Entete 3

Monthly Archives: September 2013

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.

Depression Screening and Multimorbidity

By Bhautesh Jani and Frances Mair

Our new paper published in Plos One examines the impact of routine depression screening, using the Hospital Anxiety and Depression Scale (HADS), and its relationship with multimorbidity and chronic disease management. In our study based on more than 125000 patients with chronic disease, the findings highlight the difficulties in implementing depression screening universally in primary care, despite incentivisation. Younger patients and those from deprived socio-economic background were more likely to have a positive result, when screened for depression symptoms. Importantly, depression screening did lead to an increase in the rate of anti-depressant prescribing in patients with chronic disease, which has significant resource implications.

In our study, depression screening was more often undertaken in patients with multimorbidity when compared to those with a single disease. Patients with multimorbidity had a greater chance of having a raised HADS score on depression screening, which resonates with the emerging evidence in this area. The crucial question will be to investigate the effect of depression screening in patients with chronic disease and multimorbidity on clinical outcomes, if any. The next phase of our project aims to address this question.