From guidelines to practice: general practitioners' consensus on indicators for managing selected multimorbidity in...

Multimorbidity is rising in primary care, yet adherence to guidelines is hindered by fragmented, disease-specific recommendations. This study sought to establish consensus among general practitioners (GPs) on indicators of adherence to Australian guidelines in managing five common chronic conditions [type 2 diabetes mellitus (T2DM), obesity, hypertension, cardiovascular disease, and chronic kidney disease (CKD)], aiming to develop a unified tool for holistic care.

A two-round reactive Delphi survey was conducted with 21 GPs in Western Australia, following RAND methodology. Indicators were drawn from the Royal Australian College of General Practitioners' guidelines and covered biophysical markers, lifestyle risks, and pharmacological management. Participants rated indicators for relevance and clarity on a 4-point Likert scale without a neutral option. Consensus was defined as ≥70% of GPs rating an indicator ≥3 for mean relevance. The process ended when ≥80% of indicators reached this threshold, and no new items were proposed. Feedback refined wording and, where relevant, was reported verbatim.

In Round 1, 57 indicators achieved consensus on relevance, with four additional items suggested. By Round 2, consensus was reached on 61 indicators. Most were rated clear, except two addressing pharmacological management of CKD with T2DM, which require clearer guidance. Feedback emphasized the need for refined lipid management guidelines, prioritizing obesity management for prevention, and challenges in lifestyle counselling.

This study represents the first integration of disease-specific indicators into a GP-informed tool for multimorbidity management. Strong consensus highlights its practicality, warranting piloting to evaluate effects on guideline adherence and patient outcomes.