Primary Care Clinicians' Experiences With Treatment Decision Making for Older Persons With Multiple Conditions

“Second, the presence of these conditions may also increase the likelihood that the individual will experience adverse effects with any given intervention.(3,4) Finally, the polypharmacy that generally accompanies multimorbidity confers an increased risk of adverse drug events, independent of the chronic conditions.”

“Second, the presence of these conditions may also increase the likelihood that the individual will experience adverse effects with any given intervention.(3,4) Finally, the polypharmacy that generally accompanies multimorbidity confers an increased risk of adverse drug events, independent of the chronic conditions.”

“In addition to the studies demonstrating the risk of adverse outcomes associated with guideline-directed care, evidence also suggests that the patients who are at the highest risk for these adverse outcomes may also be the ones most likely to derive benefit from the intervention.(17) Clinicians’ descriptions of how th…”

“Finally, the polypharmacy that generally accompanies multimorbidity confers an increased risk of adverse drug events, independent of the chronic conditions.(5,6) On the other hand, editorials and clinical studies remind readers that the clinical trials”

“Moreover, other clinicians noted that the reduction in risk for a disease-specific outcome might not be what was most important to the patient, an observation supported by studies indicating that the adverse effects of medications may be as, if not more, important to patients than their primary effects.(20,21) Disagre…”

“Moreover, other clinicians noted that the reduction in risk for a disease-specific outcome might not be what was most important to the patient, an observation supported by studies indicating that the adverse effects of medications may be as, if not more, important to patients than their primary effects.(20,21) Disagre…”

“Many patients are willing to take medication only if the benefits provided by the medication is far greater than the adverse effects of the medication [16].”

“Productivity requirements for physicians typically dictate a quota of patients be seen per day, usually in 15-minute time slots designed for maximal efficiency rather than the highest level of patient care.(12-15,17,20) For older adults with multiple medical issues as well as psychosocial needs, short appointments are…”

“tension between delivering care to meet quality targets and fulfilling the patient's expectations;(68;69) 3.”

“Care-related goals for frail older adults vary and often include well-being alongside health and functioning [36], necessitating the integration of priority setting with complex care interventions.”

“Although healthcare professionals (HCPs) express the need to address multimorbidity more, they report a lack of support due to fragmented (i.e., discipline-specific) clinical guidelines [11,12].”

“This siloed approach leads to predictable and costly failures: adverse drug events, preventable hospitalizations, iatrogenic complications, and poor quality of life (Fried et al., 2011).”

“Frailty is a public health concern as it has been shown to lead to mortality, functional decline, falls, disability, decreased quality of life, and increased health care utilization (Ament et al., 2014; Gobbens et al., 2010; Census, 2011; CIHI, 2011; Fried et al., 2011).”

“Nevertheless, it may be difficult for physicians to administer all of the guideline-recommended preventive care screening due to time constraints, concern about harms associated with care and patient preferences (Fried et al., 2011).”

“Réalisées chez des médecins généralistes, des infirmières et des médecins prenant en charge des vétérans, elles ont mis en évidence une variabilité de l’opinion des cliniciens quant à l’adhésion de leurs patients âgés aux protocoles trop complexes issus de référentiels [18].”