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Kimura T, Nomura K, Hashimoto M, Shinmura K. Relationship between the characteristics of Japanese physicians involved in medical care for older adults and their approaches to treating older patients with multimorbidity. PLoS One 2024; 19:e0302532. [PMID: 38865339 PMCID: PMC11168666 DOI: 10.1371/journal.pone.0302532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/09/2024] [Indexed: 06/14/2024] Open
Abstract
One countermeasure against the increasing prevalence of multimorbidity is the need to provide clinical education and training that considers the characteristics of physicians. We conducted a questionnaire survey to determine the relationship between physicians' characteristics and their approach to treating older patients with multimorbidity. A total of 3300 geriatric specialists and primary care specialists in Japan were enrolled. A 4-point Likert scale was used to score the following items: difficult diseases (43 items), difficult patient backgrounds (14 items), important clinical factors (32 items), and important clinical management (32 items). Exploratory factor analysis was performed to examine the constructs in each of the scales Diseases, Backgrounds, Clinical Factors, and Clinical Management, and group comparisons by physician characteristics were conducted. A total of 778 respondents were included in the analysis. Six factors for Diseases, two factors for Patient Background, four factors for Clinical Factors, and two factors for Clinical Management were explored as patterns. Group comparison between mean scores for each factor and the characteristics of responding physicians showed statistically significant differences in at least one factor for all patterns in terms of years of experience as a physician (26 years or less, 27 years or more), the clinical setting (providing or not providing home medical care), and sex (male or female). Our results suggest a need for clinical education and training that takes into account not only physicians' experience and clinical setting, but also their sex.
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Affiliation(s)
- Takuma Kimura
- Department of R&D Innovation for Home Care Medicine, Department of General Medicine, Tokyo Medical and Dental University School of Medicine, Tokyo, Japan
| | - Kyoko Nomura
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Akita, Japan
| | - Masayoshi Hashimoto
- Department of R&D Innovation for Home Care Medicine, Department of General Medicine, Tokyo Medical and Dental University School of Medicine, Tokyo, Japan
| | - Ken Shinmura
- Department of General Internal Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Hyogo, Japan
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McDonald C, Cooper R, Sayer AA, Witham MD. Improving care for patients with multiple long-term conditions admitted to hospital: challenges and potential solutions. Br J Hosp Med (Lond) 2024; 85:1-8. [PMID: 38557098 DOI: 10.12968/hmed.2023.0428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Increasing numbers of people live with multiple long-term conditions. These people are more likely to be admitted to hospital, experience adverse outcomes and receive poorer quality care than those with a single condition. Hospitals remain organised around a model of single-organ, disease-specific care which is not equipped to meet the needs of people living with multiple long-term conditions. This article considers these challenges and explores potential solutions. These include different service models to provide holistic, multidisciplinary inpatient and outpatient care across specialty boundaries, training a workforce to deliver high-quality hospital care for people living with multiple long-term conditions, and developing technological, financial and cultural enablers of change. Considerably more research is required to fully appreciate the shared risk factors, underlying mechanisms, patterns and consequences of multiple long-term conditions. This is essential to design and deliver better structures and processes of hospital care for people living with multiple long-term conditions.
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Affiliation(s)
- Claire McDonald
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Rachel Cooper
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Avan A Sayer
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Miles D Witham
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
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Woodall AA, Abuzour AS, Wilson SA, Mair FS, Buchan I, Sheard SB, Atkinson P, Joyce DW, Symon P, Walker LE. Management of antipsychotics in primary care: Insights from healthcare professionals and policy makers in the United Kingdom. PLoS One 2024; 19:e0294974. [PMID: 38427674 PMCID: PMC10906843 DOI: 10.1371/journal.pone.0294974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/26/2024] [Indexed: 03/03/2024] Open
Abstract
INTRODUCTION Antipsychotic medication is increasingly prescribed to patients with serious mental illness. Patients with serious mental illness often have cardiovascular and metabolic comorbidities, and antipsychotics independently increase the risk of cardiometabolic disease. Despite this, many patients prescribed antipsychotics are discharged to primary care without planned psychiatric review. We explore perceptions of healthcare professionals and managers/directors of policy regarding reasons for increasing prevalence and management of antipsychotics in primary care. METHODS Qualitative study using semi-structured interviews with 11 general practitioners (GPs), 8 psychiatrists, and 11 managers/directors of policy in the United Kingdom. Data was analysed using thematic analysis. RESULTS Respondents reported competency gaps that impaired ability to manage patients prescribed antipsychotic medications, arising from inadequate postgraduate training and professional development. GPs lacked confidence to manage antipsychotic medications alone; psychiatrists lacked skills to address cardiometabolic risks and did not perceive this as their role. Communication barriers, lack of integrated care records, limited psychology provision, lowered expectation towards patients with serious mental illness by professionals, and pressure to discharge from hospital resulted in patients in primary care becoming 'trapped' on antipsychotics, inhibiting opportunities to deprescribe. Organisational and contractual barriers between services exacerbate this risk, with socioeconomic deprivation and lack of access to non-pharmacological interventions driving overprescribing. Professionals voiced fears of censure if a catastrophic event occurred after stopping an antipsychotic. Facilitators to overcome these barriers were suggested. CONCLUSIONS People prescribed antipsychotics experience a fragmented health system and suboptimal care. Several interventions could be taken to improve care for this population, but inadequate availability of non-pharmacological interventions and socioeconomic factors increasing mental distress need policy change to improve outcomes. The role of professionals' fear of medicolegal or regulatory censure inhibiting antipsychotic deprescribing was a new finding in this study.
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Affiliation(s)
- Alan A. Woodall
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
- Powys Teaching Health Board, Bronllys Hospital, Powys, United Kingdom
| | - Aseel S. Abuzour
- Unit for Ageing and Stroke Research, School of Medicine, University of Leeds, West Yorkshire, United Kingdom
| | - Samantha A. Wilson
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Frances S. Mair
- General Practice & Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Iain Buchan
- NIHR Mental Health Research for Innovation Centre, University of Liverpool, Liverpool, United Kingdom
| | - Sally B. Sheard
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Paul Atkinson
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Dan W. Joyce
- NIHR Mental Health Research for Innovation Centre, University of Liverpool, Liverpool, United Kingdom
| | - Pyers Symon
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Lauren E. Walker
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
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Ohta R, Sano C. Challenges Faced by Medical Trainees in Outpatient Management Education in Acute Care Hospitals: A Thematic Analysis. Cureus 2024; 16:e53800. [PMID: 38465019 PMCID: PMC10924075 DOI: 10.7759/cureus.53800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction As societies age globally, medical education faces the challenge of adapting to the evolving healthcare needs of an aging population. This study focuses on the education of medical residents in outpatient departments in Japan, a country with a rapidly aging society. The research aims to understand the perceptions and challenges medical residents face in outpatient management, highlighting the areas for potential improvement in their educational framework. Method This study involved first-year medical residents at Fuchu Hospital in Osaka, using thematic analysis based on relativist ontology and constructivist epistemology. Data were collected through field notes and reflection sheets, documenting residents' interactions with patients, learning difficulties, and personal reflections. Semi-structured interviews were conducted to gain profound insights into their experiences and views on outpatient management education. Results Three main themes emerged from the analysis: The experience of continuity of care, the view regarding comprehensive management, and the gap between purposes and learning content. Residents expressed concerns about the limited opportunities for continuous patient care, leading to challenges in managing chronic diseases effectively. The focus on organ-specific specialties in acute care hospitals resulted in a fragmented understanding of patient care, particularly for elderly patients with multimorbidity. Furthermore, the study identified a discrepancy between the educational goals of outpatient management and the actual content delivered, highlighting the need for more observational experiences and practical guidance in outpatient settings. Conclusion The findings suggest a pressing need for a more structured, comprehensive, and personalized approach to outpatient management education for medical residents. As aging populations continue to grow, it is vital to equip medical professionals with the skills and knowledge to manage a wide range of patient conditions effectively. Improving the educational framework in outpatient departments can enhance patient care quality and prepare medical residents to meet the challenges of an aging society. This study contributes valuable insights into improving medical education in outpatient settings, particularly in aging societies like Japan.
