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GPs are the ‘specialists in multimorbidity’, Forum hears

Speaking on the theme of ‘Realising the Potential for General Practice Delivery of Patient-Centred Care’, Dr Sheehan said this was the best approach for delivering quality care to patients with chronic disease rather than “fragmentation of care” by multiple hospital departments.

Most patients with chronic disease had more than one such condition, she said.

She outlined the example of an elderly patient with diabetes, asthma, heart failure, rheumatoid arthritis, renal impairment and recurring DVTs, as well as atrial fibrillation. This patient attended five or six different outpatient clinics where the specialists or their junior staff made changes to the medication list every time he attended.

Dr Sheehan added: “A statin may be indicated because of the diabetic guidelines but he and I know that while he can tolerate 10mg of atorvastatin… increasing the dose while lowering his cholesterol also gives him a myalgia, which in conjunction with his rheumatoid arthritis, decreases his ability to function day-to-day. So, we make a shared decision to accept that any dose of statin will lower his cardiovascular risk but that for him, treating to target reduces his quality of life and he and I accept this risk.”

She said GPs are the specialists in multimorbidity. “We deal with the challenges of drug-disease interactions and drug-drug interactions for these patients trying to optimise their disease control and at the same time, maintain or improve their quality of life.”

Amid the “furore” over the under-sixes contract, the funding of a cycle of care for childhood asthma and type 2 diabetes had received less attention.

“This contact is a first step in acknowledging the expertise of general practice in delivering high-quality care for chronic disease. While funding has been secured for a cycle of care rather than a full structured care programme, it is a step in the right direction.”

Irish general practice had already demonstrated its ability to deliver diabetes chronic disease management in a structured care programme. However, a recent study also showed that unresourced general practice in Ireland provided suboptimal diabetes care, she said.

Other chronic diseases targeted by the clinical care programmes like heart failure, COPD, ischaemic heart disease and atrial fibrillation, for example, could all be managed in general practice in their uncomplicated and stable states and should follow into primary care. However, this required the resources “to enable us to deliver a world-class comprehensive care package to our patients”.

The Forum also heard from Dr Susan Smith on the challenges of multimorbidity in general practice, Dr Velma Harkins on structured diabetes care and Dr Brian Osborne on lack of GP access to diagnostics and how this can affect patient outcomes.

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