GPs' considerations in multimorbidity management: a qualitative study
GPs' considerations in multimorbidity management: a qualitative study
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DOI：
10.3399/bjgp12x652373
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发表时间：
2012-07-01
影响因子：
5.9
通讯作者：
Schermer, Tjard R.
中科院分区：
文献类型：
--
作者：
Luijks, Hilde D.;Loeffen, Maartje J. W.;Schermer, Tjard R.
背景：关于如何管理多发病的科学证据有限，但全科医生在多发病管理方面拥有丰富的实践经验。目的：探讨全科医生在多发病管理中的考虑因素和主要目标，并探讨影响其多发病管理的因素。设计和设置：荷兰全科医生的焦点小组研究；方法：主持人利用访谈指南进行访谈。两名研究人员根据逐字记录并应用持续比较分析技术，以迭代过程进行分析。数据收集一直进行到达到饱和为止。结果：五个焦点小组由 25 名参与的全科医生组成。关于多病管理的主题是个体化、应用综合方法、正确地考虑医疗因素以及分担决策和责任。个人医患关系被认为是积极影响多发病管理的主要因素。心理健康问题和相互作用的条件被认为是这方面的主要障碍，参与者遇到了一些实际问题。以患者为中心的概念超越了参与者的主要目标。结论：全科医生在多发病管理中的主要目标是采用以患者为中心的方法。这种方法受到欢迎，因为它抵消了多种疾病的一些潜在陷阱。进一步的研究应包括在不同环境下的类似设计，并应旨在开发多病管理的最佳实践。
Background:Scientific evidence on how to manage multimorbidity is limited, but GPs have extensive practical experience with multimorbidity management.Aim:To explore GPs' considerations and main objectives in the management of multimorbidity and to explore factors influencing their management of multimorbidity.Design and setting:Focus group study of Dutch GPs; with heterogeneity in characteristics such as sex, age and urbanisation.Method:The moderator used an interview guide in conducting the interviews. Two researchers performed the analysis as an iterative process, based on verbatim transcripts and by applying the technique of constant comparative analysis. Data collection proceeded until saturation was reached.Results:Five focus groups were conducted with 25 participating GPs. The main themes concerning multimorbidity management were individualisation, applying an integrated approach, medical considerations placed in perspective, and sharing decision making and responsibility. A personal patient-doctor relationship was considered a major factor positively influencing the management of multimorbidity. Mental-health problems and interacting conditions were regarded as major barriers in this respect and participants experienced several practical problems. The concept of patient-centredness overarches the participants' main objectives.Conclusion:GPs' main objective in multimorbidity management is applying a patient-centred approach. This approach is welcomed since it counteracts some potential pitfalls of multimorbidity. Further research should include a similar design in a different setting and should aim at developing best practice in multimorbidity management.