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Affiliation(s)
| | - Chiaki Sano
- Community Medicine Management, Faculty of Medicine, Shimane University, Izumo, JPN
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Brown S, Manoharan D, Burford B, Rothwell C, Vance G. A qualitative study to explore multiple long-term conditions in the undergraduate medical school curriculum. Future Healthc J 2023; 10:33. [PMID: 38406743 PMCID: PMC10884647 DOI: 10.7861/fhj.10-3-s33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
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Penner K, Wicklum S, Johnston A, Kelly MA. Family medicine teaching strategy for managing patients with comorbidity: Collect, cluster, and coordinate. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:507-510. [PMID: 37451988 PMCID: PMC10348799 DOI: 10.46747/cfp.6907507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Kristy Penner
- Assistant Clinical Professor in the Department of Family Medicine in the Faculty of Medicine and Dentistry at the University of Alberta in Edmonton
| | - Sonja Wicklum
- Clerkship Director in the Department of Family Medicine in the Cumming School of Medicine at the University of Calgary in Alberta
| | - Aaron Johnston
- Associate Dean, Distributed Learning and Rural Initiatives, in the Cumming School of Medicine at the University of Calgary
| | - Martina Ann Kelly
- Undergraduate Director of Family Medicine in the Cumming School of Medicine at the University of Calgary.
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Penner K, Wicklum S, Johnston A, Kelly MA. Stratégie d’enseignement pour la prise en charge des patients présentant des comorbidités en médecine de famille. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:e154-e158. [PMID: 37451995 PMCID: PMC10348783 DOI: 10.46747/cfp.6907e154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Kristy Penner
- Professeure adjointe clinique au département de médecine familiale de la faculté de médecine et de dentisterie de l'Université d'Alberta à Edmonton
| | - Sonja Wicklum
- Directrice de stage au département de médecine familiale de l'École de médecine Cumming de l'Université de Calgary en Alberta
| | - Aaron Johnston
- Doyen associé, responsable de l'apprentissage distribué et des initiatives rurales, à l'École de médecine Cumming de l'Université de Calgary
| | - Martina Ann Kelly
- Directrice du premier cycle de médecine familiale à l'École de médecine Cumming de l'Université de Calgary.
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Bell C, Vedsted P, Kraus DGA, Fredberg U, Jeffery L, Dahlgaard MB, Aarhus R, Appel CW. Clinic for Multimorbidity: An Innovative Approach to Integrate General Practice and Specialized Health Care Services. Int J Integr Care 2023; 23:25. [PMID: 37333774 PMCID: PMC10275160 DOI: 10.5334/ijic.7015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 06/01/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Caring for patients with multimorbidity in general practice is increasing in amount and complexity. To integrate care for patients with multimorbidity and to support general practitioners (GPs), the Clinic for Multimorbidity (CM) was established in 2012 at Silkeborg Regional Hospital, Denmark. This case study aims to describe the CM and the patients seen in it. Results CM is an outpatient clinic that offers a comprehensive one-day assessment of the patient's complete health status and medication. GPs can refer patients with complex multimorbidity (≥2 chronic conditions). It involves collaboration across medical specialties and healthcare professions. The assessment is completed with a multidisciplinary conference and recommendation.In all, 141 patients were referred to the CM between May 2012 and November 2017. The median age was 70 years, 80% had more than five diagnoses, and in median patients had a usage of 11 drugs (IQI, 7-15). Physical and mental health was reported low (SF-12 score: 26 and 42). In median four specialties were involved and 4 examinations (IQI, 3-5) conducted. Conclusion The CM offers innovative care by bridging and exceeding conventional boundaries of disciplines, professions, organizations, and primary and specialized care. The patients represented a very complex group, requiring many examinations and involvement of several specialists.
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Affiliation(s)
- Cathrine Bell
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Peter Vedsted
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
- Research Unit for General Practice, Faculty of Health, Aarhus University, Denmark
| | - Dorte Gunver Adsersen Kraus
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Ulrich Fredberg
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Linda Jeffery
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
- Hospital Pharmacy, Central Jutland Region, Denmark
| | - Marianne Bjørn Dahlgaard
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Rikke Aarhus
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Charlotte Weiling Appel
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
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Interventions and management on multimorbidity: An overview of systematic reviews. Ageing Res Rev 2023; 87:101901. [PMID: 36905961 DOI: 10.1016/j.arr.2023.101901] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/08/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Multimorbidity poses an immense burden on the healthcare systems globally, whereas the management strategies and guidelines for multimorbidity are poorly established. We aim to synthesize current evidence on interventions and management of multimorbidity. METHODS We searched four electronic databases (PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews). Systematic reviews (SRs) on interventions or management of multimorbidity were included and evaluated. The methodological quality of each SR was assessed by the AMSTAR-2 tool, and the quality of evidence on the effectiveness of interventions was assessed by the grading of recommendations assessment, development and evaluation (GRADE) system. RESULTS A total of 30 SRs (464 unique underlying studies) were included, including 20 SRs of interventions and 10 SRs summarizing evidence on management of multimorbidity. Four categories of interventions were identified: patient-level interventions, provider-level interventions, organization-level interventions, and combined interventions (combining the aforementioned two or three- level components). The outcomes were categorized into six types: physical conditions/outcomes, mental conditions/outcomes, psychosocial outcomes/general health, healthcare utilization and costs, patients' behaviors, and care process outcomes. Combined interventions (with patient-level and provider-level components) were more effective in promoting physical conditions/outcomes, while patient-level interventions were more effective in promoting mental conditions/outcomes and psychosocial outcomes/general health. As for healthcare utilization and care process outcomes, organization-level and combined interventions (with organization-level components) were more effective. The challenges in the management of multimorbidity at the patient, provider and organizational levels were also summarized. CONCLUSION Combined interventions for multimorbidity at different levels would be favored to promote different types of health outcomes. Challenges exist in the management at the patient, provider, and organization levels. Therefore, a holistic and integrated approach of patient-, provider- and organization- level interventions is required to address the challenges and optimize care of patients with multimorbidity.
