Damarell Raechel A, Morgan Deidre D, Tieman Jennifer J, Senior Tim
Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
Tharawal Aboriginal Corporation/School of Medicine. Western Sydney University, Sydney, NSW, Australia.
Fam Pract. 2023 Mar 28;40(2):360-368. doi: 10.1093/fampra/cmac096.
Multimorbidity is prevalent in general practice and general practitioners internationally report challenges in its management. Understanding the perspectives of general practitioners at the frontline of care is important for system sustainability and accessibility as populations age.
To explore Australian general practitioner perspectives on managing multimorbidity, the factors supporting their work, and those impeding their ability to meet their own standards of care provision.
A qualitative study conducted with Australian general practitioners using semistructured, in-depth interviews and inductive thematic data analysis.
Twelve interviews with general practitioners were conducted. Three main themes were constructed from the data: Multimorbidity as an encounter with complexity and contingency; Evidence constraints in multimorbidity care; and Concerns for patient safety. System structure and the Australian general practice model restrict general practitioners' ability to provide care to their level of satisfaction by linking short consultation times to practice remuneration. Attitudes toward the applicability of guideline evidence were mixed despite most general practitioners questioning its generalizability. Patient safety concerns pervaded most interviews and largely centered on system fragmentation and insufficient intersectoral communication. General practitioners rely on multiple sources of information to provide patient-centered care but chiefly the accumulated knowledge of their patients.
Australian general practitioners share many multimorbidity concerns with international colleagues. While multimorbidity-specific evidence may be unrealistic to expect in the immediate term, system investment and adaptation is needed to support general practice sustainability and clinician ability to provide adequate multimorbidity care, suitably remunerated, into the future.
多重疾病在全科医疗中普遍存在，国际上的全科医生报告称在其管理方面存在挑战。随着人口老龄化，了解处于医疗一线的全科医生的观点对于系统的可持续性和可及性至关重要。
探讨澳大利亚全科医生对管理多重疾病的观点、支持其工作的因素以及阻碍他们达到自身护理标准的因素。
对澳大利亚全科医生进行定性研究，采用半结构化深度访谈和归纳主题数据分析。
对全科医生进行了12次访谈。从数据中构建了三个主要主题：多重疾病是一种面对复杂性和偶然性的情况；多重疾病护理中的证据限制；以及对患者安全的担忧。系统结构和澳大利亚全科医疗模式通过将短咨询时间与执业报酬挂钩，限制了全科医生按照自己满意的水平提供护理的能力。尽管大多数全科医生质疑指南证据的普遍性，但他们对其适用性的态度不一。患者安全问题在大多数访谈中普遍存在，主要集中在系统碎片化和部门间沟通不足。全科医生依靠多种信息来源提供以患者为中心的护理，但主要是依靠他们对患者积累的了解。
澳大利亚全科医生与国际同行有许多关于多重疾病的共同担忧。虽然短期内期望有针对多重疾病的具体证据可能不现实，但需要进行系统投资和调整，以支持全科医疗的可持续性以及临床医生在未来提供充分的多重疾病护理并获得适当报酬的能力。
