How GPs value guidelines applied to patients with multimorbidity: a qualitative study
To explore and describe the value general practitioner (GPs) attribute to medical guidelines when they are applied to patients with multimorbidity, and to describe which benefits GPs experience from guideline adherence in these patients. Also, we aimed to identify limitations from guideline adherenc...
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| Veröffentlicht in: | BMJ open 2015-10, Vol.5 (10), p.e007905-e007905 |
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| creator | Luijks, Hilde Lucassen, Peter van Weel, Chris Loeffen, Maartje Lagro-Janssen, Antoine Schermer, Tjard |
| description | To explore and describe the value general practitioner (GPs) attribute to medical guidelines when they are applied to patients with multimorbidity, and to describe which benefits GPs experience from guideline adherence in these patients. Also, we aimed to identify limitations from guideline adherence in patients with multimorbidity, as perceived by GPs, and to describe their empirical solutions to manage these obstacles.
Focus group study with purposive sampling of participants. Focus groups were guided by an experienced moderator who used an interview guide. Interviews were transcribed verbatim. Data analysis was performed by two researchers using the constant comparison analysis technique and field notes were used in the analysis. Data collection proceeded until saturation was reached.
Primary care, eastern part of The Netherlands.
Dutch GPs, heterogeneous in age, sex and academic involvement.
25 GPs participated in five focus groups. GPs valued the guidance that guidelines provide, but experienced shortcomings when they were applied to patients with multimorbidity. Taking these patients' personal circumstances into account was regarded as important, but it was impeded by a consistent focus on guideline adherence. Preventative measures were considered less appropriate in (elderly) patients with multimorbidity. Moreover, the applicability of guidelines in patients with multimorbidity was questioned. GPs' extensive practical experience with managing multimorbidity resulted in several empirical solutions, for example, using their 'common sense' to respond to the perceived shortcomings.
GPs applying guidelines for patients with multimorbidity integrate patient-specific factors in their medical decisions, aiming for patient-centred solutions. Such integration of clinical experience and best evidence is required to practise evidence-based medicine. More flexibility in pay-for-performance systems is needed to facilitate this integration. Several improvements in guideline reporting are necessary to enhance the applicability of guidelines in patients with multimorbidity. |
| doi_str_mv | 10.1136/bmjopen-2015-007905 |
| format | Article |
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Focus group study with purposive sampling of participants. Focus groups were guided by an experienced moderator who used an interview guide. Interviews were transcribed verbatim. Data analysis was performed by two researchers using the constant comparison analysis technique and field notes were used in the analysis. Data collection proceeded until saturation was reached.
Primary care, eastern part of The Netherlands.
Dutch GPs, heterogeneous in age, sex and academic involvement.
25 GPs participated in five focus groups. GPs valued the guidance that guidelines provide, but experienced shortcomings when they were applied to patients with multimorbidity. Taking these patients' personal circumstances into account was regarded as important, but it was impeded by a consistent focus on guideline adherence. Preventative measures were considered less appropriate in (elderly) patients with multimorbidity. Moreover, the applicability of guidelines in patients with multimorbidity was questioned. GPs' extensive practical experience with managing multimorbidity resulted in several empirical solutions, for example, using their 'common sense' to respond to the perceived shortcomings.
GPs applying guidelines for patients with multimorbidity integrate patient-specific factors in their medical decisions, aiming for patient-centred solutions. Such integration of clinical experience and best evidence is required to practise evidence-based medicine. More flexibility in pay-for-performance systems is needed to facilitate this integration. Several improvements in guideline reporting are necessary to enhance the applicability of guidelines in patients with multimorbidity.</description><identifier>ISSN: 2044-6055</identifier><identifier>EISSN: 2044-6055</identifier><identifier>DOI: 10.1136/bmjopen-2015-007905</identifier><identifier>PMID: 26503382</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Adult ; Attitude of Health Personnel ; Chronic illnesses ; Comorbidity ; Data collection ; Disease ; Evidence-Based Medicine ; Female ; Focus Groups ; General practice / Family practice ; General Practitioners - standards ; Guideline Adherence - standards ; Health Knowledge, Attitudes, Practice ; Humans ; Interviews ; Male ; Medical research ; Middle Aged ; Netherlands ; Patients ; Physician-Patient Relations ; Primary care ; Primary Health Care - organization & administration ; Qualitative Research ; Urbanization</subject><ispartof>BMJ open, 2015-10, Vol.5 (10), p.e007905-e007905</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ 2015 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) 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/4.0/ Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c433t-fca2107143302101b368f66591de08a481ae974abec367deb9c790784a71c3123</citedby><cites>FETCH-LOGICAL-c433t-fca2107143302101b368f66591de08a481ae974abec367deb9c790784a71c3123</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636666/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636666/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26503382$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Luijks, Hilde</creatorcontrib><creatorcontrib>Lucassen, Peter</creatorcontrib><creatorcontrib>van Weel, Chris</creatorcontrib><creatorcontrib>Loeffen, Maartje</creatorcontrib><creatorcontrib>Lagro-Janssen, Antoine</creatorcontrib><creatorcontrib>Schermer, Tjard</creatorcontrib><title>How GPs value guidelines applied to patients with multimorbidity: a qualitative study</title><title>BMJ open</title><addtitle>BMJ Open</addtitle><description>To explore and describe the value general practitioner (GPs) attribute to medical guidelines when they are applied to patients with multimorbidity, and to describe which benefits GPs experience from guideline adherence in these patients. Also, we aimed to identify limitations from guideline adherence in patients with multimorbidity, as perceived by GPs, and to describe their empirical solutions to manage these obstacles.
