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BMC Family Practice

, 13:118

Clinical presentation, diagnosis, and management


BackgroundThis study investigates the efficacy of a complex multifaceted intervention aiming at increasing the quality of care of GPs for patients with multimorbidity. In its core, the intervention aims at enhancing the doctor-patient-dialogue and identifying the patient’s agenda and needs. Also, a medication check is embedded. Our primary hypothesis is that a more patient-centred communication will reduce the number of active pharmaceuticals taken without impairing the patients’ quality of life. Secondary hypotheses include a better knowledge of GPs about their patients’ medication, a higher patient satisfaction and a more effective and-or efficient health care utilization.

Methods-designMulti-center, parallel group, cluster randomized controlled clinical trial in GP surgeries. Inclusion criteria: Patients aged 65–84 years with at least 3 chronic conditions. Intervention: GPs allocated to this group will receive a multifaceted educational intervention on performing a narrative doctor-patient dialogue reflecting treatment targets and priorities of the patient and on performing a narrative patient-centred medication review. During the one year intervention GPs will have a total of three conversations à 30 minutes with the enrolled patients. Control: Care as usual. Follow-up per patient: 14 months after baseline interview. Primary efficacy endpoints: Differences in medication intake and health related quality of life between baseline and follow-up in the intervention compared to the control group. Randomization: Computer-generated by an independent institute. It will be performed successively when patient recruitment in the respective surgery is finished. Blinding: Participants GPs and patients will not be blinded to their assignment but will be unaware of the study hypotheses or outcome measures.

DiscussionThere is growing evidence that the phenomenon of polypharmacy and low quality of drug use is substantially due to mis-communication or non-communication in the doctor patient interaction. We assume that the number of pharmaceutical agents taken can be reduced by a communicational intervention and that this will not impair the patients’ health-related quality of life. Improving communication is a core issue of future interventions, especially for patients with multimorbidity.

Trial registrationCurrent Controlled Trials ISRCTN46272088.

KeywordsMultimorbidity Primary care Randomised controlled trial Polypharmacy Narrative based medicine  Download fulltext PDF

Autor: Attila Altiner - Ingmar Schäfer - Christine Mellert - Christin Löffler - Achim Mortsiefer - Annette Ernst - Carl-Otto Sto


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