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Brown JB, Reichert SM, Boeckxstaens P, Stewart M, Fortin M. Responding to vulnerable patients with multimorbidity: an interprofessional team approach. BMC PRIMARY CARE 2022; 23:62. [PMID: 35354407 PMCID: PMC8969317 DOI: 10.1186/s12875-022-01670-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022]
Abstract
Background People with multimorbidity, who may be more vulnerable to certain social determinants of health, often require care by an interprofessional primary healthcare (PHC) team that can tailor their approach to address the multiple and complex needs of this population. This paper describes how the needs of vulnerable patients experiencing multimorbidity are identified and provided care by innovative interprofessional PHC teams during an innovative one-hour consultation, outside of usual care. Methods This was a descriptive qualitative study. Forty-eight interviews were conducted with 20 allied healthcare professionals: (e.g., social work, pharmacy); 19 physicians (e.g., psychiatry, internal medicine, family medicine); and 9 decision makers. The thematic analysis was iterative using an individual and team approach to identify the main themes and exemplar quotations for illustration. Results Participants described patients with multimorbidity who were vulnerable as those experiencing major challenges accessing and navigating the healthcare system. Mental health issues were a major contributor to being vulnerable and often linked to common social determinants of health. Cultural factors were identified as potentially causing patients to be vulnerable. Participants articulated how the collaborative nature of the team generated new ideas and facilitated creative recommendations designed to meet the specific needs of each patient. Conclusions This one-time consultation went beyond the assessment of a patient’s multimorbidity by including a psycho-social-contextual understanding of vulnerability within the healthcare system. Findings may have important clinical and policy implications in the adoption and implementation of this approach and further assist vulnerable patients with multimorbidity in having their complex needs addressed.
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Malo S, Maldonado L, Rabanaque MJ, Gimeno-Miguel A, Castel-Feced S, Lallana MJ, Aguilar-Palacio I. Patterns of statin adherence in primary cardiovascular disease prevention during the pandemic. Front Pharmacol 2022; 13:980391. [PMID: 36452233 PMCID: PMC9702325 DOI: 10.3389/fphar.2022.980391] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/30/2022] [Indexed: 01/24/2024] Open
Abstract
Background: Study of medication adherence patterns can help identify patients who would benefit from effective interventions to improve adherence. Objectives: To identify and compare groups of statin users based on their adherence patterns before and during the COVID-19 pandemic, to characterize the profile of users in each group, and to analyze predictors of distinct adherence patterns. Methods: Participants of the CARhES (CArdiovascular Risk factors for HEalth Services research) cohort, comprising individuals aged >16 years, residing in Aragón (Spain), with hypertension, diabetes mellitus and/or dyslipidemia, took part in this observational longitudinal study. Individuals who began statin therapy during January-June 2019 were selected and followed up until June 2021. Those with a cardiovascular event before or during follow-up were excluded. Data were obtained from healthcare system data sources. Statin treatment adherence during the implementation phase was estimated bimonthly using the Continuous Medication Availability (CMA9) function in the AdhereR package. Group-based trajectory models were developed to group statin users according to their adherence pattern during July 2019-June 2021. Group characteristics were compared and predictors of each adherence pattern were analyzed using multinomial logistic regression. Results: Of 15,332 new statin users, 30.8% had a mean CMA9 ≥80% for the entire study period. Four distinct adherence patterns were identified: high adherence (37.2% of the study population); poor adherence (35.6%); occasional use (14.9%); and gradual decline (12.3%). The latter two groups included users who showed a change in adherence (increase or decrease) during the pandemic emergence. Users with suboptimal adherence were likely to be younger, not pensioners, not institutionalized, with low morbidity burden and a low number of comorbidities. Female sex and switching between statins of different intensity increased the likelihood of belonging to the occasional use group, in which improved adherence coincided with the pandemic. Conclusion: We identified four distinct adherence patterns in a population of new statin users; two of them modified their adherence during the pandemic. Characterization of these groups could enable more effective distribution of resources in future similar crisis and the routine implementation of patient-centered interventions to improve medication adherence.
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Affiliation(s)
- Sara Malo
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, Health Promotion (RICAPPS), ISCIII, Madrid, Spain
| | - Lina Maldonado
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Department of Applied Economics, University of Zaragoza, Zaragoza, Spain
| | - María José Rabanaque
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, Health Promotion (RICAPPS), ISCIII, Madrid, Spain
| | - Antonio Gimeno-Miguel
- Network for Research on Chronicity, Primary Care, Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Sara Castel-Feced
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - María Jesús Lallana
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Primary Care Pharmacy Service, Sector Zaragoza III, Servicio Aragonés de Salud (SALUD), Zaragoza, Spain
| | - Isabel Aguilar-Palacio
- Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, Health Promotion (RICAPPS), ISCIII, Madrid, Spain
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Del Cura-González I, López-Rodríguez JA, Leiva-Fernández F, Gimeno-Feliu LA, Pico-Soler V, Bujalance-Zafra MJ, Domínguez-Santaella M, Polentinos-Castro E, Poblador-Plou B, Ara-Bardají P, Aza-Pascual-Salcedo M, Rogero-Blanco M, Castillo-Jiménez M, Lozano-Hernández C, Gimeno-Miguel A, González-Rubio F, Medina-García R, González-Hevilla A, Gil-Conesa M, Martín-Fernández J, Valderas JM, Marengoni A, Muth C, Prados-Torres JD, Prados-Torres A. Effectiveness of the MULTIPAP Plus intervention in youngest-old patients with multimorbidity and polypharmacy aimed at improving prescribing practices in primary care: study protocol of a cluster randomized trial. Trials 2022; 23:479. [PMID: 35681224 PMCID: PMC9178530 DOI: 10.1186/s13063-022-06293-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/09/2022] [Indexed: 12/21/2022] Open
Abstract
Background The progressive ageing of the population is leading to an increase in multimorbidity and polypharmacy, which in turn may increase the risk of hospitalization and mortality. The enhancement of care with information and communications technology (ICT) can facilitate the use of prescription evaluation tools and support system for decision-making (DSS) with the potential of optimizing the healthcare delivery process. Objective To assess the effectiveness and cost-effectiveness of the complex intervention MULTIPAP Plus, compared to usual care, in improving prescriptions for young-old patients (65-74 years old) with multimorbidity and polypharmacy in primary care. Methods/design This is a pragmatic cluster-randomized clinical trial with a follow-up of 18 months in health centres of the Spanish National Health System. Unit of randomization: family physician. Unit of analysis: patient. Population Patients aged 65–74 years with multimorbidity (≥ 3 chronic diseases) and polypharmacy (≥ 5 drugs) during the previous 3 months were included. Sample size n = 1148 patients (574 per study arm). Intervention Complex intervention based on the ARIADNE principles with three components: (1) family physician (FP) training, (2) FP-patient interview, and (3) decision-making support system. Outcomes The primary outcome is a composite endpoint of hospital admission or death during the observation period measured as a binary outcome, and the secondary outcomes are number of hospital admission, all-cause mortality, use of health services, quality of life (EQ-5D-5L), functionality (WHODAS), falls, hip fractures, prescriptions and adherence to treatment. Clinical and sociodemographic factors will be explanatory variables. Statistical analysis The main result is the difference in percentages in the final composite endpoint variable at 18 months, with its corresponding 95% CI. Adjustments by the main confounding and prognostic factors will be performed through a multilevel analysis. All analyses will be carried out in accordance to the intention-to-treat principle. Discussion It is important to prevent the cascade of negative health and health care impacts attributable to the multimorbidity-polypharmacy binomial. ICT-enhanced routine clinical practice could improve the prescription process in patient care. Trial registration ClinicalTrials.gov NCT04147130. Registered on 22 October 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06293-x.
