Programme no. 365-P
Quality Improvement
Problems and challenges in relation to the treatment of patients with multimorbidity: General Practitioners’ views and attitudes.
Elisabeth Søndergaard*1, Ann Dorrit Guassora2, Niels de Fine Olivarius3, Susanne Reventlow4, Tora Grauers Willadsen5, Mogens Vestergaard6, Margret Olafia Tomasdottir 7, Lars Borgquist 8, Doris Holmberg-Marttila9
1The Research Unit for General Practice and Section of General Practice,Department of Public Health, University of Copenhagen ,Copenhagen,Denmark, 2The Research Unit for General Practice and Section of General Practice,Department of Public Health, University of Copenhagen ,Copenhagen,Denmark, 3The Research Unit for General Practice and Section of General Practice,Department of Public Health, University of Copenhagen ,Copenhagen,Denmark, 4The Research Unit for General Practice and Section of General Practice,Department of Public Health, University of Copenhagen ,Copenhagen,Denmark, 5The Research Unit for General Practice and Section of General Practice,Department of Public Health, University of Copenhagen ,Copenhagen,Denmark, 6The Research Unit for General Practice and Department of General Practice,Institute of Public Health, University of Aarhus,Aarhus,Denmark, 7Department of Family Medicine,University of Iceland,Reykjavik,Iceland, 8Department of Medical and Health Sciences,Linköping University,Linköping,Sweden, 9Department of General Practice,Pirkanmaa Hospital District,Pirkanmaa,Finland
* = Presenting author
Objectives: To explore workshop participants’ views and attitudes toward problems and challenges related to treatment of patients with multimorbidity in general practice.
Background: The number of people living with multiple chronic diseases, multimorbidity, is high and rising, also in the Nordic countries. Although care of patients with multimorbidity has been a fundamental task in general practice for many years, more research is needed to facilitate and guide the quality development. The possible topics of this research were explored at a workshop at the Nordic Congress of General Practice in Tampere in 2013. With this presentation we wish to present the results of the workshop.
Results: Complex care pathways and clinical guidelines developed for single diseases were identified as very challenging when handling patients with multimorbidity. Insufficient cooperation between the professionals involved in the care of multimorbid patients underlined the GPs’ impression of a fragmented health care system. Furthermore, GPs found it challenging to establish a good dialogue and prioritize problems with patients within the timeframe of a normal consultation. Finally, the future role of the GP was discussed and current payment systems, in some of the Nordic countries, criticized for not matching the treatment patterns of patients with multimorbidity.
Material/Methods: The data consists of 76 completed questionnaires collected during the workshop, recorded and transcribed plenary discussions among the 180 participants, and notes taken by rapporteurs during the discussions. A framework analysis has been applied to analyse the material.
Conclusion: The workshop’s Nordic participants supported the development of a future research strategy to improve the treatment of patients with multimorbidity. Our findings identified four main areas: 1) complex care and clinical guidelines; 2) insufficient cooperation and fragmented health care; 3) difficulties with patient dialogue and prioritization in the consultation; and 4) the role of the GP and unadapted payment systems, all of which need to be investigated further to improve care for this steadily growing patient group.
Points for discussion: What could be suggestions for better ways of sharing the task of managing multimorbidity among professionals?

What educational and communications skills are needed to improve the handling of patients with multimorbidity in general practice?