GPs’ perspectives on the management of patients with multimorbidity: systematic review and synthesis of qualitative research

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dc.contributor.author Sinnott, Carol
dc.contributor.author McHugh, Sheena M.
dc.contributor.author Browne, John P.
dc.contributor.author Bradley, Colin P.
dc.date.accessioned 2017-04-05T16:02:22Z
dc.date.available 2017-04-05T16:02:22Z
dc.date.issued 2013-09
dc.identifier.citation Sinnott, C., Mc Hugh, S., Browne, J. and Bradley, C. (2013) 'GPs’ perspectives on the management of patients with multimorbidity: systematic review and synthesis of qualitative research', BMJ Open, 3:e003610. doi:10.1136/bmjopen-2013-00361 en
dc.identifier.volume 3 en
dc.identifier.issn 2044-6055
dc.identifier.uri http://hdl.handle.net/10468/3857
dc.description.abstract Objective To synthesise the existing published literature on the perceptions of general practitioners (GPs) or their equivalent on the clinical management of multimorbidity and determine targets for future research that aims to improve clinical care in multimorbidity. Design Systematic review and metaethnographic synthesis of primary studies that used qualitative methods to explore GPs’ experiences of clinical management of multimorbidity or multiple chronic diseases. Data sources EMBASE, MEDLINE, CINAHL, PsycInfo, Academic Search Complete, SocIndex, Social Science Full Text and digital theses/online libraries (database inception to September 2012) to identify literature using qualitative methods (focus groups or interviews). Review methods The 7-step metaethnographic approach described by Noblit and Hare, which involves cross-interpretation between studies while preserving the context of the primary data. Results Of 1805 articles identified, 37 were reviewed in detail and 10 were included, using a total of 275 GPs in 7 different countries. Four areas of difficulty specific to the management of multimorbidity emerged from these papers: disorganisation and fragmentation of healthcare; the inadequacy of guidelines and evidence-based medicine; challenges in delivering patient-centred care; and barriers to shared decision-making. A ‘line of argument’ was drawn which described GPs’ sense of isolation in decision-making for multimorbid patients. Conclusions This systematic review shows that the problem areas for GPs in the management of multimorbidity may be classified into four domains. There will be no ‘one size fits all’ intervention for multimorbidity but these domains may be useful targets to guide the development of interventions that will assist and improve the provision of care to multimorbid patients. en
dc.description.sponsorship Health Research Board (HRB*NSAFP/2011/3 (CS) and HRB*ICE/2012/12 (SMH)) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher BMJ Publishing Group en
dc.relation.uri http://bmjopen.bmj.com/content/bmjopen/3/9/e003610.full.pdf
dc.rights This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/ en
dc.rights.uri https://creativecommons.org/licenses/by-nc/3.0/ en
dc.subject Multimorbidity en
dc.subject General practitioners en
dc.title GPs’ perspectives on the management of patients with multimorbidity: systematic review and synthesis of qualitative research en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Carol Sinnott, General Practice, University College Cork, Cork, Ireland. +353-21-490-3000 Email: csinnott@ucc.ie en
dc.internal.availability Full text available en
dc.date.updated 2017-04-05T15:17:30Z
dc.description.version Published Version en
dc.internal.rssid 227208092
dc.contributor.funder Health Research Board en
dc.description.status Peer reviewed en
dc.identifier.journaltitle BMJ Open en
dc.internal.copyrightchecked No en
dc.internal.licenseacceptance Yes en
dc.internal.IRISemailaddress csinnott@ucc.ie en
dc.internal.IRISemailaddress j.browne@ucc.ie en
dc.identifier.articleid e003610


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This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/ Except where otherwise noted, this item's license is described as This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/
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