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Nkoka O, Munthali-Mkandawire S, Mwandira K, Nindi P, Dube A, Nyanjagha I, Mainjeni A, Malava J, Amoah AS, McLean E, Stewart RC, Crampin AC, Price AJ. Association between physical multimorbidity and common mental health disorders in rural and urban Malawian settings: Preliminary findings from Healthy Lives Malawi long-term conditions survey. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002955. [PMID: 38574079 PMCID: PMC10994288 DOI: 10.1371/journal.pgph.0002955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/03/2024] [Indexed: 04/06/2024]
Abstract
In low-income Africa, the epidemiology of physical multimorbidity and associated mental health conditions is not well described. We investigated the multimorbidity burden, disease combinations, and relationship between physical multimorbidity and common mental health disorders in rural and urban Malawi using early data from 9,849 adults recruited to an on-going large cross-sectional study on long-term conditions, initiated in 2021. Multimorbidity was defined as having two or more measured (diabetes, hypertension) or self-reported (diabetes, hypertension, disability, chronic pain, HIV, asthma, stroke, heart disease, and epilepsy) conditions. Depression and anxiety symptoms were measured using the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item General Anxiety Disorder scale (GAD-7) and defined by the total score (range 0-27 and 0-21, respectively). We determined age-standardized multimorbidity prevalence and condition combinations. Additionally, we used multiple linear regression models to examine the association between physical multimorbidity and depression and anxiety symptom scores. Of participants, 81% were rural dwelling, 56% were female, and the median age was 30 years (Inter Quartile Range 21-43). The age-standardized urban and rural prevalence of multimorbidity was 14.1% (95% CI, 12.5-15.8%) and 12.2% (95% CI, 11.6-12.9%), respectively. In adults with two conditions, hypertension, and disability co-occurred most frequently (18%), and in those with three conditions, hypertension, disability, and chronic pain were the most common combination (23%). Compared to adults without physical conditions, having one (B-Coefficient (B) 0.79; 95% C1 0.63-0.94%), two- (B 1.36; 95% CI 1.14-1.58%), and three- or more- physical conditions (B 2.23; 95% CI 1.86-2.59%) were associated with increasing depression score, p-trend <0.001. A comparable 'dose-response' relationship was observed between physical multimorbidity and anxiety symptom scores. While the direction of observed associations cannot be determined with these cross-sectional data, our findings highlight the burden of multimorbidity and the need to integrate mental and physical health service delivery in Malawi.
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Affiliation(s)
- Owen Nkoka
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | | | - Kondwani Mwandira
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Providence Nindi
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Albert Dube
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | | | - Angella Mainjeni
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Jullita Malava
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Abena S. Amoah
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Estelle McLean
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robert C. Stewart
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Division of Psychiatry, Centre for Clinical Brain Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Amelia C. Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alison J. Price
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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2
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Anza-Ramirez C, Najarro L, Bernabé-Ortiz A, Diez-Canseco F, Fottrell E, Abubakar I, Hernández-Vásquez A, Carrillo-Larco RM, Hurst JR, Miranda JJ. Multimorbidity and acute infectious diseases in urban and semi-urban settings in Peru: A mixed-methods study. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2024; 14:26335565241256826. [PMID: 38798989 PMCID: PMC11119522 DOI: 10.1177/26335565241256826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 05/07/2024] [Indexed: 05/29/2024]
Abstract
Background The co-occurrence of chronic diseases and acute infectious events exacerbates disability and diminishes quality of life, yet research in Low- and Middle-Income countries is scarce. We aimed to investigate the relationship between infectious events and multimorbidity in resource-constrained settings. Methods We conducted a sequential mixed-method study in Lima and Tumbes, Peru, with participants having multimorbidity from the CRONICAS Cohort Study. They completed a questionnaire on the occurrence, treatment, and health-seeking behaviour related to acute infectious events. Qualitative interviews explored the perceptions and links between multimorbidity and acute infectious events for a subgroup of participants. Findings Among individuals with multimorbidity, low awareness of chronic conditions and poor medication adherence. The cumulative incidence for respiratory and gastrointestinal infections, the most reported acute conditions, was 2.0 [95%CI: 1.8-2.2] and 1.6 [1.2-1.9] events per person per year, respectively. Individuals with cancer (6.4 [1.6-11.2] events per person per year) or gastrointestinal reflux (7.2 [4.4-10.1] events per person per year) reported higher cumulative incidence of infectious events than others, such as those with cardiovascular and metabolic conditions (5.2 [4.6-5.8] events per person per year). Those with three or more chronic conditions had a slightly higher cumulative incidence compared with individuals with two conditions (5.7 [4.4-7.0] vs 5.0 [4.4-5.6] events per person per year). Around 40% of individuals with multimorbidity sought healthcare assistance, while others chose drugstores or didn't seek help. Our qualitative analysis showed diverse perceptions among participants regarding the connections between chronic and acute conditions. Those who recognized a connection emphasized the challenges in managing these interactions. Interpretation Our study advances understanding of multimorbidity challenges in resource-limited settings, highlighting the impact of acute infections on patients' existing multimorbidity burden.