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Affiliation(s)
- Isabel Del Cura-González
- Research Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain. .,Department of Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain. .,Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain. .,Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain. .,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.
| | - Juan A López-Rodríguez
- Research Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain.,Department of Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain.,Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,Ricardos General Health Center, Madrid Health Service, Madrid, Spain
| | - Francisca Leiva-Fernández
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,Multiprofessional Family and Community Care Teaching Unit of the Málaga-Guadalhorce Health District, Málaga, Spain.,Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain.,University of Malaga, Malaga, Spain
| | - Luis A Gimeno-Feliu
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,San Pablo Primary Care Health Centre, Aragon Health Service, Zaragoza, Spain.,University of Zaragoza, Zaragoza, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Victoria Pico-Soler
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Torrero-La Paz Primary Care Health Centre, Aragon Health Service (SALUD), Zaragoza, Spain
| | - Mª Josefa Bujalance-Zafra
- Multiprofessional Family and Community Care Teaching Unit of the Málaga-Guadalhorce Health District, Málaga, Spain.,La Victoria Health Center, Málaga-Guadalhorce Health District, Málaga, Spain
| | - Miguel Domínguez-Santaella
- Multiprofessional Family and Community Care Teaching Unit of the Málaga-Guadalhorce Health District, Málaga, Spain.,La Victoria Health Center, Málaga-Guadalhorce Health District, Málaga, Spain
| | - Elena Polentinos-Castro
- Research Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain.,Department of Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain.,Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain
| | - Beatriz Poblador-Plou
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Paula Ara-Bardají
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Mercedes Aza-Pascual-Salcedo
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Primary Care Pharmacy Service Zaragoza III, Aragon Health Service, Zaragoza, Spain
| | - Marisa Rogero-Blanco
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,Ricardos General Health Center, Madrid Health Service, Madrid, Spain
| | - Marcos Castillo-Jiménez
- Multiprofessional Family and Community Care Teaching Unit of the Málaga-Guadalhorce Health District, Málaga, Spain.,Health Center Campillos, Malaga North District (Antequera), Málaga, Spain
| | - Cristina Lozano-Hernández
- Research Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain.,Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,Primary Health Care Research and Innovation Foundation FIIBAP, Madrid, Spain
| | - Antonio Gimeno-Miguel
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Francisca González-Rubio
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Delicias Sur Primary Care Health Centre, Aragon Health Service (SALUD, Zaragoza, Spain
| | - Rodrigo Medina-García
- Research Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,Ricardos General Health Center, Madrid Health Service, Madrid, Spain.,Primary Health Care Research and Innovation Foundation FIIBAP, Madrid, Spain
| | - Alba González-Hevilla
- Multiprofessional Family and Community Care Teaching Unit of the Málaga-Guadalhorce Health District, Málaga, Spain
| | - Mario Gil-Conesa
- Preventive Medicine Service, University Hospital Alcorcon Foundation, Madrid, Spain
| | - Jesús Martín-Fernández
- Department of Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain.,Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,Multiprofessional Family and Community Care Teaching Unit West, Madrid, Spain
| | - José M Valderas
- Department of Family Medicine, National University Health System, Singapore, Singapore
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Christiane Muth
- Department of General Practice and Family Medicine, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany
| | - J Daniel Prados-Torres
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,Multiprofessional Family and Community Care Teaching Unit of the Málaga-Guadalhorce Health District, Málaga, Spain.,Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain.,University of Malaga, Malaga, Spain
| | - Alexandra Prados-Torres
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
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13
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How to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP Intervention. J Pers Med 2022; 12:jpm12050752. [PMID: 35629175 PMCID: PMC9144280 DOI: 10.3390/jpm12050752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/19/2022] [Accepted: 04/26/2022] [Indexed: 11/24/2022] Open
Abstract
(1) Purpose: To investigate a complex MULTIPAP intervention that implements the Ariadne principles in a primary care population of young-elderly patients with multimorbidity and polypharmacy and to evaluate its effectiveness for improving the appropriateness of prescriptions. (2) Methods: A pragmatic cluster-randomized clinical trial was conducted involving 38 family practices in Spain. Patients aged 65–74 years with multimorbidity and polypharmacy were recruited. Family physicians (FPs) were randomly allocated to continue usual care or to provide the MULTIPAP intervention based on the Ariadne principles with two components: FP training (eMULTIPAP) and FP patient interviews. The primary outcome was the appropriateness of prescribing, measured as the between-group difference in the mean Medication Appropriateness Index (MAI) score change from the baseline to the 6-month follow-up. The secondary outcomes were quality of life (EQ-5D-5 L), patient perceptions of shared decision making (collaboRATE), use of health services, treatment adherence, and incidence of drug adverse events (all at 1 year), using multi-level regression models, with FP as a random effect. (3) Results: We recruited 117 FPs and 593 of their patients. In the intention-to-treat analysis, the between-group difference for the mean MAI score change after a 6-month follow-up was −2.42 (95% CI from −4.27 to −0.59) and, between baseline and a 12-month follow-up was −3.40 (95% CI from −5.45 to −1.34). There were no significant differences in any other secondary outcomes. (4) Conclusions: The MULTIPAP intervention improved medication appropriateness sustainably over the follow-up time. The small magnitude of the effect, however, advises caution in the interpretation of the results given the paucity of evidence for the clinical benefit of the observed change in the MAI. Trial registration: Clinicaltrials.gov NCT02866799.
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14
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The frequency and nature of prescribing problems by general practitioners in training (REVISiT). BJGP Open 2022; 6:BJGPO.2021.0231. [PMID: 35523432 DOI: 10.3399/bjgpo.2021.0231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/26/2022] [Accepted: 03/08/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Prescribing errors can cause significant morbidity and occur in about 5% of prescriptions in English general practices. AIM Our aim was to describe the frequency and nature of prescribing problems in a cohort of GPs in training to determine whether they need additional prescribing support. DESIGN & SETTING A primary care pharmacist undertook a retrospective review of prescriptions issued between 09/10/2014 and 11/03/2015 by ten GPs in their final year of training from ten practices in England. METHOD Pre-existing standards, and expert panel discussion, were used to classify the appropriateness of prescribing. Data were imported into STATA Version 13 to perform descriptive analysis. An individualised report highlighting prescribing errors, suboptimal prescribing, and areas of good practice identified during the review was shared with the GPs in training and their trainers. This report was used to guide discussions during the GP in training's feedback session. RESULTS A total of 1028 prescription items were reviewed from 643 consultations performed by ten GPs in training. There were 92 prescribing errors (8.9%) and 360 episodes of suboptimal prescribing (35.0%). The most common types of error concerned medication dosages (n=30, 32.6% of errors). CONCLUSION Personalised review of prescribing revealed an error rate higher than recorded in a previous similar study mainly comprising GPs who had completed postgraduate training, and a substantially higher rate of suboptimal prescribing. A larger intervention study is now required to evaluate the effectiveness of receiving a personalised review of prescribing, and to assess its impact on patient safety.
