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Table 1 Individual study characteristics

From: General practitioner strategies for managing patients with multimorbidity: a systematic review and thematic synthesis of qualitative research

Author (Year) and country No. of GP participants and their characteristics Patient population and topic focus Multimorbidity content Method of data collection Theoretical framework and form of analysis
Ailabouni (2016a) [73]
New Zealand
10 GPs
No. of years’ experience prescribing in residential care: 2–32 years
A hypothetical patient with multimorbidity
Deprescribing
Focus. Uses a hypothetical patient with multimorbidity to stimulate discussion of multimorbidity Semi-structured interviews Theoretical Domain Framework
Content analysis
Ailabouni (2016b) [74]
New Zealand
10 GPs
No. of years’ experience prescribing in residential care: 2–32 years. Gender: 7 males; 3 females
Older patients in residential aged care
Deprescribing
Derived theme Semi-structured interviews Theoretical Domain Framework
Content analysis
Anderson (2017) [60]
Australia
32 GPs
Mean age: 47 years (range: 28–70 years). Mean time in practice: 18 years (range: 1–50 years).
63.3% full-time.
Gender: 18 males; 14 females.
Older patients with multimorbidity in primary care
Deprescribing
Focus. Uses a hypothetical patient with multimorbidity to stimulate discussion of multimorbidity Focus groups Not stated
Thematic analysis using Framework Method
Austad (2016) [68]
Norway
25 GPs
Not stated
Patients with multimorbidity in general practice
Clinical practice guidelines
Focus Focus groups Phenomenological approach
Systematic text condensation
Blakeman (2012) [55]
England, UK
11 GPs
Median age: 45 years (range: 30–62 years). Gender: 6 males; 5 females.
Patients with early-stage chronic kidney disease in primary care
Patient management
Focus. Section on multimorbidity included in interview guide Semi-structured interviews Normalisation Process Theory
Deductive analysis using framework
Bower
(2011) [56]
England, UK
15 GPs
‘A mix of males and females’; ‘significant variation in age and experience among participants’
Patients with multimorbidity in general practice
Service organisation; Decision making
Focus Semi-structured interviews Not stated
Framework analysis
Clyne
(2016) [70]
Ireland
17 GPs
N = 14 GPs in practice > 10 years. Gender: 13 males; 4 females
Older patients in primary care
Potentially inappropriate prescribing
Derived theme Semi-structured interviews Not stated
Thematic analysis
Jones
(2018) [61]
Australia
14 GPs
Mean time in practice: 21 years.
Remote Australian Aboriginal patients with complex health problems
Clinical practice guidelines
Focus Semi-structured interviews Critical theory and a realist paradigm
Thematic analysis
Kenning (2013) [57]
England, UK
16 GPs
Mean time in practice: 17 years. Gender: 7 males; 9 females.
Patients with multimorbidity in general practice
Working with patients; self-care
Focus Semi-structured interviews Not stated
Thematic analysis
Kristensen (2017) [64]
Denmark
12 GPs
Median time in practice: 16 years (range: 1–41 years).
Gender: 6 males, 6 females.
Patients with multimorbidity living in rural, socioeconomically deprived regions
Self-care
Focus Semi-structured interviews Not stated
Systematic text condensation
Kristensen (2018) [65]
Denmark
See Kristensen (2017) as duplicate data Patients with multimorbidity and lowered self-care ability
Disease management programs
Focus Semi-structured interviews Not stated
Systematic text condensation
Kuluski (2013) [76]
Canada
4 Family Physicians
Time in practice: 3 GPs > 10 years; 1 = 1 year.
Older patients with multimorbidity in primary care
Care goals
Focus Semi-structured interviews Not stated
Thematic analysis
Laue
(2016) [69]
International but only extracted data and findings for Norway, Wales, and the Netherlands
23 GPs (Norway: n = 7; Netherlands: n = 6; Wales: n = 10)
Norway. Time in practice: 2 months-20 years. Netherlands. Time in practice: 3–30 years. Wales. Time in practice: 4–28 years.
Patients with COPD and exacerbations
Decision making
Derived theme Focus groups Grounded theory
Thematic analysis
Laursen (2018) [66]
Denmark
14 GPs
Mean time in practice: 15 years. Gender: 7 males; 7 females.
Poly-medicated patients with multimorbidity
Medication review
Focus Semi-structured interviews Phenomenological/hermeneutic orientation
Content analysis
Luijks
(2012) [48]
Netherlands
25 GPs
Mean age = 50 years. Mean time in practice: 20 years (range: 2–36 years).
Gender: 18 males; 7 females.
