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How GPs value guidelines applied to patients with multimorbidity: A qualitative study

Luijks, Hilde D; Lucassen, Peter; Loeffen, Maartje JW; Lagro-Janssen, Antoine L; Schermer, Tjard RJ; van Weel, Chris

Description

Objectives: To explore and describe the value general practitioner (GPs) attribute to medical guidelines when they are applied to patients with multimorbidity, and to describe which benefits GPs experience from guideline adherence in these patients. Also, we aimed to identify limitations from guideline adherence in patients with multimorbidity, as perceived by GPs, and to describe their empirical solutions to manage these obstacles. Design: Focus group study with purposive sampling of...[Show more]

dc.contributor.authorLuijks, Hilde D
dc.contributor.authorLucassen, Peter
dc.contributor.authorLoeffen, Maartje JW
dc.contributor.authorLagro-Janssen, Antoine L
dc.contributor.authorSchermer, Tjard RJ
dc.contributor.authorvan Weel, Chris
dc.date.accessioned2016-02-24T22:41:52Z
dc.identifier.issn2044-6055
dc.identifier.urihttp://hdl.handle.net/1885/98837
dc.description.abstractObjectives: To explore and describe the value general practitioner (GPs) attribute to medical guidelines when they are applied to patients with multimorbidity, and to describe which benefits GPs experience from guideline adherence in these patients. Also, we aimed to identify limitations from guideline adherence in patients with multimorbidity, as perceived by GPs, and to describe their empirical solutions to manage these obstacles. Design: Focus group study with purposive sampling of participants. Focus groups were guided by an experienced moderator who used an interview guide. Interviews were transcribed verbatim. Data analysis was performed by two researchers using the constant comparison analysis technique and field notes were used in the analysis. Data collection proceeded until saturation was reached. Setting: Primary care, eastern part of The Netherlands. Participants: Dutch GPs, heterogeneous in age, sex and academic involvement. Results: 25 GPs participated in five focus groups. GPs valued the guidance that guidelines provide, but experienced shortcomings when they were applied to patients with multimorbidity. Taking these patients’ personal circumstances into account was regarded as important, but it was impeded by a consistent focus on guideline adherence. Preventative measures were considered less appropriate in (elderly) patients with multimorbidity. Moreover, the applicability of guidelines in patients with multimorbidity was questioned. GPs’ extensive practical experience with managing multimorbidity resulted in several empirical solutions, for example, using their ‘common sense’ to respond to the perceived shortcomings. Conclusions: GPs applying guidelines for patients with multimorbidity integrate patient-specific factors in their medical decisions, aiming for patient-centred solutions. Such integration of clinical experience and best evidence is required to practise evidence-based medicine. More flexibility in pay-for-performance systems is needed to facilitate this integration. Several improvements in guideline reporting are necessary to enhance the applicability of guidelines in patients with multimorbidity.
dc.publisherBMJ Publishing Group
dc.rightsAuthor/s retain copyright
dc.sourceBMJ Open
dc.titleHow GPs value guidelines applied to patients with multimorbidity: A qualitative study
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume5
dc.date.issued2015
local.identifier.absfor111701 - Aboriginal and Torres Strait Islander Health
local.identifier.absfor111717 - Primary Health Care
local.identifier.absfor160104 - Social and Cultural Anthropology
local.identifier.ariespublicationU3488905xPUB8405
local.type.statusPublished Version
local.contributor.affiliationLuijks, Hilde D, Radboud University Nijmegen Medical Centre
local.contributor.affiliationLucassen, Peter, Radboud University Nijmegen Medical Centre
local.contributor.affiliationVan Weel, Chris, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationLoeffen, Maartje JW, Radboud University Nijmegen Medical Centre
local.contributor.affiliationLagro-Janssen, Antoine L, Radboud University Nijmegen Medical Centre
local.contributor.affiliationSchermer, Tjard RJ, Radboud University Nijmegen Medical Center
local.bibliographicCitation.issue10
local.bibliographicCitation.startpage1
local.bibliographicCitation.lastpage7
local.identifier.doi10.1136/bmjopen-2015-007905
dc.date.updated2016-02-24T10:15:36Z
local.identifier.scopusID2-s2.0-84948994377
dcterms.accessRightsOpen Access
dcterms.accessRightsOpen Access
CollectionsANU Research Publications

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