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15
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Shared decision-making between older people with multimorbidity and GPs: focus group study. Br J Gen Pract 2022; 72:e609-e618. [PMID: 35379603 PMCID: PMC8999685 DOI: 10.3399/bjgp.2021.0529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/06/2022] [Indexed: 11/04/2022] Open
Abstract
Background Shared decision making (SDM), utilising the expertise of both patient and clinician, is a key feature of good-quality patient care. Multimorbidity can complicate SDM, yet few studies have explored this dynamic for older patients with multimorbidity in general practice. Aim To explore factors influencing SDM from the perspectives of older patients with multimorbidity and GPs, to inform improvements in personalised care. Design and setting Qualitative study. General practices (rural and urban) in Devon, England. Method Four focus groups: two with patients (aged ≥65 years with multimorbidity) and two with GPs. Data were coded inductively by applying thematic analysis. Results Patient acknowledgement of clinician medicolegal vulnerability in the context of multimorbidity, and their recognition of this as a barrier to SDM, is a new finding. Medicolegal vulnerability was a unifying theme for other reported barriers to SDM. These included expectations for GPs to follow clinical guidelines, challenges encountered in applying guidelines and in communicating clinical uncertainty, and limited clinician self-efficacy for SDM. Increasing consultation duration and improving continuity were viewed as facilitators. Conclusion Clinician perceptions of medicolegal vulnerability are recognised by both patients and GPs as a barrier to SDM and should be addressed to optimise delivery of personalised care. Greater awareness of multimorbidity guidelines is needed. Educating clinicians in the communication of uncertainty should be a core component of SDM training. The incorrect perception that most clinicians already effectively facilitate SDM should be addressed to improve the uptake of personalised care interventions.
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16
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Lim ZZB, Mohamed Kadir M, Ginting ML, Vrijhoef HJM, Yoong J, Wong CH. Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111160. [PMID: 34769680 PMCID: PMC8583400 DOI: 10.3390/ijerph182111160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 12/12/2022]
Abstract
Patient-Centered Medical Home (PCMH) has been found to improve care for complex needs patients in some countries but has not yet been widely adopted in Singapore. This study explored the ground-up implementation of a PCMH in Singapore by describing change strategies and unpacking initial experience and perception. In-depth interviews were conducted for twenty-two key informants from three groups: the implementers, their implementation partners, and other providers. “Diffusion of innovations” emerged as an overarching theory to contextualize PCMH in its early implementation. Three core “innovations” differentiated the PCMH from usual primary care: (i) team-based and integrated care; (ii) empanelment; and (iii) shared care with other general practitioners. Change strategies employed to implement these innovations included repurposing pre-existing resources, building a partnership to create supporting infrastructure and pathways in the delivery system, and doing targeted outreach to introduce the PCMH. Initial experience and perception were characterized by processes to “adopt” and “assimilate” the innovations, which were identified as challenging due to less predictable, self-organizing behaviors by multiple players. To work with the inherent complexity and novelty of the innovations, time, leadership, standardized methods, direct communication, and awareness-building efforts are needed. This study was retrospectively registered (Protocol ID: NCT04594967).
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Affiliation(s)
- Zoe Zon Be Lim
- Geriatric Education and Research Institute, Singapore 768024, Singapore; (M.M.K.); (M.L.G.); (J.Y.); (C.H.W.)
- Correspondence:
| | - Mumtaz Mohamed Kadir
- Geriatric Education and Research Institute, Singapore 768024, Singapore; (M.M.K.); (M.L.G.); (J.Y.); (C.H.W.)
| | - Mimaika Luluina Ginting
- Geriatric Education and Research Institute, Singapore 768024, Singapore; (M.M.K.); (M.L.G.); (J.Y.); (C.H.W.)
| | | | - Joanne Yoong
- Geriatric Education and Research Institute, Singapore 768024, Singapore; (M.M.K.); (M.L.G.); (J.Y.); (C.H.W.)
- Center for Economic and Social Research, University of Southern Carolina, Los Angeles, CA 90089, USA
- Research for Impact, Singapore 159964, Singapore
| | - Chek Hooi Wong
- Geriatric Education and Research Institute, Singapore 768024, Singapore; (M.M.K.); (M.L.G.); (J.Y.); (C.H.W.)
- Tsao Foundation, Singapore 168730, Singapore
- Health Services & Systems Research, Duke-NUS, Singapore 169857, Singapore
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17
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Kelly MA. The praxis of generalism in family medicine: Six concepts (6 Cs) to inform teaching. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:786-788. [PMID: 34649904 PMCID: PMC8516185 DOI: 10.46747/cfp.6710786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Martina Ann Kelly
- Undergraduate Director of Family Medicine at the University of Calgary in Alberta
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18
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Kelly MA, Wicklum S, Hubinette M, Power L. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:e288-e291. [PMID: 34649913 PMCID: PMC8516181 DOI: 10.46747/cfp.6710e288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Martina Ann Kelly
- Directrice du programme d'études prédoctorales en médecine de famille à l'Université de Calgary, en Alberta
| | - Sonja Wicklum
- Directrice du programme d'études prédoctorales en médecine de famille à l'Université de la Colombie-Britannique, à Vancouver
| | - Maria Hubinette
- Directrice du programme d'études prédoctorales en médecine de famille à l'Université Memorial de Terre-Neuve, à St. John's
| | - Lyn Power
- Directrice du programme d'études prédoctorales en médecine de famille à l'Université Memorial de Terre-Neuve, à St. John's
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19
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McKenzie KJ, Fletcher SL, Pierce D, Gunn JM. Moving from "let's fix them" to "actually listen": the development of a primary care intervention for mental-physical multimorbidity. BMC Health Serv Res 2021; 21:301. [PMID: 33794883 PMCID: PMC8017734 DOI: 10.1186/s12913-021-06307-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/22/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Effective person-centred interventions are needed to support people living with mental-physical multimorbidity to achieve better health and wellbeing outcomes. Depression is identified as the most common mental health condition co-occurring with a physical health condition and is the focus of this intervention development study. The aim of this study is to identify the key components needed for an effective intervention based on a clear theoretical foundation, consideration of how motivational interviewing can inform the intervention, clinical guidelines to date, and the insights of primary care nurses. METHODS A multimethod approach to intervention development involving review and integration of the theoretical principles of Theory of Planned Behavior and the patient-centred clinical skills of motivational interviewing, review of the expert consensus clinical guidelines for multimorbidity, and incorporation of a thematic analysis of group interviews with Australian nurses about their perspectives of what is needed in intervention to support people living with mental-physical multimorbidity. RESULTS Three mechanisms emerged from the review of theory, guidelines and practitioner perspective; the intervention needs to actively 'engage' patients through the development of a collaborative and empathic relationship, 'focus' on the patient's priorities, and 'empower' people to make behaviour change. CONCLUSION The outcome of the present study is a fully described primary care intervention for people living with mental-physical multimorbidity, with a particular focus on people living with depression and a physical health condition. It builds on theory, expert consensus guidelines and clinician perspective, and is to be tested in a clinical trial.