Patients with multimorbidity in general practice
Patient management
Focus Focus groups Realism paradigm
Constant comparative analysis
Luijks
(2015) [49]
Netherlands
See Luijks (2012) as duplicate data Patients with multimorbidity in general practice
Clinical practice guidelines
Focus Focus groups Not stated
Constant comparative analysis
Mc Namara (2017) [62]
Australia
5 GPs (26 health care professionals in total)
Not stated
Patients with multimorbidity in general practice
Patient management
Focus Semi-structured interviews AGS Guiding Principles (cite) used as a framework for analyis
Constant comparative analysis
O’Brien (2011) [80]
Scotland, UK
15 GPs
Gender: 8 males; 7 females
Socioeconomically deprived patients with multimorbidity in general practice
Patient management
Focus Semi-structured interviews Modified grounded theory approach
Constant comparative analysis
Ploeg
(2017) [77]
Canada
4 Family Physicians
Not stated
Older, community dwelling patients with multimorbidity
Patient management
Focus Semi-structured interviews Thorne’s interpretative description approach
Constant comparative analysis
Prazeres (2016) [79]
Portugal
74 GPs
Mean time in practice: 16 years (range 1–37 years).
Gender: 23 males; 51 females
Patients with multimorbidity in general practice
Patient management
Focus Online survey Not stated
Thematic content analysis
Risor (2013) [50]
International but only extracted data and findings for Norway, Wales, and the Netherlands
See Laue (2016) as duplicate data Patients with COPD and exacerbations
Decision making
Derived theme Focus groups Grounded theory
Not stated but ‘line-by-line coding’ used
Sandelowsky
(2016) [78]
Sweden
59 Primary Care Practitioners
Mean age: 46 years (range 28–68 years). Mean time in practice: 14 years (range 1–39 years).
Gender: 30 males; 29 females.
Patients with COPD
Patient management
Focus Semi-structured interviews and focus groups ‘Inspired by the grounded theory method’
Constant comparative analysis
Schuling (2012) [51]
Netherlands
29 GPs
Mean age: 54 years (range 39–65 years).
Gender: 27 males; 2 females.
Older patients with multimorbidity in primary care
Deprescribing
Focus Focus groups Not stated
Thematic analysis
Sinnige (2016) [52]
Netherlands
12 GPs
Mean age: 56 years (range 46–63 years). Mean time in practice: 25 years (range 10–35 years).
Older people with polypharmacy in general practice
Medication management; Polypharmacy
Focus of clinical vignettes Focus groups Not stated
Framework approach
Sinnott (2015) [71]
Ireland
20 GPs
Length of time qualified: 6 GPs < 10 years; 14 GPs > 10 years.
Patients with multimorbidity in general practice
Prescribing decisions
Focus Semi-structured interviews and chart-stimulated recall Grounded theory approach
Constant comparative analysis
Smith (2010) [72]
Ireland
13 GPs
Not stated
Patients with multimorbidity in general practice
Patient management
Focus Focus group Not stated
Framework analysis
Solomon (2012) [58]
England, UK
8 GPs
Not stated
Patients prescribed a statin or a PPI in primary care
Clinical practice guidelines; Patient-GP partnership
Derived theme Semi-structured interviews Not stated
Framework analysis
Sondergaard (2015) [67]
Nordic countries: Denmark, Finland, Iceland, Norway, Sweden
62 GPs
Not stated
Patients with multimorbidity in general practice
Patient management
Focus Plenary session and short open-ended questionnaires Not stated
Framework analysis
Stanners (2012) [63]
Australia
8 GPs
Time in practice (range): 20–40 years.
Gender: 7 males; 1 female.
Patients with multimorbidity and depression in general practice
Patient management
Focus Semi-structured interviews Grounded theory
Constant comparative analysis
Stokes (2017) [75]
New Zealand
12 GPs
Not stated
Patients with multimorbidity in general practice
Patient management
Focus Semi-structured interviews Not stated
Thematic analysis
Tonkin-Crine (2015) [59]
England, UK
19 GPs
Mean age: 46 years (range: 31–60 years). Mean time in practice: 16 years (range: 3–32 years). Gender: 12 males; 7 females.
Patients with advanced chronic kidney disease in primary care
Patient management
Derived theme Semi-structured interviews Not stated
Thematic analysis
van de Pol (2015) [53]
Netherlands
20 GPs
Mean age: 48 years (range: 32–60 years).
Gender: 11 males; 9 females.
Older patients in residential aged care
Patient management
Derived theme Focus groups Not stated
Constant comparative analysis
Vermunt (2018) [54]
Netherlands
15 GPs
Mean age: 51 years. Mean time in practice: 16 years. Gender: 6 males; 9 females.
Older patients with multimorbidity in general practice
Patient management
Focus Semi-structured interviews Not stated
Thematic analysis