Focus group study with purposive sampling of participants. Focus groups were guided by an experienced moderator who used an interview guide. Interviews were transcribed verbatim. Data analysis was performed by two researchers using the constant comparison analysis technique and field notes were used in the analysis. Data collection proceeded until saturation was reached.
Primary care, eastern part of The Netherlands.
Dutch GPs, heterogeneous in age, sex and academic involvement.
25 GPs participated in five focus groups. GPs valued the guidance that guidelines provide, but experienced shortcomings when they were applied to patients with multimorbidity. Taking these patients' personal circumstances into account was regarded as important, but it was impeded by a consistent focus on guideline adherence. Preventative measures were considered less appropriate in (elderly) patients with multimorbidity. Moreover, the applicability of guidelines in patients with multimorbidity was questioned. GPs' extensive practical experience with managing multimorbidity resulted in several empirical solutions, for example, using their 'common sense' to respond to the perceived shortcomings.
GPs applying guidelines for patients with multimorbidity integrate patient-specific factors in their medical decisions, aiming for patient-centred solutions. Such integration of clinical experience and best evidence is required to practise evidence-based medicine. More flexibility in pay-for-performance systems is needed to facilitate this integration. Several improvements in guideline reporting are necessary to enhance the applicability of guidelines in patients with multimorbidity.</description><subject>Adult</subject><subject>Attitude of Health Personnel</subject><subject>Chronic illnesses</subject><subject>Comorbidity</subject><subject>Data collection</subject><subject>Disease</subject><subject>Evidence-Based Medicine</subject><subject>Female</subject><subject>Focus Groups</subject><subject>General practice / Family practice</subject><subject>General Practitioners - standards</subject><subject>Guideline Adherence - standards</subject><subject>Health Knowledge, Attitudes, Practice</subject><subject>Humans</subject><subject>Interviews</subject><subject>Male</subject><subject>Medical research</subject><subject>Middle Aged</subject><subject>Netherlands</subject><subject>Patients</subject><subject>Physician-Patient Relations</subject><subject>Primary care</subject><subject>Primary Health Care - organization & administration</subject><subject>Qualitative Research</subject><subject>Urbanization</subject><issn>2044-6055</issn><issn>2044-6055</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNpdUU1LLDEQDKKoqL9AkIAXL6P5mCQzHgSR5wcIetBzyMz0apbMZJwkK_vvX5ZdRe1Ld9PVRRWF0DEl55RyedH0cz_CUDBCRUGIqonYQvuMlGUhiRDbP-Y9dBTCnOQqRS0E20V7TArCecX20eu9_8R3zwEvjEuA35LtwNkBAjbj6Cx0OHo8mmhhiAF_2viO--Si7f3U2M7G5SU2-CMZZ2MGLQCHmLrlIdqZGRfgaNMP0Ovtv5eb--Lx6e7h5vqxaEvOYzFrDaNE0byQPNCGy2ompahpB6QyZUUN1Ko0DbRcqg6aus1GVVUaRVtOGT9AV2veMTU9dG0WORmnx8n2Zlpqb6z-fRnsu37zC11KLnNlgrMNweQ_EoSoextacM4M4FPQVDFV15yJFfT0D3Tu0zRke5plJq5IrVaK-BrVTj6ECWbfYijRq-T0Jjm9Sk6vk8tfJz99fP985cT_A4zclng</recordid><startdate>20151026</startdate><enddate>20151026</enddate><creator>Luijks, Hilde</creator><creator>Lucassen, Peter</creator><creator>van Weel, Chris</creator><creator>Loeffen, Maartje</creator><creator>Lagro-Janssen, Antoine</creator><creator>Schermer, Tjard</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20151026</creationdate><title>How GPs value guidelines applied to patients with multimorbidity: a qualitative study</title><author>Luijks, Hilde ; Lucassen, Peter ; van Weel, Chris ; Loeffen, Maartje ; Lagro-Janssen, Antoine ; Schermer, Tjard</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c433t-fca2107143302101b368f66591de08a481ae974abec367deb9c790784a71c3123</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Attitude of Health Personnel</topic><topic>Chronic illnesses</topic><topic>Comorbidity</topic><topic>Data collection</topic><topic>Disease</topic><topic>Evidence-Based Medicine</topic><topic>Female</topic><topic>Focus Groups</topic><topic>General practice / Family practice</topic><topic>General Practitioners - standards</topic><topic>Guideline