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Affiliation(s)
- Kylie J McKenzie
- Department of General Practice, University of Melbourne, Melbourne, Australia.
| | - Susan L Fletcher
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - David Pierce
- Department of Rural Health, University of Melbourne, Ballarat, Australia
| | - Jane M Gunn
- Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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20
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Etxeberria A, Iribar J, Vrotsou K, Rotaeche R, Barral I, Barral I, Belzunegui J, Bustinduy A, Caso J, Del Bosque C, Etxeberria A, Frias O, Iribar J, Lekuona A, Lombera L, López B, Núñez J, Olasagasti B, Rotaeche R, Royo I, Vrotsou K, Zapata E, Zubeldia X. [Evaluation of the collaboration between Primary and Hospital Care in order to improve inappropriate prescription]. J Healthc Qual Res 2021; 36:91-97. [PMID: 33495114 DOI: 10.1016/j.jhqr.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/12/2020] [Accepted: 09/20/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the implementation of a collaborative experience between Primary (PC) and Hospital Care (HC) aimed at reducing potentially inappropriate prescribing (PIP) in patients with polypharmacy. MATERIALS AND METHODS Collaborative experience including a controlled before-after intervention study, carried out in the Donostialdea Integrated Health Organization (IHO), with Bilbao Basurto IHO as control group, Osakidetza, Basque Health Service. Participant were 227 PC physicians and physicians from 7 hospital services, and patients with 5 or more drugs meeting at least one PIP criteria. The intervention consisted of communication and knowledge between professionals, PC-HC consensus, training, identification of patients at risk, medication review, evaluation and feed-back. The collaboration process (agreements, consensus documents, training activities) and the change in the prevalence of PIP in polymedicated patients (using computerised health records) were evaluated. RESULTS A total of 21 PIP criteria and 6 recommendation documents were agreed. An analysis was performed on 15,570 PIP from OSI Donostialdea and 24,866 from the control group. The prevalence of PIP in polymedicated patients was reduced by -4.53% (95% CI: -4.71 to -4.36, P< .0001) in comparison with the control group. The before-after differences were statistically significant across the 7 services. CONCLUSIONS PC-HC collaboration is feasible and, along with other intervention components, reduces inappropriate polypharmacy in the context of a recently integrated healthcare organisation. The collaboration process is complex and requires continuous monitoring, policy involvement, leadership that encourages health professional participation, and intensive use of information systems.
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Affiliation(s)
- A Etxeberria
- Osakidetza, OSI Donostialdea, Farmacia Atención Primaria, Hernani, España; Instituto de Investigación Sanitaria Biodonostia, Grupo de Atención Primaria, Donostia-San Sebastián, España
| | - J Iribar
- Osakidetza, OSI Donostialdea, Farmacia Atención Primaria, Hernani, España.
| | - K Vrotsou
- Instituto de Investigación Sanitaria Biodonostia, Grupo de Atención Primaria, Donostia-San Sebastián, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Instituto de Investigación en Servicios de Salud Kronikgune, Torre del BEC, Barakaldo, España
| | - R Rotaeche
- Instituto de Investigación Sanitaria Biodonostia, Grupo de Atención Primaria, Donostia-San Sebastián, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Osakidetza, OSI Donostialdea, Centro de Salud de Alza, Donostia-San Sebastián, España
| | - I Barral
- Osakidetza, Hospital Universitario Donostia, Donostia-San Sebastián, España
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21
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Leiva-Fernández F, González-Hevilla A, Prados-Torres JD, Casas-Galán F, García-Domingo E, Ortiz-Suárez P, López-Rodríguez JA, Pico-Soler MV. Identification of the multimorbidity training needs of primary care professionals: Protocol of a survey. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2021; 11:26335565211024791. [PMID: 34422674 PMCID: PMC8371279 DOI: 10.1177/26335565211024791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022]
Abstract
Current epidemiological situation has prompted the consideration of multimorbility (MM) as a prevalent condition, influenced by age, educational level and social support, related to unfavorable social and health determinants. Primary Care (PC) has a key role in its approach but further training of professionals in MM is required. The evidence on the effectiveness of training interventions in MM is still limited. Knowing the experiences, opinions and training needs of professionals is essential to enhance training interventions. OBJECTIVES Identify perceived training needs by PC health professionals (doctors and nurses) in MM and polypharmacy. METHODS Design: Cross-sectional study based on an online survey (anonymous-ad hoc questionnaire). Participants and recruitment: 384 doctors and nurses working in healthcare centers and out-of-hospital emergencies of the Spanish National Health System. Non-probabilistic convenience sampling via email addressed to Health Institutions, and social networks. DATA Demographic characteristics and professional profile data (close-ended and multiple-choice questions) will be collected. Open-ended questions will be used to identify training needs, difficulties and resources about MM; required skills to care patients with MM will be assessed using a 4-item ordinal scale. ANALYSIS Coding of data prior to analysis. Descriptive statistical analysis, participation and completion rates of the questionnaire and estimation of absolute and relative frequencies and 95% confidence intervals in close-ended questions. Content analysis with inductive methodology in open-ended questions. Ethics: Ethical approval, Online informed consent. CONCLUSIONS The identification of training needs of health professionals who care for patients with MM will be necessary data for developing highly effective training activities.
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Affiliation(s)
- Francisca Leiva-Fernández
- Teaching Unit for Family and Community Primary Care Health District
Málaga/Guadalhorce, Andalusian Health Service, Málaga, Spain
- Biomedical Research Institute of Málaga –IBIMA-, Univesity of
Malaga, Malaga, Spain
- Health Services and Chronic conditions Research Network (REDISSEC),
Health Institute Carlos III, Madrid, Spain
| | - Alba González-Hevilla
- Teaching Unit for Family and Community Primary Care Health District
Málaga/Guadalhorce, Andalusian Health Service, Málaga, Spain
- Biomedical Research Institute of Málaga –IBIMA-, Univesity of
Malaga, Malaga, Spain
| | - Juan Daniel Prados-Torres
- Teaching Unit for Family and Community Primary Care Health District
Málaga/Guadalhorce, Andalusian Health Service, Málaga, Spain
- Biomedical Research Institute of Málaga –IBIMA-, Univesity of
Malaga, Malaga, Spain
- Health Services and Chronic conditions Research Network (REDISSEC),
Health Institute Carlos III, Madrid, Spain
| | - Fuensanta Casas-Galán
- Teaching Unit for Family and Community Primary Care Health District
Málaga/Guadalhorce, Andalusian Health Service, Málaga, Spain
- Biomedical Research Institute of Málaga –IBIMA-, Univesity of
Malaga, Malaga, Spain
| | - Eva García-Domingo
- Teaching Unit for Family and Community Primary Care Health District
Málaga/Guadalhorce, Andalusian Health Service, Málaga, Spain
- Biomedical Research Institute of Málaga –IBIMA-, Univesity of
Malaga, Malaga, Spain
| | - Paula Ortiz-Suárez
- Teaching Unit for Family and Community Primary Care Health District
Málaga/Guadalhorce, Andalusian Health Service, Málaga, Spain
- Biomedical Research Institute of Málaga –IBIMA-, Univesity of
Malaga, Malaga, Spain
| | - Juan Antonio López-Rodríguez
- Health Services and Chronic conditions Research Network (REDISSEC),
Health Institute Carlos III, Madrid, Spain
- Research Unit, Primary Health Care Management of Madrid, Madrid
Health Service, Madrid, Spain
- Public Health and Preventive Medicine Area, University Rey Juan
Carlos, Madrid, Spain
| | - Maria Victoria Pico-Soler
- Health Services and Chronic conditions Research Network (REDISSEC),
Health Institute Carlos III, Madrid, Spain
- EpiChron Research Group, Aragon Health Sciences Institute (IACS),
IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
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22
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Leiva-Fernández F, Prados-Torres JD, Prados-Torres A, del-Cura-González I, Castillo-Jimena M, López-Rodríguez JA, Rogero-Blanco ME, Lozano-Hernández CM, López-Verde F, Bujalance-Zafra MJ, Pico-Soler MV, Gimeno-Feliu LA, Poblador-Plou B, Martinez-Cañavate MT, Muth C. Training primary care professionals in multimorbidity management: Educational assessment of the eMULTIPAP course. Mech Ageing Dev 2020; 192:111354. [DOI: 10.1016/j.mad.2020.111354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/11/2020] [Indexed: 11/15/2022]
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General practitioner strategies for managing patients with multimorbidity: a systematic review and thematic synthesis of qualitative research. BMC FAMILY PRACTICE 2020; 21:131. [PMID: 32611391 PMCID: PMC7331183 DOI: 10.1186/s12875-020-01197-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 06/17/2020] [Indexed: 12/21/2022]
Abstract
