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Mannion C, Hughes J, Moriarty F, Bennett K, Cahir C. Agreement between self-reported morbidity and pharmacy claims data for prescribed medications in an older community based population. BMC Geriatr 2020; 20:283. [PMID: 32778067 PMCID: PMC7419222 DOI: 10.1186/s12877-020-01684-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/29/2020] [Indexed: 11/21/2022] Open
Abstract
Background Studies have indicated variability around prevalence estimates of multimorbidity due to poor consensus regarding its definition and measurement. Medication-based measures of morbidity may be valuable resources in the primary-care setting where access to medical data can be limited. We compare the agreement between patient self-reported and medication-based morbidity; and examine potential patient-level predictors of discordance between these two measures of morbidity in an older (≥ 50 years) community-based population. Methods A retrospective cohort study was performed using national pharmacy claims data linked to The Irish LongituDinal study on Ageing (TILDA). Morbidity was measured by patient self-report (TILDA) and two medication-based measures, the Rx-Risk (< 65 years) and Rx-Risk-V (≥65 years), which classify drug claims into chronic disease classes. The kappa statistic measured agreement between self-reported and medication-based morbidity at the individual patient-level. Multivariate logistic regression was used to examine patient-level characteristics associated with discordance between measures of morbidity. Results Two thousand nine hundred twenty-five patients were included (< 65 years: N = 1095, 37.44%; and ≥ 65 years: N = 1830 62.56%). Hypertension and high cholesterol were the most prevalent self-reported morbidities in both age cohorts. Agreement was good or very good (κ = 0.61–0.81) for diabetes, osteoporosis and glaucoma; and moderate for high cholesterol, asthma, Parkinson’s and angina (κ = 0.44–0.56). All other conditions had fair or poor agreement. Age, gender, marital status, education, poor-delayed recall, depression and polypharmacy were significantly associated with discordance between morbidity measures. Conclusions Most conditions achieved only moderate or fair agreement between self-reported and medication-based morbidity. In order to improve the accuracy in prevalence estimates of multimorbidity, multiple measures of multimorbidity may be necessary. Future research should update the current Rx-Risk algorithms in-line with current treatment guidelines, and re-assess the feasibility of using these indices alone, or in combination with other methods, to yield more accurate estimates of multimorbidity.
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Affiliation(s)
- Clionadh Mannion
- Department of Pharmacology and Therapeutics, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - John Hughes
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Frank Moriarty
- Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland.,The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Kathleen Bennett
- Department of Pharmacology and Therapeutics, University of Dublin, Trinity College Dublin, Dublin, Ireland.,Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Caitriona Cahir
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
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Tadeu ACR, E Silva Caetano IRC, de Figueiredo IJ, Santiago LM. Multimorbidity and consultation time: a systematic review. BMC FAMILY PRACTICE 2020; 21:152. [PMID: 32723303 PMCID: PMC7390198 DOI: 10.1186/s12875-020-01219-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 07/12/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Multimorbidity (MM) is one of the major challenges health systems currently face. Management of time length of a medical consultation with a patient with MM is a matter of concern for doctors. METHODS A systematic review was performed to describe the impact of MM on the average time of a medical consultation considering the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. The systematic online searches of the Embase and PubMed databases were undertaken, from January 2000 to August 2018. The studies were independently screened by two reviewers to decide which ones met the inclusion criteria. (Kappa = 0.84 and Kappa = 0.82). Differing opinions were solved by a third person. This systematic review included people with MM criteria as participants (two or more chronic conditions in the same individual). The type of outcome included was explicitly defined - the length of medical appointments with patients with MM. Any strategies aiming to analyse the impact of MM on the average consultation time were considered. The length of time of medical appointment for patients without MM was the comparator criteria. Experimental and observational studies were included. RESULTS Of 85 articles identified, only 1 observational study was included, showing a clear trend for patients with MM to have longer consultations than patients without MM criteria (p < 0.001). CONCLUSIONS More studies are required to better assess allocation length-time for patients with MM and to measure other characteristics like doctors' workload.
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Affiliation(s)
| | | | - Inês Jorge de Figueiredo
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,ACeS Dão Lafões, Coimbra, Portugal.,Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Luiz Miguel Santiago
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,General Practice/Family Practice clinic of the Faculty of Medicine of University of Coimbra, Coimbra, Portugal.,Center for Health and Investigation studies of the University of Coimbra (CEISUC), Coimbra, Portugal
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53
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Tripp-Reimer T, Williams JK, Gardner SE, Rakel B, Herr K, McCarthy AM, Hand LL, Gilbertson-White S, Cherwin C. An integrated model of multimorbidity and symptom science. Nurs Outlook 2020; 68:430-439. [PMID: 32482344 PMCID: PMC7483649 DOI: 10.1016/j.outlook.2020.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/13/2020] [Accepted: 03/21/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Prevalence and complexity of persons with multiple chronic conditions (MCC), also known as multimorbidity, are shifting clinical practice from a single disease focus to one considering MCC and symptoms. Although symptoms are intricately bound to concepts inherent in MCC science, symptoms are largely ignored in multimorbidity research and literature. PURPOSE Introduce an Integrated Model of Multimorbidity and Symptom Science. METHODS Critical integrative review and synthesis process. FINDINGS The model comprises three primary domains: 1. Contributing/ Risk Factors; 2. Symptom/Disease/Treatment Interactions; and 3. Patient Outcomes. DISCUSSION The model highlights the multilevel nature of contributing factors and the recursive interactions among multiple etiologies, conditions, symptoms, therapies, and outcomes.
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Affiliation(s)
| | | | - Sue E Gardner
- College of Nursing, The University of Iowa, Iowa City, IA
| | - Barbara Rakel
- College of Nursing, The University of Iowa, Iowa City, IA
| | - Keela Herr
- College of Nursing, The University of Iowa, Iowa City, IA
| | | | - Linda Liu Hand
- College of Nursing, The University of Iowa, Iowa City, IA
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Koh LJ, Teo SH, Jiang Y, Hwang EHJ, Lee ES. Difficulties that patients with chronic diseases face in the primary care setting in Singapore: a cross-sectional study. Singapore Med J 2020; 62:466-471. [PMID: 32299185 DOI: 10.11622/smedj.2020062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Patients with chronic diseases face difficulties when navigating the healthcare system. Using the Healthcare System Hassles Questionnaire (HSHQ) developed by Parchman et al, this study aimed to explore the degree of hassles faced by primary care patients in Singapore and identify the characteristics associated with higher hassles. METHODS A cross-sectional study was conducted among patients with chronic disease at Hougang Polyclinic, Singapore, using interviewer-administered HSHQ. Mean HSHQ score was compared with Parchman et al's study. The associations between number of chronic diseases, demographic variables and healthcare hassles were assessed using multivariate linear logistic regression analysis. RESULTS 217 outpatients aged 21 years and above were enrolled. Our overall mean HSHQ score (4.77 ± 6.18) was significantly lower than that in Parchman et al's study (15.94 ± 14.23, p < 0.001). Participants with five or more chronic diseases scored 3.38 (95% confidence interval [CI] 0.11-6.65, p = 0.043) points higher than those with one chronic disease. With each increasing year of age, mean HSHQ score decreased by 0.17 (95% CI -0.26 to -0.08, p = 0.001) points. Those with polytechnic/diploma/university education and higher scored 2.65 (95% CI 0.19-5.11, p = 0.035) points higher than those with primary education and lower. CONCLUSION Patients in our population reported lower hassles than those in Parchman et al's study. Increasing age and lower education level were associated with lower hassles. Further analysis of the types of chronic diseases may yield new information about the association of healthcare hassles with the number and types of chronic diseases.
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Affiliation(s)
- Li Jia Koh
- Hougang Polyclinic, National Healthcare Group Polyclinics, Singapore
| | - Sok Huang Teo
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | - Yilin Jiang
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | | | - Eng Sing Lee
- Hougang Polyclinic, National Healthcare Group Polyclinics, Singapore.,Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
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Thienemann F, Ntusi NAB, Battegay E, Mueller BU, Cheetham M. Multimorbidity and cardiovascular disease: a perspective on low- and middle-income countries. Cardiovasc Diagn Ther 2020; 10:376-385. [PMID: 32420119 DOI: 10.21037/cdt.2019.09.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
New and changing patterns of multimorbidity (MM), i.e., multiple concurrent acute or chronic diseases in a person, are emerging in low- and middle-income countries (LMICs). The interplay of underlying population-specific factors and lifestyle habits combined with the colliding epidemics of communicable and non-communicable diseases presents new disease combinations, complexities and risks that are not common in high-income countries (HICs). The complexities and risks include those arising from potentially harmful drug-drug and drug-disease interactions (DDIs), the management of which may be considered as MM in the true sense. A major concern in LMICs is the increasing burden of leading cardiovascular diseases, prevalence of associated risk factors and co-occurrence with other morbidities. New models of MM management and integrated care can respond to the needs of specific multimorbid populations, with some LMICs making substantial progress (e.g., integration of tuberculosis and HIV services in South Africa). But there is a dearth of relevant data on the changing patterns and underlying factors and determinants of MM, the associated complexities and risks of DDIs in MM management, and the barriers to integrated care in LMICs. This requires careful attention.
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Affiliation(s)
- Friedrich Thienemann
- Department of Internal Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa.,Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Ntobeko A B Ntusi
- Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Edouard Battegay
- Department of Internal Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland
| | - Beatrice U Mueller
- Department of Internal Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marcus Cheetham
- Department of Internal Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland
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Aubert CE, Schnipper JL, Roumet M, Marques-Vidal P, Stirnemann J, Auerbach AD, Zimlichman E, Kripalani S, Vasilevskis EE, Robinson E, Fletcher GS, Aujesky D, Limacher A, Donzé J. Best Definitions of Multimorbidity to Identify Patients With High Health Care Resource Utilization. Mayo Clin Proc Innov Qual Outcomes 2020; 4:40-49. [PMID: 32055770 PMCID: PMC7011007 DOI: 10.1016/j.mayocpiqo.2019.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective To compare different definitions of multimorbidity to identify patients with higher health care resource utilization. Patients and Methods We used a multinational retrospective cohort including 147,806 medical inpatients discharged from 11 hospitals in 3 countries (United States, Switzerland, and Israel) between January 1, 2010, and December 31, 2011. We compared the area under the receiver operating characteristic curve (AUC) of 8 definitions of multimorbidity, based on International Classification of Diseases codes defining health conditions, the Deyo-Charlson Comorbidity Index, the Elixhauser-van Walraven Comorbidity Index, body systems, or Clinical Classification Software categories to predict 30-day hospital readmission and/or prolonged length of stay (longer than or equal to the country-specific upper quartile). We used a lower (yielding sensitivity ≥90%) and an upper (yielding specificity ≥60%) cutoff to create risk categories. Results Definitions had poor to fair discriminatory power in the derivation (AUC, 0.61-0.65) and validation cohorts (AUC, 0.64-0.71). The definitions with the highest AUC were number of (1) health conditions with involvement of 2 or more body systems, (2) body systems, (3) Clinical Classification Software categories, and (4) health conditions. At the upper cutoff, sensitivity and specificity were 65% to 79% and 50% to 53%, respectively, in the validation cohort; of the 147,806 patients, 5% to 12% (7474 to 18,008) were classified at low risk, 38% to 55% (54,484 to 81,540) at intermediate risk, and 32% to 50% (47,331 to 72,435) at high risk. Conclusion Of the 8 definitions of multimorbidity, 4 had comparable discriminatory power to identify patients with higher health care resource utilization. Of these 4, the number of health conditions may represent the easiest definition to apply in clinical routine. The cutoff chosen, favoring sensitivity or specificity, should be determined depending on the aim of the definition.
