ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2015
What to give the patient who has everything? A qualitative study of prescribing for multimorbidity in primary care.
Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 54 papers, 7 of them syntheses that pooled it.
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Who cites it
54 citing papers in PubMed, 7 syntheses or guidelines pooled it.
- Total uncertainty: a systematic review and thematic synthesis of experiences of uncertainty in older people with advanced multimorbidity, their informal carers and health professionals.Age and ageing · 2022Pooled it
- Contexts and mechanisms relevant to General Practitioner (GP) based interventions to reduce adverse drug events (ADE) in community dwelling older adults: a rapid realist review.HRB open research · 2022Pooled it
- Understanding GPs' clinical reasoning processes involved in managing patients suffering from multimorbidity: A systematic review of qualitative and quantitative research.International journal of clinical practice · 2021Pooled it
- General practitioner strategies for managing patients with multimorbidity: a systematic review and thematic synthesis of qualitative research.BMC family practice · 2020Pooled it
- Pooled it
- Health care professionals' attitudes towards deprescribing in older patients with limited life expectancy: A systematic review.British journal of clinical pharmacology · 2019Pooled it
- Underlying mechanisms of complex interventions addressing the care of older adults with multimorbidity: a realist review.BMJ open · 2019Pooled it
- Patient and general practitioner experiences of implementing a medication review intervention in older people with multimorbidity: Process evaluation of the SPPiRE trial.Health expectations : an international journal of public participation in health care and health policy · 2022Trial
- A Qualitative Study of Clinician Barriers and Facilitators to De-escalation of Thyroid Stimulating Hormone Suppression in Thyroid Cancer Survivors.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2026Article
- The Challenges of Prognosticating Persistent Critical Illness: A Qualitative Study.CHEST critical care · 2026Article
- The role of general practitioners in dementia diagnosis: a scoping review of clinical practice guidelines.Family practice · 2025Article
- Review
- Stakeholder perceptions of and attitudes towards problematic polypharmacy and prescribing cascades: a qualitative study.Age and ageing · 2024Article
- Defining, identifying and addressing problematic polypharmacy within multimorbidity in primary care: a scoping review.BMJ open · 2024Article
- GP preferences for, access to, and use of evidence in clinical practice: a mixed-methods study.BJGP open · 2023Article
- Experience of living with multimorbidity and health workers perspectives on the organization of health services for people living with multiple chronic conditions in Bahir Dar, northwest Ethiopia: a qualitative study.BMC health services research · 2023Article
- Factors which influence the deprescribing decisions of community-living older adults and GPs in Australia.Health & social care in the community · 2022Article
- Deprescribing medicines in older people living with multimorbidity and polypharmacy: the TAILOR evidence synthesis.Health technology assessment (Winchester, England) · 2022Review
- The MultimorbiditY COllaborative Medication Review And DEcision Making (MyComrade) study: a protocol for a cross-border pilot cluster randomised controlled trial.Pilot and feasibility studies · 2022Article
- Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUsing clinical guidelines in the management of patients with multimorbidity can lead to the prescription of multiple and sometimes conflicting medications.
aimTo explore how GPs make decisions when prescribing for multimorbid patients, with a view to informing intervention design. DESIGN AND
settingIn-depth qualitative interviews incorporating chart-stimulated recall with purposively sampled GPs in the Republic of Ireland.
methodGrounded theory analysis with iterative theory development.
resultsTwenty GPs were interviewed about 51 multimorbid cases. In these cases, GPs integrated information from multiple sources including the patient, specialists, and evidence-based medicine. Difficulties arose when recommendations or preferences conflicted, to which GPs responded by 'satisficing': accepting care that they deemed satisfactory and sufficient for a particular patient. Satisficing was manifest as relaxing targets for disease control, negotiating compromise with the patient, or making 'best guesses' about the most appropriate course of action to take. In multimorbid patients perceived as stable, GPs preferred to 'maintain the status quo' rather than rationalise medications, even in cases with significant polypharmacy. Proactive changes in medications were facilitated by continuity of care, sufficient consultation time, and open lines of communication with the patient, other healthcare professionals, and other GPs.
conclusionGPs respond to conflicts in the management of multimorbid patients by making compromises between patient-centred and evidence-based care. These findings will be used to inform interventions that aim to care in multimorbidity.
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