Background General practitioners (GPs) increasingly manage patients with multimorbidity but report challenges in doing so. Patients describe poor experiences with health care systems that treat each of their health conditions separately, resulting in fragmented, uncoordinated care. For GPs to provide the patient-centred, coordinated care patients need and want, research agendas and health system structures and policies will need to adapt to address this epidemiologic transition. This systematic review seeks to understand if and how multimorbidity impacts on the work of GPs, the strategies they employ to manage challenges, and what they believe still needs addressing to ensure quality patient care. Methods Systematic review and thematic synthesis of qualitative studies reporting GP experiences of managing patients with multimorbidity. The search included nine major databases, grey literature sources, Google and Google Scholar, a hand search of Journal of Comorbidity, and the reference lists of included studies. Results Thirty-three studies from fourteen countries were included. Three major challenges were identified: practising without supportive evidence; working within a fragmented health care system whose policies and structures remain organised around single condition care and specialisation; and the clinical uncertainty associated with multimorbidity complexity and general practitioner perceptions of decisional risk. GPs revealed three approaches to mitigating these challenges: prioritising patient-centredness and relational continuity; relying on knowledge of patient preferences and unique circumstances to individualise care; and structuring the consultation to create a sense of time and minimise patient risk. Conclusions GPs described an ongoing tension between applying single condition guidelines to patients with multimorbidity as security against uncertainty or penalty, and potentially causing patients harm. Above all, they chose to prioritise their long-term relationships for the numerous gains this brought such as mutual trust, deeper insight into a patient’s unique circumstances, and useable knowledge of each individual’s capacity for the work of illness and goals for life. GPs described a need for better multimorbidity management guidance. Perhaps more than this, they require policies and models of practice that provide remunerated time and space for nurturing trustful therapeutic partnerships.
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24
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Ørtenblad L, Nissen NK. General practitioners’ considerations of and experiences with multimorbidity patients: A qualitative study. INTERNATIONAL JOURNAL OF CARE COORDINATION 2019. [DOI: 10.1177/2053434519890050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction General practitioners’ management of multimorbid patients is mostly described as a burden, although it is also indicated that fundamental characteristics of general practice are well-suited to accommodate appropriate management of multimorbidity. However, little is known about actual practices among general practitioners. This study explores general practitioners’ management of their multimorbid patients. Methods A qualitative methodological design using participant observation and interviews. Interpretive description was used as the analytical framework. The study took place in a provincial town in Denmark. Three general practices with a total of 12 general practitioners participated. Results ‘Multimorbidity’ as general terminology does not reflect the practice of the general practitioners. Their approach is based on the functional capacity of individual patients. The heterogeneity of the group was classified into three categories determining the general practitioners’ approach: the well-functioning patients, the surprising patients and the fragile patients. Three core characteristics were identified as pivotal for the general practitioners’ approach: holistic view of the patient’s situation, patient-centred focus and coordinator and facilitator. These are fundamental characteristics of general practice, but become especially significant because they accommodate the complexity and heterogeneity of multimorbid patients. Discussion This study expands the subject field by exploring the general practitioners’ actual practices, thereby providing new perspectives into features that support appropriate management of multimorbid patients. General practitioners balance administrative and clinical regulations in their considerations of accommodating the heterogeneity and complexity of multimorbid patients. This suggests that better possibilities must be provided to realize the fundamental characteristics of general practice to support their management of multimorbid patients.
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25
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Makovski TT, Schmitz S, Zeegers MP, Stranges S, van den Akker M. Multimorbidity and quality of life: Systematic literature review and meta-analysis. Ageing Res Rev 2019; 53:100903. [PMID: 31048032 DOI: 10.1016/j.arr.2019.04.005] [Citation(s) in RCA: 271] [Impact Index Per Article: 54.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/14/2019] [Accepted: 04/15/2019] [Indexed: 02/08/2023]
Abstract
Multimorbidity is typically defined as the co-existence of two or more chronic diseases within an individual. Its prevalence is highest among the elderly, with poor quality of life (QoL) being one of the major consequences. This study aims to: (1) understand the relationship between multimorbidity and QoL or health-related quality of life (HRQoL) through systematic literature review; (2) explore the strength of this association by conducting the first meta-analysis on the subject. Following PRISMA, Medline/PubMed, Embase, CINAHL and PsycINFO were searched for studies published through September 1st, 2018. Original studies with clear operationalization of multimorbidity and validated QoL (or HRQoL) measurement were retained. For random-effect meta-analysis, a minimum of three studies with the same multimorbidity tool (e.g. number of diseases or equal comorbidity index) and the same QoL tool were required. Number of diseases was most common and the only measure on which meta-analysis was carried out. The outcome of interest was the linear regression slope between increasing number of diseases and QoL. Heterogeneity was explored with meta-regression. Out of 25,890 studies initially identified, 74 studies were retained for systematic review (total of 2,500,772 participants), of which 39 were included in the meta-analysis. The mean decrease in HRQoL per each added disease, depending on the scale, ranged from: -1.55% (95%CI: -2.97%, -0.13%) for the mental component summary score of pooled SF-36, -12 and -8 scales to -4.37% (95%CI: -7.13%, -1.61%) for WHOQoL-BREF physical health domain. Additional studies considering severity, duration and patterns of diseases are required to further clarify this association.
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Affiliation(s)
- Tatjana T Makovski
- Epidemiology and Public Health Research Unit, Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg; Department of Family medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Chairgroup of Complex Genetics and Epidemiology, Nutrition and Metabolism in Translational Research (NUTRIM), Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - Susanne Schmitz
- Epidemiology and Public Health Research Unit, Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Maurice P Zeegers
- Chairgroup of Complex Genetics and Epidemiology, Nutrition and Metabolism in Translational Research (NUTRIM), Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Saverio Stranges
- Epidemiology and Public Health Research Unit, Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg; Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada; Department of Family Medicine, Western University, London, Ontario, Canada
| | - Marjan van den Akker
- Department of Family medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Academic Centre for General Practice/Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium; Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
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Wang YP, Nunes BP, Coêlho BM, Santana GL, do Nascimento CF, Viana MC, Benseñor IM, Andrade LH, Chiavegatto Filho ADP. Multilevel Analysis of the Patterns of Physical-Mental Multimorbidity in General Population of São Paulo Metropolitan Area, Brazil. Sci Rep 2019; 9:2390. [PMID: 30787376 PMCID: PMC6382818 DOI: 10.1038/s41598-019-39326-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/27/2018] [Indexed: 01/17/2023] Open
Abstract
Chronic diseases are often comorbid and present a weighty burden for communities in the 21st century. The present investigation depicted patterns of multimorbidity in the general population and examined its association with the individual- and area-level factors in an urban sample of non-elderly adults of Brazil. Data were from the cross-sectional São Paulo Megacity Mental Health Survey, a stratified multistage area probability sampling investigation. Trained interviewers assessed mental morbidities and asked about physical conditions for 1,571 community-dwelling women and 1,142 men, aged between 18 and 64 years. Principal component analysis depicted patterns of physical-mental multimorbidity, by sex. Following, the patterns of multimorbidity were subjected to multilevel regression analysis, taking into account individual- and area-level variables. Three patterns of clustering were found for women: 'irritable mood and headache', 'chronic diseases and pain', and 'substance use disorders'. Among men, the patterns were: 'chronic pain and respiratory disease', 'psychiatric disorders', and 'chronic diseases'. Multilevel analyses showed associations between multimorbidity patterns and both individual- and area-level determinants. Our findings call for a reformulation of health-care systems worldwide, especially in low-resource countries. Replacing the single-disease framework by multi-disease patterns in health-care settings can improve the ability of general practitioners in the health-care of person-centred needs.
