Multimorbidität aus Hausarzt- und Patientensicht (original) (raw)

Zusammenfassung

Hintergrund

Für Hausärzte ist die Betreuung von Patienten mit Multimorbidität eine alltägliche Herausforderung. Leitlinien, die jeweils nur einzelne Erkrankungen im Fokus haben, können hier nicht umfassend und „gleichberechtigt“ Anwendung finden. Stattdessen müssen Prioritäten gesetzt werden.

Fragestellung

Vor diesem Hintergrund wird herausgearbeitet, wie Hausärzte und ihre Patienten diesen Herausforderungen begegnen und welche Prioritäten sie jeweils setzen.

Material und Methoden

Neun Hausärzte und 19 ihrer Patienten mit Multimorbidität wurden narrativ interviewt. Die Analyse erfolgte inhaltsanalytisch.

Ergebnisse

Die Mehrzahl der interviewten Patienten fühlte sich durch ihren Hausarzt gut oder sehr gut betreut. Dennoch stellten sich die Prioritäten der Hausärzte und die ihrer Patienten häufig unterschiedlich dar. Während die Ärzte die meiste Energie auf das Management von Erkrankungen verwendeten, die zu potenziell lebensbedrohlichen Situationen führen können, stand bei den Patienten der unmittelbare Erhalt von Autonomie und sozialem Miteinander im Vordergrund.

Diskussion

Die Ergebnisse der Studie legen den Schluss nahe, dass die Kommunikation zwischen Hausärzten und ihren Patienten gerade in Bezug auf einen gemeinsamen Prozess der Prioritätensetzung bei Multimorbidität weiterentwickelt werden kann.

Abstract

Background

For general practioners (GP) the treatment of patients suffering from multimorbidity is an everyday challenge. For these patients guidelines which each focus on a specific chronic disease cannot be applied comprehensively and equally; therefore, it is necessary to prioritize.

Objective

Given this situation the study aimed at analyzing how GPs and patients deal with this challenge and what their priorities are.

Material and methods

Narrative interviews were conducted with 9 GPs and 19 of their multimorbid patients. The data were analyzed by means of content analysis.

Results

The majority of interviewed patients felt well or very well cared for by their GPs; however, GPs and multimorbid patients often had relatively different priorities. Whereas GPs mostly focused on the management of diseases that could lead to life-threatening situations, patients put an emphasis on maintaining autonomy and a social life.

Conclusion

The results of this study suggest that there is room for development in the way GPs and multimorbid patients communicate with each other, particularly as far as shared priority setting is concerned.

