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      The Knowledge, Awareness, and Practices of Portuguese General Practitioners Regarding Multimorbidity and Its Management: Qualitative Perspectives from Open-Ended

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          Abstract

          Multimorbidity’s high prevalence and negative impact has made it a subject of worldwide interest. The main aim of this study was to access the Portuguese knowledge, awareness, and practices of general practitioners (GPs) regarding multimorbidity and its management, in order to aid in the development of interventions for improving outcomes in multimorbid patients in primary care. A web-based qualitative descriptive study was carried out in the first trimester of 2016 with primary care physicians working in two districts of the Centre region of Portugal. Open-ended questions were analysed via inductive thematic content analysis. GPs pointed out several difficulties and challenges while managing multimorbidity. Extrinsic factors were associated with the healthcare system logistics’ management (consultation time, organization of care teams, clinical information) and society (media pressure, social/family support). Intrinsic factors related to the GP, patient, and physician-patient relationship were also stated. The most significant conclusion to emerge from this study is that although GPs perceived difficulties and challenges towards multimorbidity, they also have the tools to deal with them: the fundamental characteristics of family medicine. Also, the complex care required by multimorbid patients needs adequate consultation time, multidisciplinary teamwork, and more education/training.

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          Most cited references48

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          Analysing and presenting qualitative data.

          This paper provides a pragmatic approach to analysing qualitative data, using actual data from a qualitative dental public health study for demonstration purposes. The paper also critically explores how computers can be used to facilitate this process, the debate about the verification (validation) of qualitative analyses and how to write up and present qualitative research studies.
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            Qualitative evaluation and research methods

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              Is there time for management of patients with chronic diseases in primary care?

              Despite the availability of national practice guidelines, many patients fail to receive recommended chronic disease care. Physician time constraints in primary care are likely one cause. We applied guideline recommendations for 10 common chronic diseases to a panel of 2,500 primary care patients with an age-sex distribution and chronic disease prevalences similar to those of the general population, and estimated the minimum physician time required to deliver high-quality care for these conditions. The result was compared with time available for patient care for the average primary care physician. Eight hundred twenty-eight hours per year, or 3.5 hours a day, were required to provide care for the top 10 chronic diseases, provided the disease is stable and in good control. We recalculated this estimate based on increased time requirements for uncontrolled disease. Estimated time required increased by a factor of 3. Applying this factor to all 10 diseases, time demands increased to 2,484 hours, or 10.6 hours a day. Current practice guidelines for only 10 chronic illnesses require more time than primary care physicians have available for patient care overall. Streamlined guidelines and alternative methods of service delivery are needed to meet recommended standards for quality health care.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                08 November 2016
                November 2016
                : 13
                : 11
                : 1097
                Affiliations
                [1 ]Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã 6200-506, Portugal
                [2 ]Centro de Saúde de Aveiro, Aveiro 3810-000, Portugal
                [3 ]Unidade de Saúde Familiar Topázio, Coimbra 3020-171, Portugal; lmsantiago@ 123456netcabo.pt
                Author notes
                [* ]Correspondence: filipeprazeresmd@ 123456gmail.com ; Tel.: +35-12-3489-1197
                Article
                ijerph-13-01097
                10.3390/ijerph13111097
                5129307
                27834818
                8d0f27e2-c676-41e4-97fd-26684510e835
                © 2016 by the authors; licensee MDPI, Basel, Switzerland.

                This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 21 August 2016
                : 02 November 2016
                Categories
                Article

                Public health
                portugal,primary care,qualitative study,perceived experiences,multimorbidity
                Public health
                portugal, primary care, qualitative study, perceived experiences, multimorbidity

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