Dilemmas and Coping Strategies in Medication Decision-making for Multimorbidity in the Community

Multimorbidity refers to an individual suffering from two or more chronic diseases simultaneously. Patients with multimorbidity refers often require the concurrent use of multiple medications, posing a challenge to community general practitioners in making scientific medication decisions. This paper analyzes the reasons and influencing factors that lead to the dilemmas in medication decision-making for patients with multimorbidity in the community. It also proposes a dynamic and comprehensive decision-making framework known as the Medication Decision-making for Multimorbidity Framework (MDMF). The framework consists of five stages in the process of community general practitioners treating patients with multimorbidity, which include "Health problems review""Comprehensive medication assessment""Shared decision-making""Medication therapy recording", and "Follow-up arrangement". The MDMF facilitates the development of individualized medication therapy for patients with multimorbidity by community general practitioners, but it also places certain demands on their capabilities. Therefore, it is recommended to provide training for community general practitioners centered on the MDMF, offer decision-making support, and implement reasonable incentives and supervision measures. This is expected to promote primary care institutions to provide patient-centered medication therapy, enhance its safety and efficacy, and alleviate the treatment burden on patients.