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Affiliation(s)
- Carole E Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Jeffrey L Schnipper
- BWH Hospitalist Service, Division of General Medicine, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Marie Roumet
- CTU Bern and Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | | | - Jérôme Stirnemann
- Department of Internal Medicine, Geneva University Hospital, Switzerland
| | - Andrew D Auerbach
- Division of Hospital Medicine, University of California, San Francisco, Sheba Medical Center, Tel HaShomer, Israel
| | | | - Sunil Kripalani
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health and Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, TN
| | - Eduard E Vasilevskis
- Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, TN.,Geriatric Research Education and Clinical Center, VA Tennessee Valley, Nashville
| | | | - Grant S Fletcher
- Department of Medicine, Harborview Medical Center, University of Washington, Seattle
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Andreas Limacher
- CTU Bern and Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Jacques Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.,Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA.,Department of Internal Medicine, Hôpital neuchâtelois, Neuchâtel, Switzerland
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57
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Wong ELY, Xu RH, Cheung AWL. Measuring the impact of chronic conditions and associated multimorbidity on health-related quality of life in the general population in Hong Kong SAR, China: A cross-sectional study. PLoS One 2019; 14:e0224970. [PMID: 31747393 PMCID: PMC6867645 DOI: 10.1371/journal.pone.0224970] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/25/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives The aims of this study were to 1) evaluate the impact of eight common chronic conditions and multimorbidity on preference-based health-related quality of life (HRQoL), and 2) estimate the minimally important difference (MID) in the general population of Hong Kong (HK). Design Data were analyzed using secondary data analysis based on a cross-sectional, population-based validation study of HK’s general population. Participants A representative sample was recruited across eighteen geographical districts in HK, and 1,014 HK Chinese residents aged 18 years and older participated in the survey. The prevalence of chronic conditions among the respondents was 30.3%. Interventions The HRQoL was assessed using the locally validated version of EQ-5D-5L. The five-dimension descriptive system, and the utility scores of EQ-5D-5L were used as the dependent variable in the study. Eight common chronic conditions, multimorbidity, and demographic characteristics were defined as predictors in the analysis. Chi-squared test, analysis of variance (ANOVA), logistic regression, and Tobit regression models were used to analyze the data. A simulation-based approach was used to calculate the MID based on instrument-defined single level transitions. Results The findings indicated that respondents with physical disabilities were more likely to report problems on all five dimensions of the EQ-5D-5L than those with other chronic conditions. In addition, respondents with multiple chronic conditions were more likely to report health problems and lower utility scores of EQ-5D-5L. The mean of MID estimates among the respondents in HK was 0.093 (standard deviation = 0.001), which is higher than in other Asian countries. Conclusions The findings suggest that having more chronic conditions is strongly associated with a lower HRQoL. Healthcare reforms to address foreseeable challenges arising as more patients live with chronic conditions and multimorbidity could improve the HRQoL of HK citizens.
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Affiliation(s)
- Eliza Lai yi Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- * E-mail: (ELW); (RHX)
| | - Richard Huan Xu
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- * E-mail: (ELW); (RHX)
| | - Annie Wai ling Cheung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
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Majumdar UB, Hunt C, Doupe P, Baum AJ, Heller DJ, Levine EL, Kumar R, Futterman R, Hajat C, Kishore SP. Multiple chronic conditions at a major urban health system: a retrospective cross-sectional analysis of frequencies, costs and comorbidity patterns. BMJ Open 2019; 9:e029340. [PMID: 31619421 PMCID: PMC6797368 DOI: 10.1136/bmjopen-2019-029340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To (1) examine the burden of multiple chronic conditions (MCC) in an urban health system, and (2) propose a methodology to identify subpopulations of interest based on diagnosis groups and costs. DESIGN Retrospective cross-sectional study. SETTING Mount Sinai Health System, set in all five boroughs of New York City, USA. PARTICIPANTS 192 085 adult (18+) plan members of capitated Medicaid contracts between the Healthfirst managed care organisation and the Mount Sinai Health System in the years 2012 to 2014. METHODS We classified adults as having 0, 1, 2, 3, 4 or 5+ chronic conditions from a list of 69 chronic conditions. After summarising the demographics, geography and prevalence of MCC within this population, we then described groups of patients (segments) using a novel methodology: we combinatorially defined 18 768 potential segments of patients by a pair of chronic conditions, a sex and an age group, and then ranked segments by (1) frequency, (2) cost and (3) ratios of observed to expected frequencies of co-occurring chronic conditions. We then compiled pairs of conditions that occur more frequently together than otherwise expected. RESULTS 61.5% of the study population suffers from two or more chronic conditions. The most frequent dyad was hypertension and hyperlipidaemia (19%) and the most frequent triad was diabetes, hypertension and hyperlipidaemia (10%). Women aged 50 to 65 with hypertension and hyperlipidaemia were the leading cost segment in the study population. Costs and prevalence of MCC increase with number of conditions and age. The disease dyads associated with the largest observed/expected ratios were pulmonary disease and myocardial infarction. Inter-borough range MCC prevalence was 16%. CONCLUSIONS In this low-income, urban population, MCC is more prevalent (61%) than nationally (42%), motivating further research and intervention in this population. By identifying potential target populations in an interpretable manner, this segmenting methodology has utility for health services analysts.
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Affiliation(s)
- Usnish B Majumdar
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | - Patrick Doupe
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Aaron J Baum
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - David J Heller
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Erica L Levine
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | | | | | - Sandeep P Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Rowan CP, Chan BCF, Jaglal SB, Catharine Craven B. Describing the current state of post-rehabilitation health system surveillance in Ontario - an invited review. J Spinal Cord Med 2019; 42:21-33. [PMID: 31573448 PMCID: PMC6781471 DOI: 10.1080/10790268.2019.1605724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Context: Spinal cord injury (SCI) presents numerous physiological, psychosocial, and environmental complexities resulting in significant healthcare system resource demands. Objective: To describe the current health system surveillance mechanisms in Ontario, Canada and highlight gaps in health surveillance among adults with SCI across their lifespan. Methods: A review of administrative data sources capturing SCI-specific information took place via internet searching and networking among SCI rehabilitation and health services experts with emphasis on functionality, health service utilization, and quality of life data. Results: The review identified a distinct paucity of data elements specific to the health surveillance needs of individuals with SCI living in the community. The gaps identified are: (1) a lack of data usability; (2) inadequate linkage between available datasets; (3) inadequate/infrequent reporting of outcomes; (4) a lack of relevant content/patient-reported outcomes; and, (5) failure to incorporate additional data sources (e.g. Insurance datasets). Conclusion: Currently, SCI-specific health data is disproportionately weighted towards the first 3-6 months post injury with detailed data regarding pre-hospital care, acute management and rehabilitation, but little existing infrastructure supporting community-based health surveillance. Given this reality, the bolstering of meaningful community health surveillance of this population across the lifespan is needed. Addressing the identified gaps in health surveillance must inform the creation of a comprehensive community health dataset incorporating patient-reported outcome measures and enabling linkage with existing administrative and/or clinical databases. A future harmonized data surveillance strategy would, in turn, positively impact function, health services, resource utilization and health-related quality of life surveillance.
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Affiliation(s)
- Chip P. Rowan
- KITE, Toronto Rehab — University Health Network, Toronto, Ontario, Canada,Correspondence to: Chip P. Rowan, Research Department, KITE, Toronto Rehab — University Health Network, Lyndhurst Centre, 520 Sutherland Dr, Toronto, Ontario, Canada M4G 3V9; Ph: 416-597-3422 x6217.
| | - Brian C. F. Chan
- KITE, Toronto Rehab — University Health Network, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Susan B. Jaglal
- KITE, Toronto Rehab — University Health Network, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE, Toronto Rehab — University Health Network, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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60
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Lila AM, Gordeev AV, Olyunin YA, Galushko EA. Multimorbidity in rheumatology. From comprehensive assessment of disease to evaluation of a set of diseases. MODERN RHEUMATOLOGY JOURNAL 2019. [DOI: 10.14412/1996-7012-2019-3-4-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- A. M. Lila
- V.A. Nasonova Research Institute of Rheumatology; Department of Rheumatology, Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
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Suls J, Green PA, Boyd CM. Multimorbidity: Implications and directions for health psychology and behavioral medicine. Health Psychol 2019; 38:772-782. [PMID: 31436463 PMCID: PMC6750244 DOI: 10.1037/hea0000762] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The increasing prevalence of multimorbidity in the United States and the rest of the world poses problems for patients and for health care providers, care systems, and policy. After clarifying the difference between comorbidity and multimorbidity, this article describes the challenges that the prevalence of multimorbidity presents for well-being, prevention, and medical treatment. We submit that health psychology and behavioral medicine have an important role to play in meeting these challenges because of the holistic vision of health afforded by the foundational biopsychosocial model. Furthermore, opportunities abound for health psychology/behavioral medicine to study how biological, social and psychological factors influence multimorbidity. This article describes three major areas in which health psychologists can contribute to understanding and treatment of multimorbidity: (a) etiology; (b) prevention and self-management; and (c) clinical care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Jerry Suls
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Paige A Green
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, National Cancer Institute
| | - Cynthia M Boyd
- Cynthia M. Boyd, School of Medicine, Johns Hopkins University
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62
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Physical activity, multimorbidity, and life expectancy: a UK Biobank longitudinal study. BMC Med 2019; 17:108. [PMID: 31186007 PMCID: PMC6560907 DOI: 10.1186/s12916-019-1339-0] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 05/01/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Multimorbidity is an emerging public health priority. Physical activity (PA) is recommended as one of the main lifestyle behaviours, yet the benefits of PA for people with multimorbidity are unclear. We assessed the benefits of PA on mortality and life expectancy in people with and without multimorbidity. METHODS Using the UK Biobank dataset, we extracted data on 36 chronic conditions and defined multimorbidity as (a) 2 or more conditions, (b) 2 or more conditions combined with self-reported overall health, and (c) 2 or more top-10 most common comorbidities. Leisure-time PA (LTPA) and total PA (TPA) were measured by questionnaire and categorised as low (< 600 metabolic equivalent (MET)-min/week), moderate (600 to < 3000 MET-min/week), and high (≥ 3000 MET-min/week), while objectively assessed PA was assessed by wrist-worn accelerometer and categorised as low (4 min/day), moderate (10 min/day), and high (22 min/day) walking at brisk pace. Survival models were applied to calculate adjusted hazard ratios (HRs) and predict life expectancy differences. RESULTS 491,939 individuals (96,622 with 2 or more conditions) had a median follow-up of 7.0 (IQR 6.3-7.6) years. Compared to low LTPA, for participants with multimorbidity, HR for mortality was 0.75 (95% CI 0.70-0.80) and 0.65 (0.56-0.75) in moderate and high LTPA groups, respectively. This finding was consistent when using TPA measures. Using objective PA, HRs were 0.49 (0.29-0.80) and 0.29 (0.13-0.61) in the moderate and high PA groups, respectively. These findings were similar for participants without multimorbidity. In participants with multimorbidity, at the age of 45 years, moderate and high LTPA were associated with an average of 3.12 (95% CI 2.53, 3.71) and 3.55 (2.34, 4.77) additional life years, respectively, compared to low LTPA; in participants without multimorbidity, corresponding figures were 1.95 (1.59, 2.31) and 1.85 (1.19, 2.50). Similar results were found with TPA. For objective PA, moderate and high levels were associated with 3.60 (- 0.60, 7.79) and 5.32 (- 0.47, 11.11) life years gained compared to low PA for those with multimorbidity and 3.88 (1.79, 6.00) and 4.51 (2.15, 6.88) life years gained in those without. Results were consistent when using other definitions of multimorbidity. CONCLUSIONS There was an inverse dose-response association between PA and mortality. A moderate exercise is associated with a longer life expectancy, also in individuals with multimorbidity.
