Background: Readily available guidance on managing patients with multimorbidity in general practice is limited. Decision-making frameworks for managing multimorbidity have been developed but these do not extend to a practical tool to assist with clinical decisions. This study reports on general practitioners (GPs) views on the guidance needed at the point of care. Clinical information in existing guidelines was reviewed to support development of a tool.
Method: Two focus group sessions (n=9, n=10) involved academic and practicing GPs (Brisbane, Australia). Participants were asked to propose tool features and identify the clinical information needed to support management of patients with multimorbidity. The availability of this clinical information was assessed by reviewing fifteen existing clinical guidelines for eight conditions commonly seen in general practice.
Results: Participants emphasised the importance of accessing summarised clinical information quickly, with the ability to obtain more detailed information when needed for specific decisions-. Ten categories of clinical information for inclusion in a point of care multimorbidity tool were identified. The review of existing clinical guidelines revealed gaps between what GPs need and the information provided.
Discussion: As patients with multimorbidity are often excluded from clinical trials, the desired evidence to support moderation of treatments is commonly not available. Clinical information included in existing clinical guidelines is insufficient to support development of a multimorbidity tool at the point of care. A checklist for general practice guideline writers could improve the relevance of information included. Panels of relevant specialists and GPs could provide interim guidance based on clinical expertise. In addition, an information source providing the relative benefits of medications in the context of multimorbidity, and patient age is recommended.
Implications for practice: Improved guidelines and the ability to quickly access information on managing multimorbidity in general practice would improve patient care