How do general practitioners recognize the definition of multimorbidity? A European qualitative study

Abstract

Background: Multimorbidity is a challenging concept for general practice. An EGPRN working group has published a comprehensive definition of the concept of multimorbidity. As multimorbidity could be a way to explore complexity in general practice, it was of importance to explore whether European general practitioners (GPs) recognize this concept and whether they would change it.

Objectives: To investigate whether European GPs recognize the EGPRN concept of multimorbidity and whether they would change it.

Methods: Focus group meetings and semi-structured interviews as data collection techniques with a purposive sample of practicing GPs from every country. Data collection continued until saturation was reached in every country. The analysis was undertaken using a grounded theory based method. In each national team, four independent researchers, working blind and pooling data, carried out the analysis. To ensure the internationalization of the data, an international team of 10 researchers pooled the axial and selective coding of all national teams to check the concept and highlight emerging themes.

Results: The maximal variation and saturation of the sample were reached in all countries with 211 selected GPs. The EGPRN definition was recognized in all countries. Two additional ideas emerged, the use of Wonca’s core competencies of general practice, and the dynamics of the doctor–patient relationship for detecting and managing multimorbidity and patient’s complexity.

Conclusion: European GPs recognized and enhanced the EGPRN concept of multimorbidity. These results open new perspectives regarding the management of complexity using the concept of multimorbidity in general practice.

Key Messages

• European general practitioners recognize the EGPRN enhanced, comprehensive concept of multimorbidity.

• They add the use of Wonca’s core competencies and the patient–doctor relationship dynamics for detecting and managing multimorbidity.

• The EGPRN concept of multimorbidity leads to new perspectives for the management of complexity.

Keywords:

• Multimorbidity
• qualitative research
• competencies

Acknowledgements

We should like to thank all the GPs who participated in the research process throughout Europe and all trainees in general practice from Brest University who participated in the research process. J. Y. Le Reste designed the study, collected data for all of Europe, organized all the meetings, drafted the article and prepared it for publication. P. Nabbe designed the study, collected data for all of Europe, organized all the meetings and reviewed the article. D. Lazic collected data for Croatia and reviewed the article. R. Assenova collected data for Bulgaria and reviewed the article. H. Lingner collected data for Germany and reviewed the article. S. Czachowski collected data for Poland and reviewed the article. S. Argyriadou collected data for Greece and reviewed the article. A. Sowinska collected data for Poland, checked the linguistic homogeneity and reviewed the article. C. Lygidakis collected data for Italy and reviewed the article. C. Doerr collected data for Germany and reviewed the article. A. Claveria reviewed the article. B. Le Floch collected data for France and reviewed the article. J. Derrienic collected data for France and reviewed the article. H. Van Marwijk designed the study and reviewed the article. P. Van Royen designed the study and reviewed the article.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Funding

Funding of the Department of General Practice of Brest University (France) and a Grant of €8000 from the EGPRN.