A study of how primary care clinicians approach treatment decision-making for older patients with multiple diseases found that clinicians struggle with applying disease-specific guidelines and face a lack of resources, and a variety of barriers to determine the ideal approach to care.
The authors conducted focus groups with 40 primary care physicians, nurse practitioners and nurse assistants from academic, community and Veterans Affairs-affiliated practices.
- Participants worried about patients’ ability to adhere to complicated medical regimes and therefore often altered their recommendations.
- Participants varied in their beliefs about guideline-directed care, as well as their approaches to managing its benefits and harms.
- Participants varied in how they involved their patients in decision-making and reported conflict between their own and patients’ treatment goals.
- Barriers to making good treatment decisions included lack of outcome data, the involvement of specialists, unrealistic patient and family expectations, and lack of time and reimbursement.
Clinicians need support for adapting treatments based on the patient’s ability to adhere, ways to harmonize their own and patients’ goals, support from specialist physicians, more outcome data and a different reimbursement system to better care for older patients with multiple conditions. Because of its qualitative measures, this study does not indicate the prevalence of the views reported.