Multiple poor outcomes were connected with complex multimorbidity, defined as 3 or more chronic illnesses affecting 3 or more different body systems or by the patient’s general practitioner (GP). It was currently under-researched how GPs make decisions for this complicated population of patients, with possible implications for health systems and service delivery. Internal factors of individuals (decisions tailored to patients; Primary Care Physician (PCP) consultation style; care planning towards an agreed goal of care), external factors within the environment or context of encounter (patient access to healthcare; organizational structures acting as barriers), and relationship-based factors (collaborative care planning; decisions within a dynamic patient clinic) were identified through a qualitative approach by Schuttner and colleagues. The ongoing separation of physical and mental health, which persisted even within integrated care systems, the fact that GPs continued to prioritize continuity of care, and the fact that organizational barriers were reported as factors in clinician decision-making for patients were significant findings with broader implications for the literature. In a broader sense, the investigation contributed to the extension of previously reported findings regarding care coordination and the limitations of current guidelines for patients with complicated multimorbidity. Due to an aging population, the rising prevalence of multimorbidity and polypharmacy, and the shift of clinical activities from secondary to primary care, the workload in general practice was increasing. Understanding how GPs make decisions and how this might be supported was critical for the long-term viability of general practice, given that the future of general practice involves an increase in complexity in the clinic room.

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