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Affiliation(s)
- Cecilia Anza-Ramirez
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lizzete Najarro
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabé-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Francisco Diez-Canseco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Edward Fottrell
- UCL Institute for Global Health, University College London, London, UK
| | - Ibrahim Abubakar
- UCL Institute for Global Health, University College London, London, UK
| | - Akram Hernández-Vásquez
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rodrigo M. Carrillo-Larco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - John R. Hurst
- UCL Respiratory, University College London, London, UK
| | - Juan Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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3
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Bernabeu-Wittel M, Para O, Voicehovska J, Gómez-Huelgas R, Václavík J, Battegay E, Holecki M, van Munster BC. Competences of internal medicine specialists for the management of patients with multimorbidity. EFIM multimorbidity working group position paper. Eur J Intern Med 2023; 109:97-106. [PMID: 36653235 DOI: 10.1016/j.ejim.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Abstract
Patients with multimorbidity increasingly impact healthcare systems, both in primary care and in hospitals. This is particularly true in Internal Medicine. This population associates with higher mortality rates, polypharmacy, hospital readmissions, post-discharge syndrome, anxiety, depression, accelerated age-related functional decline, and development of geriatric syndromes, amongst others. Internists and Hospitalists, in one of their roles as Generalists, are increasingly asked to attend to these patients, both in their own Departments as well as in surgical areas. The management of polypathology and multimorbidity, however, is often complex, and requires specific clinical skills and corresponding experience. In addition, patients' needs, health-care environment, and routines have changed, so emerging and re-emerging specific competences and approaches are required to offer the best coordinated, continuous, and comprehensive integrated care to these populations, to achieve optimal health outcomes and satisfaction of patients, their relatives, and staff. This position paper proposes a set of emerging and re-emerging competences for internal medicine specialists, which are needed to optimally address multimorbidity now and in the future.