Adherence - standards</topic><topic>Health Knowledge, Attitudes, Practice</topic><topic>Humans</topic><topic>Interviews</topic><topic>Male</topic><topic>Medical research</topic><topic>Middle Aged</topic><topic>Netherlands</topic><topic>Patients</topic><topic>Physician-Patient Relations</topic><topic>Primary care</topic><topic>Primary Health Care - organization & administration</topic><topic>Qualitative Research</topic><topic>Urbanization</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Luijks, Hilde</creatorcontrib><creatorcontrib>Lucassen, Peter</creatorcontrib><creatorcontrib>van Weel, Chris</creatorcontrib><creatorcontrib>Loeffen, Maartje</creatorcontrib><creatorcontrib>Lagro-Janssen, Antoine</creatorcontrib><creatorcontrib>Schermer, Tjard</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Luijks, Hilde</au><au>Lucassen, Peter</au><au>van Weel, Chris</au><au>Loeffen, Maartje</au><au>Lagro-Janssen, Antoine</au><au>Schermer, Tjard</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>How GPs value guidelines applied to patients with multimorbidity: a qualitative study</atitle><jtitle>BMJ open</jtitle><addtitle>BMJ Open</addtitle><date>2015-10-26</date><risdate>2015</risdate><volume>5</volume><issue>10</issue><spage>e007905</spage><epage>e007905</epage><pages>e007905-e007905</pages><issn>2044-6055</issn><eissn>2044-6055</eissn><abstract>To explore and describe the value general practitioner (GPs) attribute to medical guidelines when they are applied to patients with multimorbidity, and to describe which benefits GPs experience from guideline adherence in these patients. Also, we aimed to identify limitations from guideline adherence in patients with multimorbidity, as perceived by GPs, and to describe their empirical solutions to manage these obstacles.
Focus group study with purposive sampling of participants. Focus groups were guided by an experienced moderator who used an interview guide. Interviews were transcribed verbatim. Data analysis was performed by two researchers using the constant comparison analysis technique and field notes were used in the analysis. Data collection proceeded until saturation was reached.
Primary care, eastern part of The Netherlands.
Dutch GPs, heterogeneous in age, sex and academic involvement.
25 GPs participated in five focus groups. GPs valued the guidance that guidelines provide, but experienced shortcomings when they were applied to patients with multimorbidity. Taking these patients' personal circumstances into account was regarded as important, but it was impeded by a consistent focus on guideline adherence. Preventative measures were considered less appropriate in (elderly) patients with multimorbidity. Moreover, the applicability of guidelines in patients with multimorbidity was questioned. GPs' extensive practical experience with managing multimorbidity resulted in several empirical solutions, for example, using their 'common sense' to respond to the perceived shortcomings.
GPs applying guidelines for patients with multimorbidity integrate patient-specific factors in their medical decisions, aiming for patient-centred solutions. Such integration of clinical experience and best evidence is required to practise evidence-based medicine. More flexibility in pay-for-performance systems is needed to facilitate this integration. Several improvements in guideline reporting are necessary to enhance the applicability of guidelines in patients with multimorbidity.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>26503382</pmid><doi>10.1136/bmjopen-2015-007905</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Attitude of Health Personnel Chronic illnesses Comorbidity Data collection Disease Evidence-Based Medicine Female Focus Groups General practice / Family practice General Practitioners - standards Guideline Adherence - standards Health Knowledge, Attitudes, Practice Humans Interviews Male Medical research Middle Aged Netherlands Patients Physician-Patient Relations Primary care Primary Health Care - organization & administration Qualitative Research Urbanization |
| title | How GPs value guidelines applied to patients with multimorbidity: a qualitative study |
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