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Affiliation(s)
- Yuan-Pang Wang
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Instituto de Psiquiatria, Hospital das Clinicas HC FMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Bruno P Nunes
- Nursing Department, Federal University of, Pelotas, RS, Brazil
| | - Bruno M Coêlho
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Instituto de Psiquiatria, Hospital das Clinicas HC FMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Geilson L Santana
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Instituto de Psiquiatria, Hospital das Clinicas HC FMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Carla F do Nascimento
- Department of Epidemiology, School of Public Health, University of São Paulo, Sao Paulo, SP, Brazil
| | - Maria Carmen Viana
- Department of Social Medicine, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Isabela M Benseñor
- Center for Clinical and Epidemiological Research, Hospital Universitario HU USP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Laura H Andrade
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Instituto de Psiquiatria, Hospital das Clinicas HC FMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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van den Akker M, Vaes B, Goderis G, Van Pottelbergh G, De Burghgraeve T, Henrard S. Trends in multimorbidity and polypharmacy in the Flemish-Belgian population between 2000 and 2015. PLoS One 2019; 14:e0212046. [PMID: 30753214 PMCID: PMC6372187 DOI: 10.1371/journal.pone.0212046] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/25/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The aim of this paper was to describe the time trends in the prevalence of multimorbidity and polypharmacy in Flanders (Belgium) between 2000 and 2015, while controlling for age and sex. METHODS Data were available from Intego, a Flemish-Belgian general practice-based morbidity registration network. The practice population between 2000 and 2015 was used as the denominator, representing a mean of 159,946 people per year. Age and gender-standardised prevalence rates were used for the trends of multimorbidity and polypharmacy in the total population and for subgroups. Joinpoint regression analyses were used to analyse the time trends and breaks in trends, for the entire population as well as for specific age and sex groups. RESULTS Overall, in 2015, 22.7% of the population had multimorbidity, while the overall prevalence of polypharmacy was 20%. Throughout the study period the standardised prevalence rate of multimorbidity rose for both sexes and in all age groups. The largest relative increase in multimorbidity was observed in the younger age groups (up to the age of 50 years). The prevalence of polypharmacy showed a significant increase between 2000 and 2015 for all age groups except the youngest (0-25 years). CONCLUSION For all adult age groups multimorbidity and polypharmacy are frequent, dynamic over time and increasing. This asks for both epidemiological and interventional studies to improve the management of the resulting complex care.
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Affiliation(s)
- Marjan van den Akker
- Department of Family Medicine, School Caphri, Maastricht University, Maastricht, the Netherlands
- Department of Public Health and Primary Care, University of Leuven (KU Leuven), Leuven, Belgium
- * E-mail:
| | - Bert Vaes
- Department of Public Health and Primary Care, University of Leuven (KU Leuven), Leuven, Belgium
| | - Geert Goderis
- Department of Public Health and Primary Care, University of Leuven (KU Leuven), Leuven, Belgium
| | - Gijs Van Pottelbergh
- Department of Public Health and Primary Care, University of Leuven (KU Leuven), Leuven, Belgium
| | - Tine De Burghgraeve
- Department of Public Health and Primary Care, University of Leuven (KU Leuven), Leuven, Belgium
| | - Séverine Henrard
- Department of Public Health and Primary Care, University of Leuven (KU Leuven), Leuven, Belgium
- Louvain Drug Research Institute and Institute of Health and Society (IRSS), Université catholique de Louvain (UCL), Brussels, Belgium
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28
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Clinical assessment and management of multimorbidity: NICE guideline. Br J Gen Pract 2018; 67:235-236. [PMID: 28450343 DOI: 10.3399/bjgp17x690857] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/03/2017] [Indexed: 10/31/2022] Open
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Prados-Torres A, Del Cura-González I, Prados-Torres JD, Leiva-Fernández F, López-Rodríguez JA, Calderón-Larrañaga A, Muth C. [Multimorbidity in general practice and the Ariadne principles. A person-centred approach]. Aten Primaria 2017; 49:300-307. [PMID: 28427915 PMCID: PMC6875989 DOI: 10.1016/j.aprim.2016.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 11/19/2022] Open
Abstract
La multimorbilidad, definida como la presencia de dos o más enfermedades crónicas en un mismo individuo, conlleva consecuencias negativas para la persona e importantes retos para los sistemas sanitarios. En atención primaria, donde recae esencialmente la atención de este grupo de pacientes, la consulta es más compleja que la de un paciente con una única enfermedad debido, entre otros, al hecho de tener que manejar mayor cantidad de información clínica, disponer de poca evidencia científica para abordar la multimorbilidad, y tener que coordinar la labor de múltiples profesionales para garantizar la continuidad asistencial. Además, para poder implementar correctamente los planes de tratamiento en estos pacientes es necesario un proceso de toma de decisiones compartida médico-paciente. Entre las distintas herramientas disponibles para apoyar dicho proceso, recientemente se ha desarrollado una dirigida específicamente a pacientes con multimorbilidad en atención primaria y que se describe en el presente artículo: los principios Ariadne.
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Affiliation(s)
- Alexandra Prados-Torres
- Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, España; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España; Universidad de Zaragoza, Zaragoza, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Joint Action on Chronic Diseases (JA-CHRODIS), Unión Europea
| | - Isabel Del Cura-González
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Madrid, España; Universidad Rey Juan Carlos, Madrid, España
| | - Juan Daniel Prados-Torres
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria, Distrito Sanitario Málaga/Guadalhorce, Málaga, España; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; Universidad de Málaga, Málaga, España.
| | - Francisca Leiva-Fernández
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria, Distrito Sanitario Málaga/Guadalhorce, Málaga, España; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; Universidad de Málaga, Málaga, España
| | - Juan Antonio López-Rodríguez
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Madrid, España; Universidad Rey Juan Carlos, Madrid, España; Centro de Salud Los Pintores, Parla, Madrid, España
| | - Amaia Calderón-Larrañaga
- Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, España; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Joint Action on Chronic Diseases (JA-CHRODIS), Unión Europea; Aging Research Center, NVS Department - Karolinska Institutet, Solna, Suecia
| | - Christiane Muth
- Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt del Main, Alemania
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