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Affiliation(s)
- M Bernabeu-Wittel
- Department of Medicine, Internal Medicine Department. Hospital Universitario Virgen del Rocío, University of Sevilla, Spain
| | - O Para
- Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - J Voicehovska
- Internal Diseases Department, Nephrology and Renal replacement therapy clinics, Riga Stradins University, Riga East University hospital, Riga, Latvia
| | - R Gómez-Huelgas
- Internal Medicine Department. Department of Medicine, Hospital Universitario Regional de Málaga, University of Málaga, Spain
| | - J Václavík
- Department of Internal Medicine and Cardiology, University Hospital Ostrava and Ostrava University Faculty of Medicine, Ostrava, Czech Republic
| | - E Battegay
- International Center for Multimorbidity and Complexity (ICMC), University of Zurich, Zurich, University Hospital Basel (Department of Psychosomatic Medicine) and Merian Iselin Klinik Basel. Switzerland
| | - M Holecki
- Department of Internal, Autoimmune and Metabolic Diseases. Medical University of Silesia, Katowice. Poland
| | - B C van Munster
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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4
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Brünn R, Lemke D, Basten J, Kellermann-Mühlhoff P, Köberlein-Neu J, Muth C, van den Akker M. Use of an Electronic Medication Management Support System in Patients with Polypharmacy in General Practice: A Quantitative Process Evaluation of the AdAM Trial. Pharmaceuticals (Basel) 2022; 15:ph15060759. [PMID: 35745678 PMCID: PMC9230750 DOI: 10.3390/ph15060759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/10/2022] [Accepted: 06/16/2022] [Indexed: 11/21/2022] Open
Abstract
Polypharmacy is associated with a risk of negative health outcomes. Potentially inappropriate medications, interactions resulting from contradicting medical guidelines, and inappropriate monitoring, all increase the risk. This process evaluation (PE) of the AdAM study investigates implementation and use of a computerized decision-support system (CDSS). The CDSS analyzes medication appropriateness by including claims data, and hence provides general practitioners (GPs) with full access to patients’ medical treatments. We based our PE on pseudonymized logbook entries into the CDSS and used the four dimensions of the Medical Research Council PE framework. Reach, which examines the extent to which the intended study population was included, and Dose, Fidelity, and Tailoring, which examine how the software was actually used by GPs. The PE was explorative and descriptive. Study participants were representative of the target population, except for patients receiving a high level of nursing care, as they were treated less frequently. GPs identified and corrected inappropriate prescriptions flagged by the CDSS. The frequency and intensity of interventions documented in the form of logbook entries lagged behind expectations, raising questions about implementation barriers to the intervention and the limitations of the PE. Impossibility to connect the CDSS to GPs’ electronic medical records (EMR) of GPs due to technical conditions in the German healthcare system may have hindered the implementation of the intervention. Data logged in the CDSS may underestimate medication changes in patients, as documentation was voluntary and already included in EMR.
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Affiliation(s)
- Robin Brünn
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (D.L.); (C.M.); (M.v.d.A.)
- Correspondence:
| | - Dorothea Lemke
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (D.L.); (C.M.); (M.v.d.A.)
| | - Jale Basten
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University, 44789 Bochum, Germany;
| | | | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, 42119 Wuppertal, Germany;
| | - Christiane Muth
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (D.L.); (C.M.); (M.v.d.A.)
- Department of General Practice and Family Medicine, Medical Faculty East-Westphalia, University of Bielefeld, 33615 Bielefeld, Germany
| | - Marjan van den Akker
- Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany; (D.L.); (C.M.); (M.v.d.A.)
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, 6200 Maastricht, The Netherlands
- Department of Public Health and Primary Care, Academic Centre of General Practice, KU Leuven, 3000 Leuven, Belgium
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5
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Del Cura-González I, López-Rodríguez JA, Leiva-Fernández F, Gimeno-Feliu LA, Pico-Soler V, Bujalance-Zafra MJ, Domínguez-Santaella M, Polentinos-Castro E, Poblador-Plou B, Ara-Bardají P, Aza-Pascual-Salcedo M, Rogero-Blanco M, Castillo-Jiménez M, Lozano-Hernández C, Gimeno-Miguel A, González-Rubio F, Medina-García R, González-Hevilla A, Gil-Conesa M, Martín-Fernández J, Valderas JM, Marengoni A, Muth C, Prados-Torres JD, Prados-Torres A. Effectiveness of the MULTIPAP Plus intervention in youngest-old patients with multimorbidity and polypharmacy aimed at improving prescribing practices in primary care: study protocol of a cluster randomized trial. Trials 2022; 23:479. [PMID: 35681224 PMCID: PMC9178530 DOI: 10.1186/s13063-022-06293-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/09/2022] [Indexed: 12/21/2022] Open
