{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T21:04:15Z","timestamp":1784754255563,"version":"3.55.0"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":41,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100025520","name":"Medical Research Future Fund","doi-asserted-by":"publisher","award":["2032129"],"award-info":[{"award-number":["2032129"]}],"id":[{"id":"10.13039\/501100025520","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Royal Australian College of General Practitioners for the research"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 \u226570% of GPs rating an indicator \u22653 for mean relevance. The process ended when \u226580% of indicators reached this threshold, and no new items were proposed. Feedback refined wording and, where relevant, was reported verbatim.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/fampra\/cmag055","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T11:52:20Z","timestamp":1783684340000},"source":"Crossref","is-referenced-by-count":0,"title":["From guidelines to practice: general practitioners' consensus on indicators for managing selected multimorbidity in primary care in Western Australia"],"prefix":"10.1093","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9928-5891","authenticated-orcid":false,"given":"Sage M C","family":"Ishimwe","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences, Curtin School of Population Health, Curtin University , Bentley campus, Perth, Western Australia 6102 ,","place":["Australia"]},{"name":"Institute of Global Health Equity Research, University of Global Health Equity , Kigali 6955 ,","place":["Rwanda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy A","family":"Carey","sequence":"additional","affiliation":[{"name":"Centre Health Equity in Regional and Remote Communities, CQUniversity , Rockhampton, Queensland 4701 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacquita S","family":"Affandi","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Curtin School of Population Health, Curtin University , Bentley campus, Perth, Western Australia 6102 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ninh Thi","family":"Ha","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Curtin School of Population Health, Curtin University , Bentley campus, Perth, Western Australia 6102 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amna","family":"Mushtaq","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Curtin School of Population Health, Curtin University , Bentley campus, Perth, Western Australia 6102 ,","place":["Australia"]},{"name":"Royal Australian College of General Practitioners , Melbourne, Victoria 3002 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayyida","family":"Anees","sequence":"additional","affiliation":[{"name":"Royal Australian College of General Practitioners , Melbourne, Victoria 3002 ,","place":["Australia"]},{"name":"General Practice Research, Curtin Medical School, Curtin University , Bentley campus, Perth, Western Australia 6102 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M","family":"Reid","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Curtin School of Population Health, Curtin University , Bentley campus, Perth, Western Australia 6102 ,","place":["Australia"]},{"name":"School of Public Health and Preventive Medicine, Monash University , Melbourne, Victoria 3800 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Xu","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Curtin School of Population Health, Curtin University , Bentley campus, Perth, Western Australia 6102 ,","place":["Australia"]},{"name":"General Practice Research, Curtin Medical School, Curtin University , Bentley campus, Perth, Western Australia 6102 ,","place":["Australia"]},{"name":"Department of Medical Education and General Practice, The First Affiliated Hospital, Sun Yat-Sen University , Guangzhou 510060 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delia","family":"Hendrie","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Curtin School of Population Health, Curtin University , Bentley campus, Perth, Western Australia 6102 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"2026072216161258800_cmag055-B1","doi-asserted-by":"publisher","first-page":"101860","DOI":"10.1016\/j.eclinm.2023.101860","article-title":"Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis","volume":"57","author":"Chowdhury","year":"2023","journal-title":"EClinicalMedicine"},{"key":"2026072216161258800_cmag055-B2","author":"Australian Institute of Health and Welfare"},{"key":"2026072216161258800_cmag055-B3","author":"Australian Institute of Health and Welfare"},{"key":"2026072216161258800_cmag055-B4","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/j.jclinepi.2023.08.017","article-title":"The barriers and facilitators for the implementation of clinical practice guidelines in healthcare: an umbrella review of qualitative and quantitative literature","volume":"162","author":"Zhou","year":"2023","journal-title":"J