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. Aim: To explore GPs' considerations and main objectives in the management of multimorbidity and to explore factors influencing their management of multimorbidity. Design and setting: Focus group study of Dutch GPs; with heterogeneity in characteristics such as sex, age and urbanisation. Method: 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. Conclusion: 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.