Abstract
Background The progressive ageing of the population is leading to an increase in multimorbidity and polypharmacy, which in turn may increase the risk of hospitalization and mortality. The enhancement of care with information and communications technology (ICT) can facilitate the use of prescription evaluation tools and support system for decision-making (DSS) with the potential of optimizing the healthcare delivery process. Objective To assess the effectiveness and cost-effectiveness of the complex intervention MULTIPAP Plus, compared to usual care, in improving prescriptions for young-old patients (65-74 years old) with multimorbidity and polypharmacy in primary care. Methods/design This is a pragmatic cluster-randomized clinical trial with a follow-up of 18 months in health centres of the Spanish National Health System. Unit of randomization: family physician. Unit of analysis: patient. Population Patients aged 65–74 years with multimorbidity (≥ 3 chronic diseases) and polypharmacy (≥ 5 drugs) during the previous 3 months were included. Sample size n = 1148 patients (574 per study arm). Intervention Complex intervention based on the ARIADNE principles with three components: (1) family physician (FP) training, (2) FP-patient interview, and (3) decision-making support system. Outcomes The primary outcome is a composite endpoint of hospital admission or death during the observation period measured as a binary outcome, and the secondary outcomes are number of hospital admission, all-cause mortality, use of health services, quality of life (EQ-5D-5L), functionality (WHODAS), falls, hip fractures, prescriptions and adherence to treatment. Clinical and sociodemographic factors will be explanatory variables. Statistical analysis The main result is the difference in percentages in the final composite endpoint variable at 18 months, with its corresponding 95% CI. Adjustments by the main confounding and prognostic factors will be performed through a multilevel analysis. All analyses will be carried out in accordance to the intention-to-treat principle. Discussion It is important to prevent the cascade of negative health and health care impacts attributable to the multimorbidity-polypharmacy binomial. ICT-enhanced routine clinical practice could improve the prescription process in patient care. Trial registration ClinicalTrials.gov NCT04147130. Registered on 22 October 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06293-x.
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Affiliation(s)
- Isabel Del Cura-González
- Research Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain. .,Department of Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain. .,Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain. .,Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain. .,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.
| | - Juan A López-Rodríguez
- Research Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain.,Department of Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain.,Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,Ricardos General Health Center, Madrid Health Service, Madrid, Spain
| | - Francisca Leiva-Fernández
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,Multiprofessional Family and Community Care Teaching Unit of the Málaga-Guadalhorce Health District, Málaga, Spain.,Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain.,University of Malaga, Malaga, Spain
| | - Luis A Gimeno-Feliu
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,San Pablo Primary Care Health Centre, Aragon Health Service, Zaragoza, Spain.,University of Zaragoza, Zaragoza, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Victoria Pico-Soler
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Torrero-La Paz Primary Care Health Centre, Aragon Health Service (SALUD), Zaragoza, Spain
| | - Mª Josefa Bujalance-Zafra
- Multiprofessional Family and Community Care Teaching Unit of the Málaga-Guadalhorce Health District, Málaga, Spain.,La Victoria Health Center, Málaga-Guadalhorce Health District, Málaga, Spain
| | - Miguel Domínguez-Santaella
- Multiprofessional Family and Community Care Teaching Unit of the Málaga-Guadalhorce Health District, Málaga, Spain.,La Victoria Health Center, Málaga-Guadalhorce Health District, Málaga, Spain
| | - Elena Polentinos-Castro
- Research Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain.,Department of Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain.,Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain
| | - Beatriz Poblador-Plou
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Paula Ara-Bardají
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Mercedes Aza-Pascual-Salcedo
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Primary Care Pharmacy Service Zaragoza III, Aragon Health Service, Zaragoza, Spain
| | - Marisa Rogero-Blanco
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,Ricardos General Health Center, Madrid Health Service, Madrid, Spain
| | - Marcos Castillo-Jiménez
- Multiprofessional Family and Community Care Teaching Unit of the Málaga-Guadalhorce Health District, Málaga, Spain.,Health Center Campillos, Malaga North District (Antequera), Málaga, Spain
