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Monthly Archives: March 2015

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.