Clin Epidemiol"},{"key":"2026072216161258800_cmag055-B5","first-page":"D6953","article-title":"Are guidelines still supportive in clinical practice?","volume":"166","author":"Burgers","year":"2022","journal-title":"Ned Tijdschr Geneeskd"},{"key":"2026072216161258800_cmag055-B6","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s12913-019-4807-5","article-title":"Combining patient, clinical and system perspectives in assessing performance in healthcare: an integrated measurement framework","volume":"20","author":"Levesque","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"2026072216161258800_cmag055-B7","first-page":"316","article-title":"Why compliance to national prescribing guidelines is important especially across sub-saharan Africa and suggestions for the future","volume":"4","author":"Campbell","year":"2021","journal-title":"J Biomed Pharm Res"},{"key":"2026072216161258800_cmag055-B8","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1097\/ACO.0000000000001344","article-title":"Implementation of guidelines in clinical practice; barriers and strategies","volume":"37","author":"Stefana","year":"2024","journal-title":"Curr Opin Anaesthesiol"},{"key":"2026072216161258800_cmag055-B9","doi-asserted-by":"publisher","first-page":"S35","DOI":"10.1016\/j.cjca.2024.05.010","article-title":"Care gaps and system issues with delivering cardiovascular risk reduction and lipid-lowering therapy in secondary preventio","volume":"40","author":"Marquis-Gravel","year":"2024","journal-title":"Can J Cardiol"},{"key":"2026072216161258800_cmag055-B10","doi-asserted-by":"publisher","first-page":"370","DOI":"10.5694\/mja14.00998","article-title":"Obesity management in general practice: does current practice match guideline recommendations?","volume":"202","author":"Turner","year":"2015","journal-title":"Med J Aust"},{"key":"2026072216161258800_cmag055-B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12875-020-01197-8","article-title":"General practitioner strategies for managing patients with multimorbidity: a systematic review and thematic synthesis of qualitative research","volume":"21","author":"Damarell","year":"2020","journal-title":"BMC Fam Pract"},{"key":"2026072216161258800_cmag055-B12","first-page":"272","volume-title":"Evidence Supporting the Best Clinical Management of Patients with Multimorbidity and Polypharmacy: A Systematic Guideline Review and Expert Consensus","author":"Muth","year":"2019"},{"key":"2026072216161258800_cmag055-B13","volume-title":"Improving GPS'Knowledge of the Benefits and Harms of Treatments to Support Decision Making in Multimorbidity: Qualitative Research and Co-Design of a Novel Electronic Information Resource","author":"Treadwell","year":"2023"},{"key":"2026072216161258800_cmag055-B14","volume-title":"Guideline-Concordant Care in Patients With Multiple Chronic Conditions: Pervasiveness And Precursors","author":"Cohen-Stavi","year":"2020"},{"key":"2026072216161258800_cmag055-B15","doi-asserted-by":"publisher","first-page":"584","DOI":"10.11622\/smedj.2019109","article-title":"Patient-centred and not disease-focused: a review of guidelines and multimorbidity","volume":"61","author":"Ong","year":"2020","journal-title":"Singapore Med J"},{"key":"2026072216161258800_cmag055-B16","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1186\/s12875-022-01781-0","article-title":"Understanding the processes behind the decisions\u2013GPs and complex multimorbidity decision making","volume":"23","author":"Hughes","year":"2022","journal-title":"BMC Prim Care"},{"key":"2026072216161258800_cmag055-B17","volume-title":"A Process Evaluation of a Patient-centred Intervention in General Practice to Improve the Management of Multimorbidity","author":"Mann","year":"2019"},{"key":"2026072216161258800_cmag055-B18","volume-title":"The Organisation of Care for People with Multimorbidity in General Practice: An Exploratory Case Study of Service Delivery","author":"Lewis","year":"2015"},{"key":"2026072216161258800_cmag055-B19","doi-asserted-by":"publisher","DOI":"10.24875\/GMM.M22000723","article-title":"Professional medical liability, clinical practice guidelines and Lex Artis. The importance of following clinical practice guidelines recommendations","volume":"158","author":"Ga-V","year":"2023","journal-title":"Gac Med Mex"},{"key":"2026072216161258800_cmag055-B20","volume-title":"RAND Methodological Guidance for Conducting and Critically Appraising Delphi Panels","author":"Khodyakov","year":"2023"},{"key":"2026072216161258800_cmag055-B21","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1097\/ACM.0000000000002887","article-title":"The Delphi method","volume":"95","author":"Humphrey-Murto","year":"2020","journal-title":"Acad Med"},{"key":"2026072216161258800_cmag055-B22","doi-asserted-by":"publisher","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform"},{"key":"2026072216161258800_cmag055-B23","doi-asserted-by":"publisher","first-page":"116","DOI":"10.5662\/wjm.v11.i4.116","article-title":"Delphi methodology in healthcare research: