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Research

Family practitioners' top medical priorities when managing patients with multimorbidity: a cross-sectional study

Lilli Herzig, Yolanda Mueller, Dagmar M Haller, Andreas Zeller, Stefan Neuner-Jehle, Anouk Déruaz-Luyet, Christine Cohidon, Sven Streit, Bernard Burnand and Jean-Christophe Zuchuat
BJGP Open 2019; 3 (1): bjgpopen18X101622. DOI: https://doi.org/10.3399/bjgpopen18X101622
Lilli Herzig
1Chief of Research Department, Department of Family Medicine, General Medicine and Public Health Centre, University of Lausanne, , Switzerland
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  • For correspondence: lilli.herzig@hin.ch
Yolanda Mueller
2Chief of Research Department, Department of Family Medicine, General Medicine and Public Health Care Centre, University of Lausanne, , Switzerland
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Dagmar M Haller
3Chief of Research Department, Primary Care Unit, Faculty of Medicine, University of Geneva, , Switzerland
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Andreas Zeller
4Chief of Institution, Centre of Primary Health Care, University of Basel, , Switzerland
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Stefan Neuner-Jehle
5Research Collaborator, Institute of Primary Care, University of Zürich, , Switzerland
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Anouk Déruaz-Luyet
6Projects Chief, Department of Family Medicine, General Medicine and Public Health Centre, University of Lausanne, , Switzerland
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Christine Cohidon
7Research Collaborator, Institute of Primary Care, Department of Family Medicine, General Medicine and Public Health Centre, University of Lausanne, , Switzerland
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Sven Streit
8Research Collaborator, Institute of Primary Health Care (BIHAM), University of Bern, , Switzerland
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Bernard Burnand
9Head of Department, Institute of Social and Preventive Medicine, Lausanne University Hospital, , Switzerland
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Jean-Christophe Zuchuat
10Statistician, Department of Family Medicine, General Medicine and Public Health Centre, University of Lausanne, , Switzerland
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Abstract

Background Managing multiple chronic and acute conditions in patients with multimorbidity requires setting medical priorities. How family practitioners (FPs) rank medical priorities between highly, moderately, or rarely prevalent chronic conditions (CCs) has never been described. The authors hypothesised that there was no relationship between the prevalence of CCs and their medical priority ranking in individual patients with multimorbidity.

Aim To describe FPs’ medical priority ranking of conditions relative to their prevalence in patients with multimorbidity.

Design & setting This cross-sectional study of 100 FPs in Switzerland included patients with ≥3 CCs on a predefined list of 75 items from the International Classification of Primary Care 2 (ICPC-2); other conditions could be added. FPs ranked all conditions by their medical priority.

Method Priority ranking and distribution were calculated for each condition separately and for the top three priorities together.

Results The sample contained 888 patients aged 28–98 years (mean 73), of which 48.2% were male. Included patients had 3–19 conditions (median 7; interquantile range [IQR] 6–9). FPs used 74/75 CCs from the predefined list, of which 27 were highly prevalent (>5%). In total, 336 different conditions were recorded. Highly prevalent CCs were only the top medical priority in 66%, and the first three priorities in 33%, of cases. No correlation was found between prevalence and the ranking of medical priorities.

Conclusion FPs faced a great diversity of different conditions in their patients with multimorbidity, with nearly every condition being found at nearly every rank of medical priority, depending on the patient. Medical priority ranking was independent of the prevalence of CCs.

  • primary care
  • chronic disease
  • multimorbidity
  • epidemiology
  • prioritisation
  • Received June 14, 2018.
  • Accepted August 16, 2018.
  • Copyright © The Authors 2019

This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)

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Family practitioners' top medical priorities when managing patients with multimorbidity: a cross-sectional study
Lilli Herzig, Yolanda Mueller, Dagmar M Haller, Andreas Zeller, Stefan Neuner-Jehle, Anouk Déruaz-Luyet, Christine Cohidon, Sven Streit, Bernard Burnand, Jean-Christophe Zuchuat
BJGP Open 2019; 3 (1): bjgpopen18X101622. DOI: 10.3399/bjgpopen18X101622

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Family practitioners' top medical priorities when managing patients with multimorbidity: a cross-sectional study
Lilli Herzig, Yolanda Mueller, Dagmar M Haller, Andreas Zeller, Stefan Neuner-Jehle, Anouk Déruaz-Luyet, Christine Cohidon, Sven Streit, Bernard Burnand, Jean-Christophe Zuchuat
BJGP Open 2019; 3 (1): bjgpopen18X101622. DOI: 10.3399/bjgpopen18X101622
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Keywords

  • primary care
  • chronic disease
  • multimorbidity
  • epidemiology
  • prioritisation

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