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Open Access Research article

What is important, what needs treating? How GPs perceive older patients’ multiple health problems: a mixed method research study

Ulrike Junius-Walker1*, Jennifer Wrede12, Tanja Schleef1, Heike Diederichs-Egidi1, Birgitt Wiese3, Eva Hummers-Pradier1 and Marie-Luise Dierks4

Author Affiliations

1 Institute of General Practice, Hannover Medical School, Hannover, Germany

2 Institute of General Practice, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany

3 Institute of Biometrics, Hannover Medical School, Hannover, Germany

4 Institute of Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover, Germany

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BMC Research Notes 2012, 5:443  doi:10.1186/1756-0500-5-443

Published: 16 August 2012



GPs increasingly deal with multiple health problems of their older patients. They have to apply a hierarchical management approach that considers priorities to balance competing needs for treatment. Yet, the practice of setting individual priorities in older patients is largely unexplored. This paper analyses the GPs’ perceptions on important and unimportant health problems and how these affect their treatment.


GPs appraised the importance of health problems for a purposive sample of their older patients in semi-structured interviews. Prior to the interviews, the GPs had received a list of their patients’ health problems resulting from a geriatric assessment and were asked to rate the importance of each identified problem. In the interviews the GPs subsequently explained why they considered certain health problems important or not and how this affected treatment. Data was analysed using qualitative content analysis and quantitative methods.


The problems GPs perceive as important are those that are medical and require active treatment or monitoring, or that induce empathy or awareness but cannot be assisted further. Unimportant problems are those that are well managed problems and need no further attention as well as age-related conditions or functional disabilities that provoke fatalism, or those considered outside the GPs’ responsibility. Statements of professional actions are closely linked to explanations of important problems and relate to physical problems rather than functional and social patient issues.


GPs tend to prioritise treatable clinical conditions. Treatment approaches are, however, vague or missing for complex chronic illnesses and disabilities. Here, patient empowerment strategies are of value and need to be developed and implemented. The professional concepts of ageing and disability should not impede but rather foster treatment and care. To this end, GPs need to be able to delegate care to a functioning primary care team.

Trial Registration

German Trial Register (DRKS): 00000792

Health priorities; Multimorbidity; Old age; Family practice; Patient-centred care