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dc.contributor.authorHughes, Lloyd D.
dc.identifier.citationHughes , L D 2022 , ' Understanding the processes behind the decisions – GPs and complex multimorbidity decision making ' , BMC Primary Care , vol. 23 , 162 .
dc.identifier.otherPURE: 280273992
dc.identifier.otherPURE UUID: b384bbd2-d140-4f05-9d8d-669826756a8d
dc.identifier.otherRIS: urn:99C3DD9FEDA9B206D97C9AB1857B93EF
dc.identifier.otherRIS: Hughes2022
dc.identifier.otherScopus: 85132952703
dc.identifier.otherWOS: 000817295100002
dc.descriptionLDH is grateful to National Education Scotland for funding the NES Academic Fellowship scheme which has provided the financial means for this work to be performed.en
dc.description.abstractComplex multimorbidity, defined either as three or more chronic conditions affecting three or more different body systems or by the patients General Practitioner (GPs), is associated with various adverse outcomes. Understanding how GPs reach decisions for this complex group of patients is currently under-researched, with potential implications for health systems and service delivery. Schuttner and colleagues, through a qualitative approach, reported that internal factors of individuals (decisions tailored to patients; Primary Care Physician (PCP) consultation style; care planning towards an agreed goal of care), external factors within the environment or context of encounter (patient access to healthcare; organizational structures acting as barriers), and relationship-based factors (collaborative care planning; decisions within a dynamic patient clinician relationship) all influence care planning decisions. There are other important findings which have broader relevance to the literature such as the ongoing separation of physical and mental health which persist even within integrated care systems, GPs continue to prioritize continuity of care and that organizational barriers are reported as factors in clinician decision-making for patients. More broadly, the work has proved valuable in extending previously reported findings surrounding care coordination, and limitation of current guidelines for patients with complex multimorbidity. Work-load in general practice is increasing due to an ageing population, increasing prevalence of multimorbidity and polypharmacy, and transfer of clinical activities from secondary to primary care. The future for GPs is more complexity in the clinic room, understanding how GPs make decisions and how this can be supported is crucial for the sustainability for general practice.
dc.relation.ispartofBMC Primary Careen
dc.rightsCopyright © The Author(s) 2022. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.en
dc.subjectR Medicine (General)en
dc.subjectSDG 3 - Good Health and Well-beingen
dc.titleUnderstanding the processes behind the decisions – GPs and complex multimorbidity decision makingen
dc.typeJournal itemen
dc.description.versionPublisher PDFen
dc.contributor.institutionUniversity of St Andrews. School of Medicineen
dc.description.statusPeer revieweden

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