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John C, Reeve NF, Free RC, Williams AT, Ntalla I, Farmaki AE, Bethea J, Barton LM, Shrine N, Batini C, Packer R, Terry S, Hargadon B, Wang Q, Melbourne CA, Adams EL, Bee CE, Harrington K, Miola J, Brunskill NJ, Brightling CE, Barwell J, Wallace SE, Hsu R, Shepherd DJ, Hollox EJ, Wain LV, Tobin MD. Cohort Profile: Extended Cohort for E-health, Environment and DNA (EXCEED). Int J Epidemiol 2019; 48:678-679j. [PMID: 31062032 PMCID: PMC6659362 DOI: 10.1093/ije/dyz073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
- Catherine John
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Nicola F Reeve
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Robert C Free
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | | | - Ioanna Ntalla
- Department of Health Sciences, University of Leicester, Leicester, UK
- Department of Clinical Pharmacology, William Harvey Research Institute, Barts & The London Medical School, Queen Mary University of London, Charterhouse Square, London, UK
| | - Aliki-Eleni Farmaki
- Department of Health Sciences, University of Leicester, Leicester, UK
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK
| | - Jane Bethea
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Linda M Barton
- Department of Haematology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Nick Shrine
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Chiara Batini
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Richard Packer
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sarah Terry
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Beverley Hargadon
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Qingning Wang
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Carl A Melbourne
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Emma L Adams
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Catherine E Bee
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Kyla Harrington
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - José Miola
- Leicester Law School, University of Leicester, Leicester, UK
| | - Nigel J Brunskill
- Department of Cardiovascular Sciences University of Leicester, Leicester, UK
| | - Christopher E Brightling
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Julian Barwell
- Department of Genetics and Genome Biology, University of Leicester, Leicester, UK
| | - Susan E Wallace
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Ron Hsu
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - David J Shepherd
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Edward J Hollox
- Department of Genetics and Genome Biology, University of Leicester, Leicester, UK
| | - Louise V Wain
- Department of Health Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Martin D Tobin
- Department of Health Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
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Smith S, Murphy E, Hannigan C, Dinsmore J, Doyle J. Supporting older people with multimorbidity: The care burden of home health-care assistants in Ireland. Home Health Care Serv Q 2019; 38:241-255. [DOI: 10.1080/01621424.2019.1614506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Suzanne Smith
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Co. Louth, Ireland
| | - Emma Murphy
- Trinity Centre for Practice and Healthcare Innovation, Trinity College, Dublin, Ireland
| | - Caoimhe Hannigan
- Trinity Centre for Practice and Healthcare Innovation, Trinity College, Dublin, Ireland
| | - John Dinsmore
- Trinity Centre for Practice and Healthcare Innovation, Trinity College, Dublin, Ireland
| | - Julie Doyle
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Co. Louth, Ireland
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Griffith LE, Gilsing A, Mangin D, Patterson C, van den Heuvel E, Sohel N, St John P, van den Akker M, Raina P. Multimorbidity Frameworks Impact Prevalence and Relationships with Patient-Important Outcomes. J Am Geriatr Soc 2019; 67:1632-1640. [PMID: 30957230 DOI: 10.1111/jgs.15921] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 03/02/2019] [Accepted: 03/13/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To explore how different frameworks and categories of chronic conditions impact multimorbidity (defined as two or more chronic conditions) prevalence estimates and associations with patient-important functional outcomes. DESIGN Baseline data from a population-based cohort study. SETTING National sample of Canadians. PARTICIPANTS A total of 51 338 community-living adults, aged 45 to 85 years. MAIN OUTCOME MEASURES Chronic conditions from three commonly recognized frameworks were categorized as: (1) diseases, (2) risk factors, or (3) symptoms. Estimates of multimorbidity prevalence were compared among frameworks by age and sex. Separate weighted logistic regression models were used to explore the impact of the different frameworks and categories of chronic conditions on odds ratios (ORs) for multimorbidity for four patient-important functional outcomes: disability, social participation restriction, and self-rated physical and mental health. RESULTS One framework included diseases and risk factors, and two frameworks included diseases, risk factors, and symptoms. The prevalence of multimorbidity differed among the frameworks, ranging from 33.5% to 60.6% having two or more chronic conditions. Including risk factors in frameworks increased prevalence estimates, while including symptoms increased prevalence estimates and associations with most patient-important outcomes. The two frameworks that included symptoms had the largest ORs for associations with disability, social participation restriction, and self-rated physical health but not self-rated mental health. Similar results were found when we compared ORs for patient-important outcome for multimorbidity based on three subframeworks: one including diseases only, one including diseases and risk factors, and one including diseases, risk factors, and symptoms. CONCLUSIONS Including risk factors appeared to increase only the prevalence of multimorbidity without significantly altering relationships to outcomes. The inclusion of symptoms increased prevalence and associations with patient-important outcomes. These findings underscore the importance of considering not only the number, but also the category, of conditions included in multimorbidity frameworks, as simply counting the number of diagnoses may reduce sensitivity to outcomes that are important to individuals. J Am Geriatr Soc 67:1632-1640, 2019.
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Affiliation(s)
- Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anne Gilsing
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Edwin van den Heuvel
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Nazmul Sohel
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Philip St John
- Section of Geriatric Medicine, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marjan van den Akker
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands.,Department of Public Health and Primary Care, Academic Center for General Practice - KU Leuven, Leuven, Belgium
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Ofori-Asenso R, Chin KL, Curtis AJ, Zomer E, Zoungas S, Liew D. Recent Patterns of Multimorbidity Among Older Adults in High-Income Countries. Popul Health Manag 2019; 22:127-137. [DOI: 10.1089/pop.2018.0069] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Richard Ofori-Asenso
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ken Lee Chin
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrea J. Curtis
- Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ella Zomer
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sophia Zoungas
- Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Danny Liew
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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McKinlay E, McDonald J, Darlow B, Perry M. The social networks of New Zealand patients with multimorbidity and the work of those nominated as their 'significant supporters': An exploratory study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:392-399. [PMID: 30175532 DOI: 10.1111/hsc.12657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/04/2018] [Accepted: 08/03/2018] [Indexed: 06/08/2023]
Abstract
Social networks are informal relationships often with social ties and voluntary or mandatory obligations that can positively support a patient with multimorbidity. This exploratory study sought insights into the social networks of New Zealand people with multimorbidity and also the work of those nominated as providing significant support. Ten participants were recruited from general practice as part of an education programme in which health professional students discussed living with multimorbidity and completed a social network template together with patients. Each patient nominated an individual from their social network whom they considered provided significant support. A researcher interviewed each supporter about their experience of providing support, and their view of the patient's social network. Significant supporters included three classified as 'lay' supporters (sister, wife and daughter) and seven classified as 'professional' supporters (exercise physiologist, general practitioners, nurse, medical specialists). The activities described by supporters was classified according to Vassilev et al.'s expansion of Corbin and Strauss's 1985 classification of work in chronic illness, including the categories of "illness," "everyday" and "emotional" work. Irrespective of whether supporters were lay or professional, they gave examples of each category. While this is expected of lay supporters, it is not expected of professional supporters who are typically viewed as undertaking illness work. Lay supporters described a complex array of activities sometimes impacting on their own personal well-being, making them more akin to meeting the formal definition of being a carer, while professional supports gave objective yet professionally invested descriptions. The work of lay and professional supporters is complementary in the provision of support for those with multimorbidity. Consideration should be given to the role of lay supporters and to their own needs if they are to be able to sustain their support work with patients.
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Affiliation(s)
| | - Janet McDonald
- Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand
| | - Ben Darlow
- University of Otago Wellington, Wellington, New Zealand
| | - Meredith Perry
- School of Physiotherapy, Centre for Health, Activity and Rehabilitation Research, University of Otago Wellington, Wellington, New Zealand
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68
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Maehder K, Löwe B, Härter M, Heddaeus D, Scherer M, Weigel A. Management of comorbid mental and somatic disorders in stepped care approaches in primary care: a systematic review. Fam Pract 2019; 36:38-52. [PMID: 30535053 DOI: 10.1093/fampra/cmy122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Stepped care models comprise a graded treatment intensity and a systematic monitoring. For an effective implementation, stepped care models have to account for the high rates of mental and somatic comorbidity in primary care. OBJECTIVES The aim of the systematic review was to take stock of whether present stepped care models take comorbidities into consideration. A further aim was to give an overview on treatment components and involved health care professionals. METHODS A systematic literature search was performed using the databases PubMed, PsycINFO, Cochrane Library and Web of Science. Selection criteria were a randomized controlled trial of a primary-care-based stepped care intervention, adult samples, publication between 2000 and 2017 and English or German language. RESULTS Of 1009 search results, 39 studies were eligible. One-third of the trials were conceived for depressive disorders only, one-third for depression and further somatic and/or mental comorbidity and one-third for conditions other than depression. In 39% of the studies comorbidities were explicitly integrated in treatment, mainly via transdiagnostic self-management support, interprofessional collaboration and digital approaches for treatment, monitoring and communication. Most care teams were composed of a primary care physician, a care manager and a psychiatrist and/or psychologist. Due to the heterogeneity of the addressed disorders, no meta-analysis was performed. CONCLUSIONS Several stepped care models in primary care already account for comorbidities, with depression being the predominant target disorder. To determine their efficacy, the identified strategies to account for comorbidities should be investigated within stepped care models for a broader range of disorders.