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Notes

  1. Städtenamen wurden pseudonymisiert.

Literatur

  1. Beck RS, Daughtridge R, Sloane PD (2002) Physician-patient communication in the primary care office: a systematic review. J Am Board Fam Pract 15:25–38
    PubMed Google Scholar
  2. Björkelund C, Maun A, Murante AM, Hoffman K, De Maeseneer J, Farkas-Pall Z (2013) Impact of continuity on quality of primary care: from the perspective of citizens’ preference and multimorbidity – position paper of the European Forum for Primary Care. Qual Prim Care 21:193–204
    PubMed Google Scholar
  3. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW (2005) Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 294:716–724
    Article CAS PubMed Google Scholar
  4. Corbin J, Strauss A (2008) Basics of qualitative research: techniques and procedures for developing grounded theory. Sage, Los Angeles
    Google Scholar
  5. Fung CH, Setodji CM, Kung FY et al (2008) The relationship between multimorbidity and patients’ ratings of communication. J Gen Intern Med 23:788–793
    Article PubMed Central PubMed Google Scholar
  6. Gill A, Kuluski K, Jaakkimainen L, Naganathan G, Upshur R, Wodchis WP (2014) „Where do we go from here?“ Health system frustrations expressed by patients with multimorbidity, their caregivers and family physicians. Healthc Policy 9:73–89
    PubMed Google Scholar
  7. Greenhalgh T, Hurwitz B (1998) Narrative based medicine: dialogue and discourse in clinical practice. BMJ, London
    Google Scholar
  8. Harrington J, Noble LM, Newman SP (2004) Improving patients’ communication with doctors: a systematic review of intervention studies. Patient Educ Couns 52:7–16
    Article PubMed Google Scholar
  9. Junius-Walker U, Voigt I, Wrede J, Hummers-Pradier E, Lazic D, Dierks ML (2010) Health and treatment priorities in patients with multimorbidity: report on a workshop from the European General Practice Network meeting ‚Research on multimorbidity in general practice‘. Eur J Gen Pract 16:51–54
    Article PubMed Google Scholar
  10. Mason B, Nanton V, Epiphaniou E, Murray SA, Donaldson A, Shipman C, Daveson BA, Harding R, Higginson IJ, Munday D, Barclay S, Dale J, Kendall M, Worth A, Boyd K (2014) „My body’s falling apart.“ Understanding the experiences of patients with advanced multimorbidity to improve care: serial interviews with patients and carers. BMJ Support Palliat Care. DOI doi: 10.1136/bmjspcare-2013-000639
  11. Mayring P (2010) Qualitative Inhaltsanalyse: Grundlagen und Techniken. Beltz, Weinheim
    Book Google Scholar
  12. Moore LG (2006) Escaping the tyranny of the urgent by delivering planned care. Fam Pract Manag 13:37–40
    PubMed Google Scholar
  13. Muth C, Beyer M, Fortin M, Rochon J, Oswald F, Valderas JM, Harder S, Glynn LG, Perera R, Freitag M, Kaspar R, Gensichen J, van den Akker M (2014) Multimorbidity’s research challenges and priorities from a clinical perspective: the case of „Mr Curran“. Eur J Gen Pract 20:139–147
    Article PubMed Google Scholar
  14. Smith SM, O’Kelly S, O’Dowd T (2010) GPs’ and pharmacists’ experiences managing multimorbidity: a „Pandora’s box“. Br J Gen Pract 60:285–294
    Article PubMed Google Scholar
  15. Smith SM, Soubhi H, Fortin M, Hudon C, O’Dowd T (2012) Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. BMJ 3:345
    Google Scholar
  16. Street RL Jr (1991) Information-giving in medical consultations: the influence of patients’ communicative styles and personal characteristics. Soc Sci Med 32:541–548
    Article PubMed Google Scholar
  17. Street RL Jr (2002) Gender differences in health care provider-patient communication: are they due to style, stereotypes, or accommodation? Patient Educ Couns 48:201–206
    Article PubMed Google Scholar
  18. Wagner EH, Austin BT, Von Korff M (1996) Organizing care for patients with chronic illness. Milbank Q 74:511–544
    Article CAS PubMed Google Scholar
  19. Wagner EH, Bennett SM, Austin BT, Greene SM, Schaefer JK, Vonkorff M (2005) Finding common ground: patient-centeredness and evidence-based chronic illness care. J Altern Complement Med 11(Suppl 1):7–15
    Google Scholar
  20. Willems S, De Maesschalck S, Deveugele M, Derese A, De Maeseneer J (2005) Socio-economic status of the patient and doctor-patient communication: does it make a difference? Patient Educ Couns 56:139–146
    Article CAS PubMed Google Scholar
  21. van den Bussche H, Scherer M (2011) Das Verbundvorhaben „Komorbidität und Multimorbidität in der hausärztlichen Versorgung“ (Multicare). Z Gerontol Geriatr 44(Suppl 2):73–100
    Article PubMed Google Scholar

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Einhaltung ethischer Richtlinien

Interessenkonflikt

C. Löffler, A. Altiner, W. Streich, C.-O. Stolzenbach, A. Fuchs, E. Drewelow, A. Hornung, G. Feldmeier, H. van den Bussche und H. Kaduszkiewicz geben an, dass keine Interessenskonflikte bestehen.

Dieses Projekt wurde vom Bundesministerium für Bildung und Forschung gefördert (Förderkennzeichen 01ET0725 und 01ET0727; Votum der Ethikkommission Nr. PV3091). Dieser Beitrag enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Institut für Allgemeinmedizin, Universitätsmedizin Rostock, Postfach 100888, 18055, Rostock, Deutschland
    Christin Löffler Ph.D., Attila Altiner, Eva Drewelow MSc, Anne Hornung MSc & Gregor Feldmeier
  2. Institut für Allgemeinmedizin, Heinrich-Heine-Universität, Düsseldorf, Deutschland
    Waldemar Streich & Angela Fuchs
  3. Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
    Carl-Otto Stolzenbach & Hendrik van den Bussche
  4. Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
    Hanna Kaduszkiewicz

Authors

  1. Christin Löffler Ph.D.
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  2. Attila Altiner
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  3. Waldemar Streich
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  4. Carl-Otto Stolzenbach
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  5. Angela Fuchs
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  6. Eva Drewelow MSc
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  7. Anne Hornung MSc
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  8. Gregor Feldmeier
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  9. Hendrik van den Bussche
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  10. Hanna Kaduszkiewicz
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Corresponding author

Correspondence to Christin Löffler Ph.D..

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Löffler, C., Altiner, A., Streich, W. et al. Multimorbidität aus Hausarzt- und Patientensicht.Z Gerontol Geriat 48, 452–456 (2015). https://doi.org/10.1007/s00391-014-0820-9

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