What are the challenges to managing multimorbidity in the elderly, from both GP and patient perspectives?
The prevalence of multimorbidity in the elderly is high and is predicted to rise. Providing clinical care to this patient group places a large demand on the healthcare system. Shared-decision making is a recognised feature of good quality clinical care. However, older patients are often less involved in decision-making about healthcare compared to younger patients. We explored the challenges of managing multimorbidity in the elderly, from the perspectives of GPs and patients, with a focus on shared-decision making.
Qualitative focus groups with older patients with multimorbidity and with GPs. Eight patients and eight GPs from four GP practices in Devon. A facilitator guided discussion in separate patient and GP focus groups. Constant comparative technique with a deductive framework, coding inductively for analysis.
GPs expressed concerns around the complexity of managing multimorbidity in the context of clinical uncertainty and a perceived scarcity of relevant guidelines. They felt pressure to use condition-specific guidelines and feared medico-legal consequences if they didn’t. Both GPs and patients identified time-pressures and a lack of continuity of care as potential barriers to shared-decision making, and acknowledged the importance of the doctor-patient relationship in overcoming perceived barriers. Further barriers to shared-decision making were identified as a lack of patient empowerment, GP reluctance to allow shared-decision making, unconsciously incompetent GPs in regard to shared-decision making and patient perception that their GP did not allow shared-decision making.
The management of multimorbidity in the elderly requires ‘the art of medicine’. However, in an age where evidence-based medicine is prioritised, and there are difficulties with access to primary healthcare, GPs require further support to provide good quality care for this vulnerable patient group. Development is needed in the understanding and practise of shared-decision making by both GPs and the elderly with multimorbidity.