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Affiliation(s)
- Kerstin Maehder
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
| | - Daniela Heddaeus
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
| | - Martin Scherer
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Germany
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
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Lai FTT, Guthrie B, Wong SYS, Yip BHK, Chung GKK, Yeoh EK, Chung RY. Sex-specific intergenerational trends in morbidity burden and multimorbidity status in Hong Kong community: an age-period-cohort analysis of repeated population surveys. BMJ Open 2019; 9:e023927. [PMID: 30782718 PMCID: PMC6347870 DOI: 10.1136/bmjopen-2018-023927] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Prevalence of multimorbidity has been increasing worldwide. While population ageing undoubtedly contributes, secular trends have seldom been decomposed into age, period and cohort effects to investigate intergenerational differences. This study examines the birth cohort effect on morbidity burden and multimorbidity in Hong Kong community. DESIGN Sex-specific age-period-cohort analysis with repeated cross-sectional surveys. SETTING A territory-wide population survey database. PARTICIPANTS 69 636 adults aged 35 or above who participated in the surveys in 1999, 2001, 2005 or 2008. MAIN OUTCOME MEASURES Morbidity burden was operationalised as number of chronic conditions from a list of 14, while multimorbidity was defined as a dichotomous status of whether participants had two or more conditions. RESULTS For both sexes, there was an upward inflection (positive change) of risk of increased morbidity burden starting from cohort 1955-1959. For men born after 1945-1954, there was a trend of lower risk (relative risk=0.63, 95% CI 0.50 to 0.80 for 1950-1954 vs 1935-1939) which continued through subsequent cohorts but with no further declines. In women, there had been a gradual increase of risk, although only significant for cohort 1970-1974 (relative risk=1.90, 95% CI 1.08 to 1.34 vs 1935-1939). Similar results were found for dichotomous multimorbidity status. CONCLUSIONS The trend of lower risk starting from men born in 1945-1954 may be due to a persistent decline in smoking rates since the 1980s. On the other hand, the childhood obesity epidemic starting from the late 1950s coincided with the observed upward inflection of risk for both sexes, that is, notably more drastic increase of risk in women and the levelling-off of the decline of risk in men. These findings highlight that the cohort effects on morbidity burden and multimorbidity may be sex-specific and contextual. By examining such effects in different world populations, localised sex-specific and generation-specific risk factors can be identified to inform policy-making.
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Affiliation(s)
- Francisco T T Lai
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Bruce Guthrie
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Samuel Y S Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Benjamin H K Yip
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Gary K K Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Eng-Kiong Yeoh
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Roger Y Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
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Macinko J, Andrade FCD, Nunes BP, Guanais FC. Primary care and multimorbidity in six Latin American and Caribbean countries. Rev Panam Salud Publica 2019; 43:e8. [PMID: 31093232 PMCID: PMC6393736 DOI: 10.26633/rpsp.2019.8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 09/17/2018] [Indexed: 01/15/2023] Open
Abstract
Objectives To describe patterns of multimorbidity in six diverse Latin American and Caribbean countries, examine its effects on primary care experiences, and assess its influence on reported overall health care assessments. Methods Cross-sectional data are from the Inter-American Development Bank's international primary care survey, conducted in 2013/2014, and represent the adult populations of Brazil, Colombia, El Salvador, Jamaica, Mexico and Panama. Robust Poisson regression models were used to estimate the extent to which those with multimorbidity receive adequate and appropriate primary care, have confidence in managing their health condition, and are able to afford needed medical care. Results The prevalence of multimorbidity ranged from 17.5% in Colombia to 37.3% in Jamaica. Most of the examined conditions occur along with others, with diabetes and heart disease being the two problems most associated with other conditions. The proportions of adults with high out-of-pocket payments, problems paying their medical bills, seeing multiple doctors, and being in only fair/poor health were higher among those with greater levels of multimorbidity and poorer primary care experiences. Multimorbidity and difficulties with primary care were positively associated with trouble paying for medical care and managing one's conditions. Nonetheless, adults with multimorbidity were more likely to have received lifestyle advice and to be up to date with preventive exams. Conclusions Multimorbidity is reported frequently. Providing adequate care for the growing number of such patients is a major challenge facing most health systems, which will require considerable strengthening of primary care along with financial protection for those most in need.
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Affiliation(s)
- James Macinko
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Flavia C D Andrade
- University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Bruno P Nunes
- Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
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Marino M, de Belvis AG, Tanzariello M, Dotti E, Bucci S, Colotto M, Ricciardi W, Boccia S. Effectiveness and cost-effectiveness of integrated care models for elderly, complex patients: A narrative review. Don’t we need a value-based approach? INTERNATIONAL JOURNAL OF CARE COORDINATION 2018. [DOI: 10.1177/2053434518817019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The management of patients with complex health and social needs is one of the main challenges for healthcare systems. Integrated care seems to respond to this issue, with collaborative working and integration efforts of the care system components professionals and service providers aimed at improving efficiency, appropriateness and person centeredness of care. We conducted a narrative review to analyse the available evidences published on effectiveness and cost-effectiveness of integrated care models targeted on the management of such elderly patients. Methods MEDLINE, Scopus and EBSCO were searched. We reported this narrative review according to the PRISMA Checklist. For studies to be included, they had to: (i) refer to integrated care models through implemented experimental or demonstration projects; (ii) focus on frail elderly ≥65 years old, with complex health and social needs, not disease-specific; (iii) evaluate effectiveness and/or cost and/or cost-effectiveness; (iv) report quantitative data (e.g. health outcomes, utilization outcomes, cost and cost-effectiveness). Results Thirty articles were included, identifying 13 integrated care models. Common features were identified in case management, geriatric assessment and multidisciplinary team. Favourable impacts on healthcare facilities utilization rates, though with mixed results on costs, were found. The development of community-based and cost-effective integrated systems of care for the elderly is possible, thanks to the cooperation across care professionals and providers, to achieving a relevant impact on healthcare and efficient resource management. The elements of success or failure are not always unique and identifiable, but the potential clearly exists for these models to be successful and generalized on a large scale. Discussion We found out a favourable impact of integrated care models/methods on health outcomes, care utilization and costs. The selected interventions are likely to be implemented at community level, focused on the patient management in terms of continuity of care. Thus, we propose a value-based framework for the evaluation of these services.
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Araujo MEA, Silva MT, Galvao TF, Nunes BP, Pereira MG. Prevalence and patterns of multimorbidity in Amazon Region of Brazil and associated determinants: a cross-sectional study. BMJ Open 2018; 8:e023398. [PMID: 30391918 PMCID: PMC6231594 DOI: 10.1136/bmjopen-2018-023398] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of multimorbidity and to identify factors associated with it in the adult population from the metropolitan region of Manaus. DESIGN Cross-sectional population-based study. SETTING Interviews conducted between May and August of 2015 in eight cities that compose the metropolitan region of Manaus, Amazonas, Brazil. PARTICIPANTS 4001 adults aged ≥18 years. PRIMARY OUTCOME MEASURES Multimorbidity, measured by the occurrence of ≥2 and ≥3 chronic diseases, was the primary outcome. The associated factors were investigated by calculating the prevalence ratio (PR) obtained by Poisson regression, with robust adjustment of the variance in a hierarchical model. A factor analysis was conducted to investigate multimorbidity clusters. RESULTS Half of the interviewees were women. The presence of a chronic disease was reported by 57.2% (95% CI 56.6% to 59.7%) of the interviewees, and the mean morbidity was 1.2 (1.1-1.2); 29.0% (95% CI 27.6% to 30.5%) reported ≥2 morbidities and 15.2% (95% CI 14.1% to 16.4%) reported ≥3 chronic conditions. Back pain was reported by one-third of the interviewees. Multimorbidity was highest in women, PR=1.66 (95% CI 1.50 to 1.83); the elderly, PR=5.68 (95% CI 4.51 to 7.15) and individuals with worse health perception, PR=3.70 (95% CI 2.73 to 5.00). Associated factors also included undergoing medical consultations, hospitalisation in the last year, suffering from dengue in the last year and seeking the same healthcare service. Factor analysis revealed a pattern of multimorbidity in women. The factor loading the most strength of association in women was heart disease. In men, an association was identified in two groups, and lung disease was the disease with the highest factorial loading. CONCLUSION Multimorbidity was frequent in the metropolitan region of Manaus. It occurred most often in women, in the elderly and in those with worse health perception.
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Affiliation(s)
- Maria Elizete A Araujo
- Post-Graduate Program Health Sciences, University of Brasilia, Brasilia, Brazil
- Getulio Vargas University Hospital, Federal University of Amazonas, Manaus, Brazil
| | - Marcus T Silva
- Faculty Medicine, Federal University of Amazonas, Manaus, Brazil
- Post-Graduate Program of Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
| | - Tais F Galvao
- Faculty of Pharmaceutical Sciences, State University of Campinas, Campinas, Brazil
| | - Bruno P Nunes
- Department of Nursing in Public Health, Federal University of Pelotas, Pelotas, Brazil
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Nunes BP, Batista SRR, Andrade FBD, Souza Junior PRBD, Lima-Costa MF, Facchini LA. Multimorbidity: The Brazilian Longitudinal Study of Aging (ELSI-Brazil). Rev Saude Publica 2018; 52Suppl 2:10s. [PMID: 30379288 PMCID: PMC6254906 DOI: 10.11606/s1518-8787.2018052000637] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/17/2018] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To evaluate the occurrence and factors associated with multimorbidity among Brazilians aged 50 years and over. METHODS This is a cross-sectional study in a nation-based cohort of the non-institutionalized population in Brazil. Data were collected between 2015 and 2016. Multimorbidity was assessed from a list of 19 morbidities, which were categorized into ≥ 2 and ≥ 3 diseases. The analysis included the calculation of frequencies and the most frequent 10 pairs and triplets of combinations of diseases. The crude and adjusted analyses evaluated the demographic, socioeconomic, behavioral, and contextual variables (area of residence, geopolitical region, and coverage of the Family Health Strategy) using Poisson regression. RESULTS From the total of 9,412 individuals, 67.8% (95%CI 65.6–69.9) and 47.1% (95%CI 44.8–49.4) showed ≥ 2 and ≥ 3 diseases, respectively. In the adjusted analysis, women, older persons, and those who did not consume alcohol had increased multimorbidity. There were no associations with race, area of residence, geopolitical region, and coverage of the Family Health Strategy. The 10 pairs (frequencies observed between 11.6% and 23.2%) and the 10 triplets (frequencies observed between 4.9% and 9.5%) of the most frequent diseases mostly included back problems (15 times) and systemic arterial hypertension (11 times). All combinations were statistically higher than expected by chance. CONCLUSIONS The occurrence of multimorbidity was high even among younger individuals (50 to 59 years). Approximately two in three (≥ 2 diseases) and one in two (≥ 3 diseases) individuals aged 50 years and over presented multimorbidity, which represents 26 and 18 million persons in Brazil, respectively. We observed high frequencies of combinations of morbidities.
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Affiliation(s)
- Bruno Pereira Nunes
- Universidade Federal de Pelotas. Faculdade de Enfermagem. Departamento de Enfermagem em Saúde Coletiva. Pelotas, RS, Brasil
| | | | - Fabíola Bof de Andrade
- Fundação Oswaldo Cruz. Instituto René Rachou. Programa de Pós-Graduação em Saúde Coletiva. Belo Horizonte, MG, Brasil.,Fundação Oswaldo Cruz. Instituto René Rachou. Núcleo de Estudos em Saúde Pública e Envelhecimento. Belo Horizonte, MG, Brasil
| | | | - Maria Fernanda Lima-Costa
- Fundação Oswaldo Cruz. Instituto René Rachou. Programa de Pós-Graduação em Saúde Coletiva. Belo Horizonte, MG, Brasil.,Fundação Oswaldo Cruz. Instituto René Rachou. Núcleo de Estudos em Saúde Pública e Envelhecimento. Belo Horizonte, MG, Brasil
| | - Luiz Augusto Facchini
- Universidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
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74
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Ferreira GD, Simões JA, Senaratna C, Pati S, Timm PF, Batista SR, Nunes BP. Physiological markers and multimorbidity: A systematic review. JOURNAL OF COMORBIDITY 2018; 8:2235042X18806986. [PMID: 30364915 PMCID: PMC6201184 DOI: 10.1177/2235042x18806986] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 09/07/2018] [Indexed: 01/08/2023]
Abstract
Background: Multimorbidity is the co-occurrence of two or more diseases in the same
individual. One method to identify this condition at an early stage is the
use of specific markers for various combinations of morbidities.
