Background Factors that Hospital-Based Geriatricians and General Practitioners Associate with Difficulty in Treating Older People with Multimorbidity: A Cross-Sectional Survey.

Abstract

In recent years, hospital-based geriatricians and general practitioners in Japan who frequently manage older people with multimorbidity in an acute setting have often found treating these patients difficult. In this study, we surveyed geriatricians and general practitioners who treat older people with multimorbidity in hospitals to identify patient characteristics that make treatment provision difficult in these patients. In June 2022, we mailed an anonymous questionnaire to 3,300 family medicine specialists, primary care-certified physicians, and geriatric specialists in Japan. We used a four-point Likert-type scale to score items specific to diseases, patient backgrounds, clinical factors, and important clinical strategies that make treatment provision difficult. We used logistic regression analysis to identify factors that hospital-based geriatricians and general practitioners associate with difficulty in treating older adults with multimorbidity. In total, 490 cases were included in the analysis. The factors that were associated with difficulty in treating older people with multimorbidity were experience as a physician (adjusted odds ratio [AOR]: 0.935; 95% confidence interval [95% CI]: 0.905-0.965), the overall scores for difficult disease (AOR: 1.028; 95% CI: 1.004-1.053) and difficult background (AOR: 1.065; 95% CI: 1.005-1.129), and the lack of emphasis on general practice guidelines (AOR: 2.91; 95% CI: 1.305-6.491). To facilitate the treatment of older people with multimorbidity, it is desirable to enhance education and training and strengthen support systems within Japan's healthcare system based on the characteristics of hospital physicians who find treating these patients difficult.