how to decide its appropriateness","volume":"11","author":"Nasa","year":"2021","journal-title":"World J Methodol"},{"key":"2026072216161258800_cmag055-B24","doi-asserted-by":"publisher","first-page":"e32829","DOI":"10.1097\/MD.0000000000032829","article-title":"Use of Delphi in health sciences research: a narrative review","volume":"102","author":"Shang","year":"2023","journal-title":"Medicine (Baltimore)"},{"key":"2026072216161258800_cmag055-B25","author":"The Royal Australian College of General Practitioners (RACGP)"},{"key":"2026072216161258800_cmag055-B26","volume-title":"American Diabetes Association Releases 2023 Standards of Care in Diabetes to Guide Prevention, Diagnosis, and Treatment for People Living with Diabetes","author":"Association AD","year":"2022"},{"key":"2026072216161258800_cmag055-B27","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1016\/j.jacc.2022.08.754","article-title":"2022 ACC expert consensus decision pathway for integrating atherosclerotic cardiovascular disease and multimorbidity treatment: a framework for pragmatic, patient-centered care: a report of the American College of Cardiology solution set oversight committee","volume":"81","author":"Committee","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"2026072216161258800_cmag055-B28","doi-asserted-by":"publisher","first-page":"7591","DOI":"10.2147\/IJGM.S333501","article-title":"Barriers to clinical practice guideline implementation among physicians: a physician survey","volume":"14","author":"Qumseya","year":"2021","journal-title":"Int J Gen Med"},{"issue":"6","key":"2026072216161258800_cmag055-B29","doi-asserted-by":"publisher","first-page":"923","DOI":"10.4172\/pharmaceutical-sciences.1000309","article-title":"A study of barriers and facilitators of clinical practice guidelines implementation among physicians","volume":"79","author":"Alnaim","year":"2017","journal-title":"Indian J Pharm Sci"},{"key":"2026072216161258800_cmag055-B30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12961-020-00588-8","article-title":"Individual, health system, and contextual barriers and facilitators for the implementation of clinical practice guidelines: a systematic metareview","volume":"18","author":"Correa","year":"2020","journal-title":"Health Res Policy Syst"},{"key":"2026072216161258800_cmag055-B31","doi-asserted-by":"publisher","first-page":"1643","DOI":"10.1111\/jocn.14766","article-title":"Preventing surgical site infections: facilitators and barriers to nurses' adherence to clinical practice guidelines\u2014A qualitative study","volume":"28","author":"Lin","year":"2019","journal-title":"J Clin Nurs"},{"key":"2026072216161258800_cmag055-B32","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1186\/s12913-024-11561-4","article-title":"Barriers and facilitators of the nurse providing evidence-based preoperative visit-care for transcatheter aortic valve replacement: a mixed-methods study based on an evidence application setting","volume":"24","author":"Wei","year":"2024","journal-title":"BMC Health Serv Res"},{"key":"2026072216161258800_cmag055-B33","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s12916-024-03263-9","article-title":"Co-designing care for multimorbidity: a systematic review","volume":"22","author":"Sumner","year":"2024","journal-title":"BMC Med"},{"key":"2026072216161258800_cmag055-B34","doi-asserted-by":"publisher","first-page":"824","DOI":"10.22034\/meb.2024.433999.1088","article-title":"A literature review of group decision-making: the case study of Delphi method","volume":"4","author":"Barkhordari Ahmadi","year":"2023","journal-title":"Med Edu Bull"},{"key":"2026072216161258800_cmag055-B35","doi-asserted-by":"publisher","first-page":"3278","DOI":"10.1016\/j.arthro.2018.10.004","article-title":"Research pearls: expert consensus based evidence using the Delphi method","volume":"34","author":"Hohmann","year":"2018","journal-title":"Arthroscopy"},{"key":"2026072216161258800_cmag055-B36","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/s13643-024-02738-3","article-title":"How Delphi studies in the health sciences find consensus: a scoping review","volume":"14","author":"Schifano","year":"2025","journal-title":"Syst Rev"}],"container-title":["Family Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/fampra\/article-pdf\/43\/4\/cmag055\/69807965\/cmag055.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/fampra\/article-pdf\/43\/4\/cmag055\/69807965\/cmag055.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T20:16:20Z","timestamp":1784751380000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/fampra\/article\/doi\/10.1093\/fampra\/cmag055\/8740097"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":36,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,6,11]]}},"URL":"https:\/\/doi.org\/10.1093\/fampra\/cmag055","relation":{},"ISSN":["0263-2136","1460-2229"],"issn-type":[{"value":"0263-2136","type":"print"},{"value":"1460-2229","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,6,11]]},"article-number":"cmag055"}}