Nonetheless, evidence related to physiological markers in multimorbidity is
limited. Objective: The aim was to perform a systematic review to identify physiological markers
associated with multimorbidity. Design: Articles available on PubMed, Register of Controlled Trials, Academic Search
Premier, CINAHL, Scopus, SocINDEX, Web of Science, LILACS, and SciELO, from
their inception to May 2018, were systematically searched and reviewed. The
project was registered in PROSPERO under the number CRD42017055522. Results: The systematic search identified 922 papers. After evaluation, 18 articles
were included in the full review reporting at least one physiological marker
in coexisting diseases or which are strongly associated with the presence of
multimorbidity in the future. Only five of these studies examined
multimorbidity in general, identifying five physiological markers associated
with multimorbidity, namely, dehydroepiandrosterone sulfate (DHEAS),
interleukin 6 (IL-6), C-reactive protein (CRP), lipoprotein (Lp), and
cystatin C (Cyst-C). Conclusions: There is a paucity of studies related to physiological markers in
multimorbidity. DHEAS, IL-6, CRP, Lp, and Cyst-C could be the initial focus
for further investigation of physiological markers related to
multimorbidity.
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Affiliation(s)
- Gustavo Dias Ferreira
- Department of Physiology and Pharmacology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Chamara Senaratna
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia.,Department of Comunity Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Department of Health Research, Bhubaneswar, Odisha, India
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75
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Pouplier S, Olsen MÅ, Willadsen TG, Sandholdt H, Siersma V, Andersen CL, Olivarius NDF. The development of multimorbidity during 16 years after diagnosis of type 2 diabetes. JOURNAL OF COMORBIDITY 2018; 8:2235042X18801658. [PMID: 30363325 PMCID: PMC6169975 DOI: 10.1177/2235042x18801658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 08/14/2018] [Indexed: 12/21/2022]
Abstract
Objective: The aims of this study were to (1) quantify the development and composition
of multimorbidity (MM) during 16 years following the diagnosis of type 2
diabetes and (2) evaluate whether the effectiveness of structured personal
diabetes care differed between patients with and without MM. Research design and methods: One thousand three hundred eighty-one patients with newly diagnosed type 2
diabetes were randomized to receive either structured personal diabetes care
or routine diabetes care. Patients were followed up for 19 years in Danish
nationwide registries for the occurrence of outcomes. We analyzed the
prevalence and degree of MM based on 10 well-defined disease groups. The
effect of structured personal care in diabetes patients with and without MM
was analyzed with Cox regression models. Results: The proportion of patients with MM increased from 31.6% at diabetes diagnosis
to 80.4% after 16 years. The proportion of cardiovascular and
gastrointestinal diseases in surviving patients decreased, while, for
example, musculoskeletal, eye, and neurological diseases increased. The
effect of the intervention was not different between type 2 diabetes
patients with or without coexisting chronic disease. Conclusions: In general, the proportion of patients with MM increased after diabetes
diagnosis, but the composition of chronic disease changed during the 16
years. We found cardiovascular and musculoskeletal disease to be the most
prevalent disease groups during all 16 years of follow-up. The post hoc
analysis of the intervention showed that its effectiveness was not different
among patients who developed MM compared to those who continued to have
diabetes alone.
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Affiliation(s)
- Sandra Pouplier
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maria Åhlander Olsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tora Grauers Willadsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Håkon Sandholdt
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christen Lykkegaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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76
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Griffith LE, Gruneir A, Fisher KA, Nicholson K, Panjwani D, Patterson C, Markle-Reid M, Ploeg J, Bierman AS, Hogan DB, Upshur R. Key factors to consider when measuring multimorbidity: Results from an expert panel and online survey. JOURNAL OF COMORBIDITY 2018; 8:2235042X18795306. [PMID: 30363320 PMCID: PMC6169974 DOI: 10.1177/2235042x18795306] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/26/2018] [Indexed: 11/28/2022]
Abstract
Background: There are multiple multimorbidity measures but little consensus on which
measures are most appropriate for different circumstances. Objective: To share insights gained from discussions with experts in the fields of
ageing research and multimorbidity on key factors to consider when measuring
multimorbidity. Design: Descriptive study of expert opinions on multimorbidity measures, informed by
literature to identify available measures followed by a face-to-face meeting
and an online survey. Results: The expert group included clinicians, researchers and policymakers in Canada
with expertise in the fields of multimorbidity and ageing. Of the 30 experts
invited, 15 (50%) attended the in-person meeting and 14 (47%) responded to
the subsequent online survey. Experts agreed that there is no single
multimorbidity measure that is suitable for all research studies. They cited
a number of factors that need to be considered in selecting a measure for
use in a research study including: (1) fit with the study purpose; (2) the
conditions included in multimorbidity measures; (3) the role of episodic
conditions or diseases; and (4) the role of social factors and other
concepts missing in existing approaches. Conclusions: The suitability of existing multimorbidity measures for use in a specific
research study depends on factors such as the purpose of the study, outcomes
examined and preferences of the involved stakeholders. The results of this
study suggest that there are areas that require further building out in both
the conceptualization and measurement of multimorbidity for the benefit of
future clinical, research and policy decisions.
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Affiliation(s)
- Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Gruneir
- Department of Family Medicine, Institute of Clinical Evaluative Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kathryn A Fisher
- School of Nursing, and Aging, Community and Health Research Unit, McMaster University, Hamilton, Ontario, Canada
| | - Kathryn Nicholson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Dilzayn Panjwani
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | | | - Maureen Markle-Reid
- School of Nursing, and Aging, Community and Health Research Unit, McMaster University, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- School of Nursing, and Aging, Community and Health Research Unit, McMaster University, Hamilton, Ontario, Canada
| | - Arlene S Bierman
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ross Upshur
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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77
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General Practitioners Records Are Epidemiological Predictors of Comorbidities: An Analytical Cross-Sectional 10-Year Retrospective Study. J Clin Med 2018; 7:jcm7080184. [PMID: 30060447 PMCID: PMC6111778 DOI: 10.3390/jcm7080184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 01/18/2023] Open
Abstract
Background. Comorbidity represents the co-occurrence of pathological conditions in the same individual, and presents with very complex patterns. In most cases, reference data for the study of various types of comorbidities linked to complex diseases are those of hospitalized patients. Such patients may likely require cure due to acute conditions. We consider the emerging role of EHR (Electronic Healthcare Records), and study comorbidity patterns in a general population, focusing on diabetic and non-diabetic patients. Methods. We propose a cross-sectional 10-year retrospective study of 14,958 patients and 1,728,736 prescriptions obtained from family doctors, and thus refer to these data as General Practitioner Records (GPR). We then choose networks as the tools to analyze the diabetes comorbidity patterns, distinguished by both prescription type and main patient characteristics (age, gender). Results. As expected, comorbidity increases with patients’ age, and the network representations allow the assessment of associations between morbidity groups. The specific morbidities present in the diabetic population justify the higher comorbidity patterns observed in the target group compared to the non-diabetic population. Conclusions. GPR are usually combined with other data types in EHR studies, but we have shown that prescription data have value as standalone predictive tools, useful to anticipate trends observed at epidemiological level on large populations. This study is thus relevant to policy makers seeking inference tools for an efficient use of massive administrative database resources, and suggests a strategy for detecting comorbidities and investigating their evolution.
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78
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Harrison SM, Wei MY, Lamerato LE, Petrie JG, Toth Martin E. Multimorbidity is associated with uptake of influenza vaccination. Vaccine 2018; 36:3635-3640. [PMID: 29748031 PMCID: PMC6258008 DOI: 10.1016/j.vaccine.2018.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/24/2018] [Accepted: 05/04/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Patients with chronic conditions have higher rates of severe influenza-related illness and mortality. However, influenza vaccination coverage in high-risk populations continues to be suboptimal. We describe the association between cumulative disease morbidity, measured by a previously validated multimorbidity index, and influenza vaccination among community-dwelling adults. METHODS We obtained interview and medical record data for participants ≥18 years who sought outpatient care for influenza-like illness between 2011 and 2016 as part of an outpatient-based study of influenza vaccine effectiveness. We defined cumulative disease morbidity by using medical diagnosis codes to calculate a multimorbidity-weighted index (MWI) for each participant. MWI and influenza vaccination status was evaluated by logistic regression. Akaike information criterion was calculated for all models. RESULTS Overall, 1458 (48%) of participants out of a total of 3033 received influenza vaccination. The median MWI was 0.9 (IQR 0.00-3.5) and was higher among vaccinated participants (median 1.6 versus 0.0; p < 0.001). We found a positive linear association between MWI and vaccination, and vaccination percentages were compared between categories of MWI. Compared to patients with no multimorbidity (MWI = 0), odds of vaccination were 17% higher in the second category (MWI 0.01-1.50; [OR: 1.17, 95% CI: 0.92-1.50]), 58% higher in the third category (MWI 1.51-3.00; [OR: 1.58, 95% CI: 1.26-1.99]), 130% higher in the fourth category (MWI 3.01-6.00; [OR: 2.30, 95% CI: 1.78-2.98]) and 214% higher in the fifth category (MWI 6.01-45.00;[OR: 3.14, 95% CI: 2.41-4.10]). Participants defined as high-risk had 86% greater odds of being vaccinated than non-high-risk individuals (OR: 1.86, 95% CI: 1.56-2.21). The AIC was lowest for MWI compared with high-risk conditions. CONCLUSIONS Our results suggest a dose response relationship between level of multimorbidity and likelihood of influenza vaccination. Compared with high-risk condition designations, MWI provided improved precision and a better model fit for the measurement of chronic disease and influenza vaccination.
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Affiliation(s)
- Samantha M Harrison
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA.
| | - Melissa Y Wei
- Division of General Medicine, Michigan Medicine, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800, USA.
| | - Lois E Lamerato
- Henry Ford Health System, One Ford Place, 5C, Detroit, MI 48202 USA.
| | - Joshua G Petrie
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA.
| | - Emily Toth Martin
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA.
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79
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Johnston MC, Crilly M, Black C, Prescott GJ, Mercer SW. Defining and measuring multimorbidity: a systematic review of systematic reviews. Eur J Public Health 2018; 29:182-189. [DOI: 10.1093/eurpub/cky098] [Citation(s) in RCA: 253] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
| | - Michael Crilly
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Public Health, NHS Grampian, Summerfield House, Aberdeen, UK
| | - Corri Black
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Public Health, NHS Grampian, Summerfield House, Aberdeen, UK
| | - Gordon J Prescott
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Stewart W Mercer
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
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80
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Battegay E, Cheetham M, Holzer BM, Nowak A, Schmidt D, Rampini S. [Multimorbidity management and the physician's daily clinical dilemma]. Internist (Berl) 2018; 58:344-353. [PMID: 28246687 DOI: 10.1007/s00108-017-0200-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
About 20-25% of all persons and about 90% of all patients who are acutely hospitalized in internal medicine departments have multiple acute or chronic diseases. They are multimorbid. The encounter with multimorbid patients has become the most common situation in the health care system. Theoretically, multimorbidity results in an innumerable potential disease constellations. In addition, the likelihood of interactions between diseases (disease-disease interactions, DDI) and the complexity increases overproportionately with each additional disease. However, multimorbidity often occurs in typical diadic, triadic, or higher characteristic combinations, in "disease clusters", e. g., vascular risk factors, heart and lung diseases, Frailty and dementia, psychiatric and somatic disorders. Such combinations lead to a worsening of the overall prognosis. In addition, DDIs are often difficult to treat or are life-threatening. Examples of DDIs include the following: anticoagulation and simultaneous severe bleeding, pain treatment and hypertension or renal insufficiency, depression and reduced medication adherence, chronic obstructive pulmonary disease and depression, Frailty and neurodepressant drugs and frequent falls, and combined psychiatric and somatic disorders. Such DDIs are common. Nevertheless, there are few studies and clinical guidelines that address these issues. The care of multimorbid patients is, therefore, heavily reliant upon guidelines developed mostly for single diseases. However, multimorbidity and serious DDIs are usually not addressed in these. Clinical guidelines can thus inadvertently jeopardize the safety of persons suffering from multiple diseases. In addition, stressful dilemmas arise for physicians encountering DDIs because of difficult treatment decisions.
