What to give the patient who has everything? A qualitative study of prescribing for multimorbidity in primary care

The British Journal of General Practice : the Journal of the Royal College of General Practitioners
Carol SinnottColin P Bradley

Abstract

Using clinical guidelines in the management of patients with multimorbidity can lead to the prescription of multiple and sometimes conflicting medications. To explore how GPs make decisions when prescribing for multimorbid patients, with a view to informing intervention design. In-depth qualitative interviews incorporating chart-stimulated recall with purposively sampled GPs in the Republic of Ireland. Grounded theory analysis with iterative theory development. Twenty GPs were interviewed about 51 multimorbid cases. In these cases, GPs integrated information from multiple sources including the patient, specialists, and evidence-based medicine. Difficulties arose when recommendations or preferences conflicted, to which GPs responded by 'satisficing': accepting care that they deemed satisfactory and sufficient for a particular patient. Satisficing was manifest as relaxing targets for disease control, negotiating compromise with the patient, or making 'best guesses' about the most appropriate course of action to take. In multimorbid patients perceived as stable, GPs preferred to 'maintain the status quo' rather than rationalise medications, even in cases with significant polypharmacy. Proactive changes in medications were facilita...Continue Reading

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Citations

May 3, 2016·Pharmacoepidemiology and Drug Safety·Judith SinnigeJoke C Korevaar
Jul 28, 2016·BMC Family Practice·Bjarne AustadAnne-Sofie Helvik
Sep 10, 2016·Journal of the American Geriatrics Society·Jojanneke J G T van SummerenJan Schuling
Jun 9, 2016·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Judith SinnigeJozé C Braspenning
Apr 20, 2016·PloS One·Nagham J AilabouniJune M Tordoff
Jun 24, 2017·Basic & Clinical Pharmacology & Toxicology·Line Due ChristensenSusanne Kaae
Sep 2, 2017·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Deborah Swinglehurst, Nina Fudge
Mar 4, 2015·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Patricia Cahill
Apr 24, 2015·Journal of Comorbidity·Carol Sinnott, Colin P Bradley
Feb 26, 2019·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Hélène CarrierPierre Verger
Jan 11, 2019·British Journal of Clinical Pharmacology·Carina LundbyDorthe Susanne Nielsen
Dec 21, 2019·Biomédica : revista del Instituto Nacional de Salud·Andres Gaviria-MendozaJorge E Machado-Alba
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Jul 30, 2020·BJGP Open·Alison Jayne DohertyLauren Walker
Aug 24, 2017·BMC Health Services Research·Carol SinnottColin P Bradley
Jan 10, 2019·Health Science Reports·Robyn J GillespieJudy Mullan
May 19, 2021·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Karolina KuberskaJenni Burt
May 12, 2021·International Journal of Clinical Practice·Henok Getachew TegegnAsnakew Achaw Ayele
May 6, 2021·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Julian TreadwellTrish Greenhalgh
Jul 20, 2021·International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care·Judith Dyson, Fiona Cowdell
Sep 25, 2021·Family Medicine and Community Health·Claire RitzMarie-Claude Audétat
Dec 4, 2020·Medical Care Research and Review : MCRR·Chandra J Cohen-StaviEfrat Shadmi

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