they would change it.
  
  
  OBJECTIVE
  To investigate whether European GPs recognize the EGPRN concept of multimorbidity and whether they would change it.
  
  
  METHODS
  Focus group meetings and semi-structured interviews as data collection techniques with a purposive sample of practicing GPs from every country. Data collection continued until saturation was reached in every country. The analysis was undertaken using a grounded theory based method. In each national team, four independent researchers, working blind and pooling data, carried out the analysis. To ensure the internationalization of the data, an international team of 10 researchers pooled the axial and selective coding of all national teams to check the concept and highlight emerging themes.
  
  
  RESULTS
  The maximal variation and saturation of the sample were reached in all countries with 211 selected GPs. The EGPRN definition was recognized in all countries. Two additional ideas emerged, the use of Wonca's core competencies of general practice, and the dynamics of the doctor-patient relationship for detecting and managing multimorbidity and patient's complexity.
  
  
  CONCLUSIONS
  European GPs recognized and enhanced the EGPRN concept of multimorbidity. These results open new perspectives regarding the management of complexity using the concept of multimorbidity in general practice. [Box: see text].
authors.affiliation: a ERCR SPURBO , Département de Médecine Générale, Université de Bretagne Occidentale , Brest , France ;
authors.forename: Jean Yves
authors.initials: JY
authors.lastname: Le Reste
authors.affiliation: a ERCR SPURBO , Département de Médecine Générale, Université de Bretagne Occidentale , Brest , France ;
authors.forename: Patrice
authors.initials: P
authors.lastname: Nabbe
authors.affiliation: b Department of Family Medicine, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb , Zagreb , Croatia ;
authors.forename: Djurdjica
authors.initials: D
authors.lastname: Lazic
authors.affiliation: c General Practice, Medical University , Plovdiv , Bulgaria ;
authors.forename: Radost
authors.initials: R
authors.lastname: Assenova
authors.affiliation: d Hannover Medical School , Hannover , Germany ;
authors.forename: Heidrun
authors.initials: H
authors.lastname: Lingner
authors.affiliation: e Faculty of Medicine , Nicolaus Copernicus University , Torun , Poland ;
authors.forename: Slawomir
authors.initials: S
authors.lastname: Czachowski
authors.affiliation: f The Greek Association of General Practitioners (ELEGEIA) , Thessaloniki , Greece ;
authors.forename: Stella
authors.initials: S
authors.lastname: Argyriadou
authors.affiliation: g Department of English, Nicolaus Copernicus University , Torun , Poland ;
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Sowinska
authors.affiliation: h Regional Health Service of Emilia Romagna , Bologna , Italy ;
authors.forename: Charilaos
authors.initials: C
authors.lastname: Lygidakis
authors.affiliation: i Department of General Practice, University Medical Center Göttingen , Georg-August-Universität , Göttingen , Germany ;
authors.forename: Christa
authors.initials: C
authors.lastname: Doerr
authors.affiliation: j Galician National Health Service , Vigo , Spain ;
authors.forename: Ana
authors.initials: A
authors.lastname: Claveria
authors.affiliation: a ERCR SPURBO , Département de Médecine Générale, Université de Bretagne Occidentale , Brest , France ;
authors.forename: Bernard
authors.initials: B
authors.lastname: Le Floch
authors.affiliation: a ERCR SPURBO , Département de Médecine Générale, Université de Bretagne Occidentale , Brest , France ;
authors.forename: Jeremy
authors.initials: J
authors.lastname: Derriennic
authors.affiliation: k Department of General Practice and the EMGO Institute for Health and Care Research , VU University Medical Center , Amsterdam , Netherlands ;
authors.forename: Harm
authors.initials: H
authors.lastname: Van Marwijk
authors.affiliation: l Primary and Interdisciplinary Care, University of Antwerp , Antwerp , Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Van Royen
mesh_terms: D002983:Clinical Competence; D005060:Europe; D005260:Female; D017144:Focus Groups; D058006:General Practice / Q000592:standards; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D038622:Internationality; D007407:Interviews as Topic; D008297:Male; D000076322:Multimorbidity; D010817:Physician-Patient Relations; D009626:Terminology as Topic
keywords: Multimorbidity; competencies; qualitative research