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Affiliation(s)
- E Battegay
- Klinik und Poliklinik für Innere Medizin, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz. .,Kompetenzzentrum Multimorbidität, Universität Zürich, Zürich, Schweiz. .,Forschungsschwerpunkt Dynamics of Healthy Aging, Universität Zürich, Zürich, Schweiz.
| | - M Cheetham
- Klinik und Poliklinik für Innere Medizin, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz.,Kompetenzzentrum Multimorbidität, Universität Zürich, Zürich, Schweiz.,Forschungsschwerpunkt Dynamics of Healthy Aging, Universität Zürich, Zürich, Schweiz
| | - B M Holzer
- Klinik und Poliklinik für Innere Medizin, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz.,Kompetenzzentrum Multimorbidität, Universität Zürich, Zürich, Schweiz.,Forschungsschwerpunkt Dynamics of Healthy Aging, Universität Zürich, Zürich, Schweiz
| | - A Nowak
- Klinik und Poliklinik für Innere Medizin, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - D Schmidt
- Klinik und Poliklinik für Innere Medizin, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz.,Kompetenzzentrum Multimorbidität, Universität Zürich, Zürich, Schweiz.,Forschungsschwerpunkt Dynamics of Healthy Aging, Universität Zürich, Zürich, Schweiz
| | - S Rampini
- Klinik und Poliklinik für Innere Medizin, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
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81
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Willadsen TG, Siersma V, Nicolaisdóttir DR, Køster-Rasmussen R, Jarbøl DE, Reventlow S, Mercer SW, Olivarius NDF. Multimorbidity and mortality: A 15-year longitudinal registry-based nationwide Danish population study. JOURNAL OF COMORBIDITY 2018; 8:2235042X18804063. [PMID: 30364387 PMCID: PMC6194940 DOI: 10.1177/2235042x18804063] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/09/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Knowledge about prevalent and deadly combinations of multimorbidity is needed. OBJECTIVE To determine the nationwide prevalence of multimorbidity and estimate mortality for the most prevalent combinations of one to five diagnosis groups. Furthermore, to assess the excess mortality of the combination of two groups compared to the product of mortality associated with the single groups. DESIGN A prospective cohort study using Danish registries and including 3.986.209 people aged ≥18 years on 1 January, 2000. Multimorbidity was defined as having diagnoses from at least 2 of 10 diagnosis groups: lung, musculoskeletal, endocrine, mental, cancer, neurological, gastrointestinal, cardiovascular, kidney, and sensory organs. Logistic regression (odds ratios, ORs) and ratio of ORs (ROR) were used to study mortality and excess mortality. RESULTS Prevalence of multimorbidity was 7.1% in the Danish population. The most prevalent combination was the musculoskeletal-cardiovascular (0.4%), which had double the mortality (OR, 2.03) compared to persons not belonging to any of the diagnosis groups but showed no excess mortality (ROR, 0.97). The neurological-cancer combination had the highest mortality (OR, 6.35), was less prevalent (0.07%), and had no excess mortality (ROR, 0.94). Cardiovascular-lung was moderately prevalent (0.2%), had high mortality (OR, 5.75), and had excess mortality (ROR, 1.18). Endocrine-kidney had high excess mortality (ROR, 1.81) and cancer-mental had low excess mortality (ROR, 0.66). Mortality increased with the number of groups. CONCLUSIONS All combinations had increased mortality risk with some of them having up to a six-fold increased risk. Mortality increased with the number of diagnosis groups. Most combinations did not increase mortality above that expected, that is, were additive rather than synergistic.
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Affiliation(s)
- TG Willadsen
- The Research Unit for General Practice and Section of General
Practice, Institute of Public Health, University of Copenhagen, Copenhagen,
Denmark
| | - V Siersma
- The Research Unit for General Practice and Section of General
Practice, Institute of Public Health, University of Copenhagen, Copenhagen,
Denmark
| | - DR Nicolaisdóttir
- The Research Unit for General Practice and Section of General
Practice, Institute of Public Health, University of Copenhagen, Copenhagen,
Denmark
| | - R Køster-Rasmussen
- The Research Unit for General Practice and Section of General
Practice, Institute of Public Health, University of Copenhagen, Copenhagen,
Denmark
| | - DE Jarbøl
- Department of Public Health, The Research Unit of General Practice,
University of Southern Denmark, Odense, Denmark
| | - S Reventlow
- The Research Unit for General Practice and Section of General
Practice, Institute of Public Health, University of Copenhagen, Copenhagen,
Denmark
| | - SW Mercer
- General Practice and Primary Care, Institute of Health and
Wellbeing, University of Glasgow, Glasgow, Scotland
| | - N de Fine Olivarius
- The Research Unit for General Practice and Section of General
Practice, Institute of Public Health, University of Copenhagen, Copenhagen,
Denmark
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82
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Kanesarajah J, Waller M, Whitty JA, Mishra GD. Multimorbidity and quality of life at mid-life: A systematic review of general population studies. Maturitas 2017; 109:53-62. [PMID: 29452782 DOI: 10.1016/j.maturitas.2017.12.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 11/24/2017] [Accepted: 12/05/2017] [Indexed: 01/29/2023]
Abstract
There is substantial multimorbidity at mid-life but little is known about the strength of evidence on multimorbidity and health-related quality of life (HrQoL) at mid-life. This review addresses this gap, focusing on studies of the general population. PubMed, Web of Science, Embase and APA PsycNET databases were screened on 6 March 2017 for original research on multimorbidity and HrQoL in adults aged 40-65 years from the general population. Studies focused on index conditions, using single-item HrQoL measures, unlikely to represent the general population (e.g. primary care), and papers that were not in the English language were excluded. A narrative synthesis was presented due to heterogeneity in the measurement of multimorbidity. Of the 2557 articles, 83 underwent full text screening and 8 were included in the review. Included studies were of moderate to high quality and no exclusions were made on the basis of quality or bias. Multimorbidity was associated with poorer HrQoL at mid-life. Two cross-sectional studies found that adults with multimorbidity at early mid-life reported poorer HrQoL than adults with multimorbidity at late mid-life, while another found the reverse. Two distinct disease clusters were identified: mental health conditions and cardiovascular disease (CVD). Those in the mental health cluster reported poorer HrQoL than those in the CVD cluster, women more so than men. Limitations of the selected studies include lack of longitudinal evidence, use of self-reported conditions and no assessment of disease severity. Multimorbidity is associated with poor HrQoL at mid-life at the population level, with some evidence of differences in association with age and disease cluster and sparse evidence on sex differences. Longitudinal research using a weighted disease severity index and multimorbidity trajectories is needed to strengthen the evidence base.
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Affiliation(s)
| | - Michael Waller
- School of Public Health, The University of Queensland, Australia
| | - Jennifer A Whitty
- School of Pharmacy, The University of Queensland, Australia; Norwich Medical School, University of East Anglia, Norwich, UK
| | - Gita D Mishra
- School of Public Health, The University of Queensland, Australia
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83
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Delaney A, Tamás PA. Searching for evidence or approval? A commentary on database search in systematic reviews and alternative information retrieval methodologies. Res Synth Methods 2017; 9:124-131. [DOI: 10.1002/jrsm.1282] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 08/20/2017] [Accepted: 10/23/2017] [Indexed: 11/09/2022]
Affiliation(s)
| | - Peter A. Tamás
- Biometris; Wageningen University; Wageningen The Netherlands
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84
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Supper I, Bourgueil Y, Ecochard R, Letrilliart L. Impact of multimorbidity on healthcare professional task shifting potential in patients with type 2 diabetes in primary care: a French cross-sectional study. BMJ Open 2017; 7:e016545. [PMID: 29170284 PMCID: PMC5719306 DOI: 10.1136/bmjopen-2017-016545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To estimate the transferability of processes of care from general practitioners (GPs) to allied healthcare professionals and the determinants of such transferability. DESIGN French national cross-sectional multicentre study SETTING: 128 family practices providing supervised training for residents in general practice. PARTICIPANTS All patients consulting with their GP over a total number of 20 days (ie, 1 day a week from December 2011 to April 2012). Encounters where type 2 diabetes was one of the managed health problems were selected for analysis. PRIMARY AND SECONDARY OUTCOME MEASURES Processes that were associated with specific health problems were collected by 54 residents. Potential process transferability was the main outcome assessed, as well as the professionals involved in the collaboration and the eventual conditions associated with transfer. RESULTS From 8572 processes of care that concerned 1088 encounters of patients with diabetes, 21.9% (95% CI 21.1% to 22.8%) were considered eligible for transfer from GPs to allied healthcare professionals (78.1% to nurses, 36.7% to pharmacists). Processes were transferable with condition(s) for 70.6% (ie, a protocol, shared record or supervision). The most transferable processes concerned health maintenance (32.1%) and cardiovascular risk factors (hypertension (28.7%), dyslipidaemia (25.3%) and diabetes (24.3%)). Multivariate analysis showed that educational processes or a long-term condition status were associated with increased transferability (OR 3.26 and 1.47, respectively), whereas patients with higher intellectual occupations or those with two or more associated health problems were associated with lower transferability (OR 0.33 and 0.81, respectively). CONCLUSIONS A significant part of GP activity relating to patients with multimorbidity including type 2 diabetes could be transferred to allied healthcare professionals, mainly on prevention and global education to cardiovascular risk factors. The organisational and finance conditions of team work as views of patients and healthcare professionals must be explored before implementation in primary care.
