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Author Archives: Carol Sinnott

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

By Carol Sinnott

Using clinical guidelines in the management of patients with multimorbidity can lead to the prescription of multiple and sometimes conflicting medications. Our research group has just published a qualitative study exploring how GPs make decisions when prescribing for complicated multimorbid patients, with a view to informing intervention design in this field [1].
In qualitative interviews with GPs, we used case-specific information to reveal how GPs make compromises between patient centred and evidence based care in multimorbidity.
In the management of these cases, GPs integrated information from multiple sources including the patient, specialists and evidence based medicine. Difficulties arose if the recommendations or preferences conflicted with each other. GPs responded to this scenario by ‘satisficing’: accepting care that they deemed satisfactory and sufficient for a particular patient. In multimorbid patients perceived as stable, GPs’ preferred to ‘maintain the status quo’ rather than rationalize medications. This approach was due to GPs’ perceptions of the potential negative repercussions associated with changing medications. Proactive changes in medications were facilitated by continuity of care, sufficient consultation time and open lines of communication with the patient, other healthcare professionals and other GPs.
These new understandings will help to inform the design of behavioural interventions to assist medication management and patient centred care in multimorbidity.

The complete article can be accessed at: http://bjgp.org/content/65/632/e184

1: Sinnott C, Hugh SM, Boyce MB, Bradley CP. What to give the patient who has everything? A qualitative study of prescribing for multimorbidity in primary care. Br J Gen Pract. 2015 Mar;65(632):e184-91. doi: 10.3399/bjgp15X684001. PubMed PMID: 25733440.

GPs’ perspectives on the management of patients with multimorbidity

By Carol Sinnott

Our research group has recently published a systematic review of the existing published literature on the perceptions of general practitioners (GPs) or their equivalent on the clinical management of multimorbidity [1].

Article focus:
• Patients with multiple morbidities present unique challenges to healthcare providers. An awareness of these challenges is needed to direct research efforts and intervention design in this field.
• Qualitative studies have explored GPs perceptions of the management of multimorbid patients, but to date these studies have not been systematically reviewed or synthesized.

Key messages:
• This systematic review shows that the problem areas for GPs in the management of multimorbidity may be classified into four domains: disorganization and fragmentation of health care; the inadequacy of guidelines and evidence based medicine; challenges in delivering patient centred care; and barriers to shared decision making.
• These domains may be useful targets to guide the development of interventions that will assist and improve the provision of care to multimorbid patients.

Strengths and limitations:
• The meta-ethnographic approach used in this review gave a broader understanding of the challenges of multimorbidity than any single study, while still preserving the context of included studies.
• We focused on the GPs’ perspective on multimorbidity – an understanding of the challenges experience by patients is also required to inform the development of effective interventions. 

The complete article can be accessed at:

[1] Sinnott C, Mc Hugh S, Browne J, Bradley C. GPs’ perspectives on the management of patients with multimorbidity: systematic review and synthesis of qualitative research. BMJ Open. 2013;3(9):e003610.