ArticleBMJ open2015
How GPs value guidelines applied to patients with multimorbidity: a qualitative study.
Article in BMJ open, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 4 of them syntheses that pooled it.
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Who cites it
22 citing papers in PubMed, 4 syntheses or guidelines pooled it, 41 citations in OpenAlex.
- 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
- Underlying mechanisms of complex interventions addressing the care of older adults with multimorbidity: a realist review.BMJ open · 2019Pooled it
- Effectiveness of interventions for managing multiple high-burden chronic diseases in older adults: a systematic review and meta-analysis.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2018Pooled it
- Trial
- Guideline adherence for the management of cardiovascular disease in primary care: a scoping review.Family practice · 2026Article
- General practitioners and management control through guidelines: a qualitative study of its effects on their practice.BMC primary care · 2026Article
- GPs' decision-making behaviour in the prescription of aspirin for primary prevention in elderly individuals: a qualitative study using semistructured interviews in France.BMC primary care · 2025Article
- Importance, facilitators and barriers for finnish general practitioner involvement in clinical practice guideline panels: a survey.BMC primary care · 2025Article
- Article
- General practitioners' assessment and management of chronic kidney disease in older patients- a mixed methods study.BMC primary care · 2024Article
- A scoping review of evidence-based guidance and guidelines published by general practice professional organizations.Family practice · 2024Article
- GP preferences for, access to, and use of evidence in clinical practice: a mixed-methods study.BJGP open · 2023Article
- Differences in nursing home admission between functionally defined populations in Germany and the association with quality of health care.BMC health services research · 2021Article
- Article
- Development of a structured clinical pharmacology review for specialist support for management of complex polypharmacy in primary care.British journal of clinical pharmacology · 2020Article
- General practitioners' perspectives on chronic care consultations for patients with a history of cancer: a qualitative interview study.BMC family practice · 2019Article
- 'More constricting than inspiring' - GPs find chronic care programmes of limited clinical utility. A qualitative study.BJGP open · 2018Article
- COPD management by Swedish general practitioners - baseline results of the PRIMAIR study.Scandinavian journal of primary health care · 2018Article
- Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo 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.
designFocus 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.
settingPrimary care, eastern part of The Netherlands.
participantsDutch GPs, heterogeneous in age, sex and academic involvement.
results25 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.
conclusionsGPs 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.
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