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Affiliation(s)
- Irène Supper
- Department of General Practice, Université Claude Bernard Lyon 1, F-69008 Lyon, France
- Health services and performance research, Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008 Lyon, France
| | - Yann Bourgueil
- IRDES, Institute for Research and Information in Health Economics, F-75019 Paris, France
| | - René Ecochard
- Department of Biostatistics, Hospices Civils de Lyon, Lyon, France
| | - Laurent Letrilliart
- Department of General Practice, Université Claude Bernard Lyon 1, F-69008 Lyon, France
- Health services and performance research, Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008 Lyon, France
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Le Reste JY, Nabbe P, Billot Grasset A, Le Floch B, Grall P, Derriennic J, odorico M, Lalande S, le Goff D, Barais M, Chiron B, Lingner H, Guillou M, Barraine P. Multimorbid outpatients: A high frequency of FP appointments and/or family difficulties, should alert FPs to the possibility of death or acute hospitalization occurring within six months; A primary care feasibility study. PLoS One 2017; 12:e0186931. [PMID: 29095849 PMCID: PMC5667834 DOI: 10.1371/journal.pone.0186931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 10/10/2017] [Indexed: 11/24/2022] Open
Abstract
Background The European General Practitioners Research Network (EGPRN) designed and validated a comprehensive definition of multimorbidity using a systematic literature review and qualitative research throughout Europe. This definition was tested as a model to assess death or acute hospitalization in multimorbid outpatients. Objective To assess which criteria in the EGPRN concept of multimorbidity could detect outpatients at risk of death or acute hospitalization in a primary care cohort at a 6-month follow-up and to assess whether a large scale cohort with FPs would be feasible. Method Family Physicians included a random sample of multimorbid patients who attended appointments in their offices from July to December 2014. Inclusion criteria were those of the EGPRN definition of Multimorbidity. Exclusion criteria were patients under legal protection and those unable to complete the 2-year follow-up. Statistical analysis was undertaken with uni- and multivariate analysis at a 6-month follow-up using a combination of approaches including both automatic classification and expert decision making. A Multiple Correspondence Analysis (MCA) completed the process with a projection of illustrative variables. A logistic regression was finally performed in order to identify and quantify risk factors for decompensation. Results 19 FPs participated in the study. 96 patients were analyzed. 3 different clusters were identified. MCA showed the central function of psychosocial factors and peaceful versus conflictual relationships with relatives in all clusters. While taking into account the limit of a small cohort, age, frequency of family physician visits and extent of family difficulties were the factors which predicted death or acute hospitalization. Conclusion A large scale cohort seems feasible in primary care. A sense of alarm should be triggered to prevent death or acute hospitalization in multimorbid older outpatients who have frequent family physician visits and who experience family difficulties.
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Affiliation(s)
- Jean Yves Le Reste
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
- * E-mail: (JYLR); (PN)
| | - Patrice Nabbe
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
- * E-mail: (JYLR); (PN)
| | - Alice Billot Grasset
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
| | - Bernard Le Floch
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
| | - Pauline Grall
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
| | - Jeremy Derriennic
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
| | - Michele odorico
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
| | - Sophie Lalande
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
| | - Delphine le Goff
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
| | - Marie Barais
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
| | - Benoit Chiron
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
| | | | - Morgane Guillou
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
| | - Pierre Barraine
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
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The contribution of musculoskeletal disorders in multimorbidity: Implications for practice and policy. Best Pract Res Clin Rheumatol 2017; 31:129-144. [PMID: 29224692 DOI: 10.1016/j.berh.2017.09.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/07/2017] [Indexed: 12/11/2022]
Abstract
People frequently live for many years with multiple chronic conditions (multimorbidity) that impair health outcomes and are expensive to manage. Multimorbidity has been shown to reduce quality of life and increase mortality. People with multimorbidity also rely more heavily on health and care services and have poorer work outcomes. Musculoskeletal disorders (MSDs) are ubiquitous in multimorbidity because of their high prevalence, shared risk factors, and shared pathogenic processes amongst other long-term conditions. Additionally, these conditions significantly contribute to the total impact of multimorbidity, having been shown to reduce quality of life, increase work disability, and increase treatment burden and healthcare costs. For people living with multimorbidity, MSDs could impair the ability to cope and maintain health and independence, leading to precipitous physical and social decline. Recognition, by health professionals, policymakers, non-profit organisations, and research funders, of the impact of musculoskeletal health in multimorbidity is essential when planning support for people living with multimorbidity.
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87
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Multimorbidity and health-related quality of life among the community-dwelling elderly: A longitudinal study. Arch Gerontol Geriatr 2017; 74:133-140. [PMID: 29096228 DOI: 10.1016/j.archger.2017.10.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 10/21/2017] [Accepted: 10/23/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Multimorbidity is a growing public health problem. The objective of this study was to investigate the impact of multimorbidity on health-related quality of life (HRQoL) of the elderly. METHODS A 24-month longitudinal study was conducted on the community-dwelling elderly. There were 411 elderly persons with complete follow-up. Information on thirteen chronic conditions was collected at baseline. Via a multi-dimensional scale, HRQoL was measured at baseline, 18 and 24 months post-baseline, respectively. Exploratory factor analyses were performed to identify multimorbidity patterns. The linear mixed effects models were conducted to analyze the associations between all dimensions of HRQoL and multimorbidity including distinct multimorbidity patterns. RESULTS Multimorbidity was found to be negatively associated with HRQoL except memory function. We identified three multimorbidity patterns, which were mainly labelled as degenerative disorders, digestive/respiratory disorders, cardiovascular/metabolic disorders, respectively. And three multimorbidity patterns were associated with lower HRQoL including general health, body function, self-care ability and social adaptability. Besides, the elderly with the multimorbidity pattern mainly labelled as digestive/respiratory disorders or cardiovascular/metabolic disorders had a decline on emotion than those without multimorbidity. According to the analysis of the longitudinal data of the sample, general health, self-care ability, emotion and social adaptability of the participants decreased in different degrees every month. CONCLUSIONS Multimorbidity was associated with lower HRQoL of the community-dwelling elderly. Distinct multimorbidity patterns had various impacts on different dimensions of HRQoL. Further studies should be carried out to investigate effective measures to improve HRQoL of the elderly with multimorbidity.
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Thavorn K, Maxwell CJ, Gruneir A, Bronskill SE, Bai Y, Koné Pefoyo AJ, Petrosyan Y, Wodchis WP. Effect of socio-demographic factors on the association between multimorbidity and healthcare costs: a population-based, retrospective cohort study. BMJ Open 2017; 7:e017264. [PMID: 28988178 PMCID: PMC5640069 DOI: 10.1136/bmjopen-2017-017264] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To estimate the attributable costs of multimorbidity and assess whether the association between the level of multimorbidity and health system costs varies by socio-demographic factors in young (<65 years) and older (≥65 years) adults living in Ontario, Canada. DESIGN A population-based, retrospective cohort study SETTING: The province of Ontario, Canada PARTICIPANTS: 6 639 089 Ontarians who were diagnosed with at least one of 16 selected medical conditions on 1 April 2009. MAIN OUTCOME MEASURES From the perspective of the publicly funded healthcare system, total annual healthcare costs were derived from linked provincial health administrative databases using a person-level costing method. We used generalised linear models to examine the association between the level of multimorbidity and healthcare costs and the extent to which socio-demographic variables modified this association. RESULTS Attributable total costs of multimorbidity ranged from C$377 to C$2073 for young individuals and C$1026 to C$3831 for older adults. The association between the degree of multimorbidity and healthcare costs was significantly modified by age (p<0.001), sex (p<0.001) and neighbourhood income (p<0.001) in both age groups, and the positive association between healthcare costs and levels of multimorbidity was statistically stronger for older than younger adults. For individuals aged 65 years or younger, the increase in healthcare costs was more gradual in women than in their male counterparts, however, for those aged 65 years or older, the increase in healthcare costs was significantly greater among women than men. Lastly, we also observed that the positive association between the level of multimorbidity and healthcare costs was significantly greater at higher levels of marginalisation. CONCLUSION Socio-demographic factors are important effect modifiers of the relationship between multimorbidity and healthcare costs and should therefore be considered in any discussion of the implementation of healthcare policies and the organisation of healthcare services aimed at controlling healthcare costs associated with multimorbidity.
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Affiliation(s)
- Kednapa Thavorn
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Colleen J Maxwell
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Schools of Pharmacy, University of Waterloo, Ontario, Canada
| | - Andrea Gruneir
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Family Medicine, University of Alberta, Alberta, Canada
| | - Susan E Bronskill
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - YuQing Bai
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Anna J Koné Pefoyo
- Department of Health Sciences, Lakehead University, Thunder Bay, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Yelena Petrosyan
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Walter P Wodchis
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Toronto, Canada
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Northwood M, Ploeg J, Markle-Reid M, Sherifali D. Integrative review of the social determinants of health in older adults with multimorbidity. J Adv Nurs 2017; 74:45-60. [DOI: 10.1111/jan.13408] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Jenny Ploeg
- School of Nursing; McMaster University; Hamilton Ontario Canada
- Aging, Community and Health Research Unit; McMaster University; Hamilton Ontario Canada
| | - Maureen Markle-Reid
- School of Nursing; McMaster University; Hamilton Ontario Canada
- Aging, Community and Health Research Unit; McMaster University; Hamilton Ontario Canada
- Canada Research Chair in Aging; Chronic Disease and Health Promotion Interventions; Hamilton Ontario Canada
| | - Diana Sherifali
- School of Nursing; McMaster University; Hamilton Ontario Canada
- Diabetes Care and Research Program; Hamilton Health Sciences; Hamilton Ontario Canada
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90
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Evidence on multimorbidity from definition to intervention: An overview of systematic reviews. Ageing Res Rev 2017; 37:53-68. [PMID: 28511964 DOI: 10.1016/j.arr.2017.05.003] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 01/08/2023]
Abstract
The increasing challenge of multiple chronic diseases (multimorbidity) requires more evidence-based knowledge and effective practice. In order to better understand the existing evidence on multimorbidity, we performed a systematic review of systematic reviews on multimorbidity with pre-established search strategies and exclusion criteria by searching multiple databases and grey literature. Of 8006 articles found, 53 systematic reviews (including meta-analysis and qualitative research synthesis performed in some reviews) that stated multimorbidity as the main focus were included, with 79% published during 2013-2016. Existing evidence on definition, measurement, prevalence, risk factors, health outcomes, clinical practice and medication (polypharmacy), and intervention and management were identified and synthesised. There were three major definitions from three perspectives. Seven studies on prevalence reported a range from 3.5% to 100%. As six studies showed, depression, hypertension, diabetes, arthritis, asthma, and osteoarthritis were prone to be comorbid with other conditions. Four groups of risk factors and eight multimorbidity associated outcomes were explored by five and six studies, respectively. Nine studies evaluated interventions, which could be categorized into either organizational or patient-oriented, the effects of these interventions were varied. Self-management process, priority setting and decision making in multimorbidity were synthesised by evidence from 4 qualitative systematic reviews. We were unable to draw solid conclusions from this overview due to the heterogeneity in methodology and inconsistent findings among included reviews. As suggested by all included studies, there is a need for prospective research, especially longitudinal cohort studies and randomized control trials, to provide more definitive evidence on multimorbidity.
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91
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McKinlay EM, Morgan SJ, Gray BV, Macdonald LM, Pullon SR. Exploring interprofessional, interagency multimorbidity care: case study based observational research. JOURNAL OF COMORBIDITY 2017; 7:64-78. [PMID: 29090190 PMCID: PMC5556439 DOI: 10.15256/joc.2017.7.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/03/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The increase in multimorbidity or co-occurring chronic illnesses is a leading healthcare concern. Patients with multimorbidity require ongoing care from many different professionals and agencies, and often report a lack of integrated care. OBJECTIVE To explore the daily help-seeking behaviours of patients with multimorbidity, including which health professionals they seek help from, how professionals work together, and perceptions and characteristics of effective interprofessional, interagency multimorbidity care. DESIGN Using a case study observational research design, multiple data sources were assembled for four patients with multimorbidity, identified by two general practitioners in New Zealand. In this paper, two case studies are presented, including the recorded instances of contact and communication between patients and professionals, and between professionals. Professional interactions were categorized as consultation, coordination, or collaboration. RESULTS The two case studies illustrated two female patients with likely similar educational levels, but with different profiles of multimorbidity, social circumstances, and personal capabilities, involving various professionals and agencies. Engagement between professionals showed varying levels of interaction and a lack of clarity about leadership or care coordination. The majority of interactions were one-to-one consultations and rarely involved coordination and collaboration. Patients were rarely included in communications between professionals. CONCLUSION Cases constructed from multiple data sources illustrate the complexity of day-to-day, interprofessional, interagency multimorbidity care. While consultation is the most frequent mode of professional interaction, targeted coordinated and collaborative interactions (including the patient) are highly effective activities. Greater attention should be given to developing and facilitating these interactions and determining who should lead them.
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Affiliation(s)
- Eileen M. McKinlay
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Sonya J. Morgan
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Ben V. Gray
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Lindsay M. Macdonald
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Susan R.H. Pullon
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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Wang L, Palmer AJ, Cocker F, Sanderson K. Multimorbidity and health-related quality of life (HRQoL) in a nationally representative population sample: implications of count versus cluster method for defining multimorbidity on HRQoL. Health Qual Life Outcomes 2017; 15:7. [PMID: 28069026 PMCID: PMC5223532 DOI: 10.1186/s12955-016-0580-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background No universally accepted definition of multimorbidity (MM) exists, and implications of different definitions have not been explored. This study examined the performance of the count and cluster definitions of multimorbidity on the sociodemographic profile and health-related quality of life (HRQoL) in a general population. Methods Data were derived from the nationally representative 2007 Australian National Survey of Mental Health and Wellbeing (n = 8841). The HRQoL scores were measured using the Assessment of Quality of Life (AQoL-4D) instrument. The simple count (2+ & 3+ conditions) and hierarchical cluster methods were used to define/identify clusters of multimorbidity. Linear regression was used to assess the associations between HRQoL and multimorbidity as defined by the different methods. Results The assessment of multimorbidity, which was defined using the count method, resulting in the prevalence of 26% (MM2+) and 10.1% (MM3+). Statistically significant clusters identified through hierarchical cluster analysis included heart or circulatory conditions (CVD)/arthritis (cluster-1, 9%) and major depressive disorder (MDD)/anxiety (cluster-2, 4%). A sensitivity analysis suggested that the stability of the clusters resulted from hierarchical clustering. The sociodemographic profiles were similar between MM2+, MM3+ and cluster-1, but were different from cluster-2. HRQoL was negatively associated with MM2+ (β: −0.18, SE: −0.01, p < 0.001), MM3+ (β: −0.23, SE: −0.02, p < 0.001), cluster-1 (β: −0.10, SE: 0.01, p < 0.001) and cluster-2 (β: −0.36, SE: 0.01, p < 0.001). Conclusions Our findings confirm the existence of an inverse relationship between multimorbidity and HRQoL in the Australian population and indicate that the hierarchical clustering approach is validated when the outcome of interest is HRQoL from this head-to-head comparison. Moreover, a simple count fails to identify if there are specific conditions of interest that are driving poorer HRQoL. Researchers should exercise caution when selecting a definition of multimorbidity because it may significantly influence the study outcomes.
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Affiliation(s)
- Lili Wang
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | - Fiona Cocker
- Monash Centre for Occupation and Environmental Health (MonCOEH), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kristy Sanderson
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia. .,School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
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Villacampa-Fernández P, Navarro-Pardo E, Tarín JJ, Cano A. Frailty and multimorbidity: Two related yet different concepts. Maturitas 2017; 95:31-35. [DOI: 10.1016/j.maturitas.2016.10.008] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 10/15/2016] [Accepted: 10/18/2016] [Indexed: 01/10/2023]
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Prazeres F, Santiago L. The Knowledge, Awareness, and Practices of Portuguese General Practitioners Regarding Multimorbidity and its Management: Qualitative Perspectives from Open-Ended Questions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E1097. [PMID: 27834818 PMCID: PMC5129307 DOI: 10.3390/ijerph13111097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 10/19/2016] [Accepted: 11/02/2016] [Indexed: 11/17/2022]
Abstract
Multimorbidity's high prevalence and negative impact has made it a subject of worldwide interest. The main aim of this study was to access the Portuguese knowledge, awareness, and practices of general practitioners (GPs) regarding multimorbidity and its management, in order to aid in the development of interventions for improving outcomes in multimorbid patients in primary care. A web-based qualitative descriptive study was carried out in the first trimester of 2016 with primary care physicians working in two districts of the Centre region of Portugal. Open-ended questions were analysed via inductive thematic content analysis. GPs pointed out several difficulties and challenges while managing multimorbidity. Extrinsic factors were associated with the healthcare system logistics' management (consultation time, organization of care teams, clinical information) and society (media pressure, social/family support). Intrinsic factors related to the GP, patient, and physician-patient relationship were also stated. The most significant conclusion to emerge from this study is that although GPs perceived difficulties and challenges towards multimorbidity, they also have the tools to deal with them: the fundamental characteristics of family medicine. Also, the complex care required by multimorbid patients needs adequate consultation time, multidisciplinary teamwork, and more education/training.
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Affiliation(s)
- Filipe Prazeres
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã 6200-506, Portugal.
- Centro de Saúde de Aveiro, Aveiro 3810-000, Portugal.
| | - Luiz Santiago
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã 6200-506, Portugal.
- Unidade de Saúde Familiar Topázio, Coimbra 3020-171, Portugal.
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95
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Identifying time trends in multimorbidity—defining multimorbidity in times of changing diagnostic practices. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0771-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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96
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Griffith LE, Raina P, Levasseur M, Sohel N, Payette H, Tuokko H, van den Heuvel E, Wister A, Gilsing A, Patterson C. Functional disability and social participation restriction associated with chronic conditions in middle-aged and older adults. J Epidemiol Community Health 2016; 71:381-389. [DOI: 10.1136/jech-2016-207982] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/28/2016] [Accepted: 09/29/2016] [Indexed: 11/04/2022]
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97
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Morley JE. JAMDA: The State of the Journal. J Am Med Dir Assoc 2016; 17:867-71. [DOI: 10.1016/j.jamda.2016.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 07/15/2016] [Indexed: 11/25/2022]
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98
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Wei MY, Kawachi I, Okereke OI, Mukamal KJ. Diverse Cumulative Impact of Chronic Diseases on Physical Health-Related Quality of Life: Implications for a Measure of Multimorbidity. Am J Epidemiol 2016; 184:357-65. [PMID: 27530335 DOI: 10.1093/aje/kwv456] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/28/2015] [Indexed: 11/13/2022] Open
Abstract
Debate continues on how to measure and weight diseases in multimorbidity. We quantified the association of a broad range of chronic diseases with physical health-related qualify of life and used these weights to develop and validate a multimorbidity weighted index (MWI). Community-dwelling adults in 3 national, prospective studies-the Nurses' Health Study (n = 121,701), Nurses' Health Study II (n = 116,686), and Health Professionals Follow-up Study (n = 51,529)-reported physician-diagnosed diseases and completed the Short Form 36 physical functioning (PF) scale over multiple survey cycles between 1992 and 2008. Mixed models were used to obtain regression coefficients for the impact of 98 morbid conditions on PF. The MWI was formed by weighting conditions by these coefficients and was validated through bootstrapping. The final sample included 612,592 observations from 216,890 participants (PF mean score = 46.5 (standard deviation, 11)). The association between diseases and PF varied severalfold (median, -1.4; range, -10.6 to 0.8). End-stage organ diseases were associated with the greatest reduction in PF. The mean MWI score was 4.8 (median, 3.7; range, 0-53), and the mean number of comorbid conditions was 3.3 (median, 2.8; range, 0-34). This validated MWI weights diseases by severity using PF, a patient-centered outcome. These results suggest that simple disease count is unlikely to capture the full impact of multimorbidity on health-related quality of life, and that the MWI is feasible and readily implemented.
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Meeting the needs of a complex population: a functional health- and patient-centered approach to managing multimorbidity. JOURNAL OF COMORBIDITY 2016; 6:76-84. [PMID: 29090178 PMCID: PMC5556449 DOI: 10.15256/joc.2016.6.83] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/12/2016] [Indexed: 11/16/2022]
Abstract
Individuals with multimorbidity have complex care needs along with significant impacts to their functional health and quality of life. Recent evidence-based and experience-based explorations have revealed the importance of patient perspectives and functional health management in improving care delivery and health outcomes for individuals with multimorbidity. The impact of managing multimorbidity is evident at multiple levels of healthcare – the individual, the provider, and the system. Our local experience dealing with these challenges has led to the development of a functional health model that includes patient perspectives in care delivery within the Integrated Chronic Care Service (ICCS) of the health authority in Nova Scotia. In this paper, we present a discussion of the challenges, guiding models, and service-level transformations that have been integrated into care delivery at the ICCS to meet the healthcare needs of people with multiple health conditions. We describe our redesign strategies for care team planning, treatment approach, and patient inclusion.
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Hede GW, Faxén-Irving G, Olin AÖ, Ebbeskog B, Crisby M. Nutritional assessment and post-procedural complications in older stroke patients after insertion of percutaneous endoscopic gastrostomy - a retrospective study. Food Nutr Res 2016; 60:30456. [PMID: 27487849 PMCID: PMC4973443 DOI: 10.3402/fnr.v60.30456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 05/12/2016] [Accepted: 05/31/2016] [Indexed: 11/14/2022] Open
Abstract
Background Oropharyngeal dysphagia is one of the major complications of stroke and a risk factor for malnutrition and prolonged in-hospital stay. Objective The overall aim was to describe to what extent nutritional assessments (i.e. BMI kg/m2, eating problem, and weight loss) were performed and documented in the records of older stroke patients treated with enteral nutrition by percutaneous endoscopic gastrostomy (PEG). A secondary aim was to identify documented post-procedural complications after PEG insertion during hospital stay. Design The study is retrospective. Data were collected from records of 161 stroke patients ≥65 years, who received PEG, admitted to three stroke units during a 4-year period. Results Mean age of the patients was 82.2 (±7) years, and 86% of the patients were ≥75 years old. On admission, body weight was documented in 50% of the patients and at discharge in 38% of the patients. BMI data were not documented at all at discharge in one of the units. Almost 80% of the patients fulfilled the European Network criteria for multimorbidity. Morbidity and multimorbidity correlated to the length of stay (p<0.0005). Complications were reported in 111 (69%) of the patient records. In 53 patients (33%) more than one complication was reported. A total of 116 pressure ulcers were reported and 30 patients had more than one pressure ulcer. The number of complications was related to weight loss (p=0.046) and BMI change (p=0.018). Conclusions Essential information of the patient's nutritional status was poorly recorded which could affect the patient's nutritional treatment during the hospital stay. This study indicates that implementation of guidelines in patients with stroke is needed. The high number of pressure ulcers was an unexpected finding.
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Affiliation(s)
- Gunnel Wärn Hede
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden;
| | - Gerd Faxén-Irving
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Clinical Nutrition and Dietetics, Karolinska University Hospital, Stockholm, Sweden
| | - Ann Ödlund Olin
- Department of Quality and Patient Safety, Karolinska University Hospital, Stockholm, Sweden
| | - Britt Ebbeskog
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Milita Crisby
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden;
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