| | - Cristina Lozano-Hernández
- Research Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain.,Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,Primary Health Care Research and Innovation Foundation FIIBAP, Madrid, Spain
| | - Antonio Gimeno-Miguel
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Francisca González-Rubio
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Delicias Sur Primary Care Health Centre, Aragon Health Service (SALUD, Zaragoza, Spain
| | - Rodrigo Medina-García
- Research Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,Ricardos General Health Center, Madrid Health Service, Madrid, Spain.,Primary Health Care Research and Innovation Foundation FIIBAP, Madrid, Spain
| | - Alba González-Hevilla
- Multiprofessional Family and Community Care Teaching Unit of the Málaga-Guadalhorce Health District, Málaga, Spain
| | - Mario Gil-Conesa
- Preventive Medicine Service, University Hospital Alcorcon Foundation, Madrid, Spain
| | - Jesús Martín-Fernández
- Department of Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain.,Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,Multiprofessional Family and Community Care Teaching Unit West, Madrid, Spain
| | - José M Valderas
- Department of Family Medicine, National University Health System, Singapore, Singapore
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Christiane Muth
- Department of General Practice and Family Medicine, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany
| | - J Daniel Prados-Torres
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,Multiprofessional Family and Community Care Teaching Unit of the Málaga-Guadalhorce Health District, Málaga, Spain.,Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain.,University of Malaga, Malaga, Spain
| | - Alexandra Prados-Torres
- Research Network on Health Services in Chronic Diseases REDISSEC-ISCIII, Madrid, Spain.,Research Networks Health Outcomes-Oriented Cooperative on Chronicity, Primary Care and Health Promotion RICORS RICAPPS, ISCIII, Madrid, Spain.,EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
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8
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Leiva-Fernández F, González-Hevilla A, Prados-Torres JD, Casas-Galán F, García-Domingo E, Ortiz-Suárez P, López-Rodríguez JA, Pico-Soler MV. Identification of the multimorbidity training needs of primary care professionals: Protocol of a survey. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2021; 11:26335565211024791. [PMID: 34422674 PMCID: PMC8371279 DOI: 10.1177/26335565211024791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022]
Abstract
Current epidemiological situation has prompted the consideration of multimorbility (MM) as a prevalent condition, influenced by age, educational level and social support, related to unfavorable social and health determinants. Primary Care (PC) has a key role in its approach but further training of professionals in MM is required. The evidence on the effectiveness of training interventions in MM is still limited. Knowing the experiences, opinions and training needs of professionals is essential to enhance training interventions. OBJECTIVES Identify perceived training needs by PC health professionals (doctors and nurses) in MM and polypharmacy. METHODS Design: Cross-sectional study based on an online survey (anonymous-ad hoc questionnaire). Participants and recruitment: 384 doctors and nurses working in healthcare centers and out-of-hospital emergencies of the Spanish National Health System. Non-probabilistic convenience sampling via email addressed to Health Institutions, and social networks. DATA Demographic characteristics and professional profile data (close-ended and multiple-choice questions) will be collected. Open-ended questions will be used to identify training needs, difficulties and resources about MM; required skills to care patients with MM will be assessed using a 4-item ordinal scale. ANALYSIS Coding of data prior to analysis. Descriptive statistical analysis, participation and completion rates of the questionnaire and estimation of absolute and relative frequencies and 95% confidence intervals in close-ended questions. Content analysis with inductive methodology in open-ended questions. Ethics: Ethical approval, Online informed consent. CONCLUSIONS The identification of training needs of health professionals who care for patients with MM will be necessary data for developing highly effective training activities.
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Affiliation(s)
- Francisca Leiva-Fernández
- Teaching Unit for Family and Community Primary Care Health District
Málaga/Guadalhorce, Andalusian Health Service, Málaga, Spain
- Biomedical Research Institute of Málaga –IBIMA-, Univesity of
Malaga, Malaga, Spain
- Health Services and Chronic conditions Research Network (REDISSEC),
Health Institute Carlos III, Madrid, Spain
| | - Alba González-Hevilla
- Teaching Unit for Family and Community Primary Care Health District
Málaga/Guadalhorce, Andalusian Health Service, Málaga, Spain
- Biomedical Research Institute of Málaga –IBIMA-, Univesity of
Malaga, Malaga, Spain
| | - Juan Daniel Prados-Torres
- Teaching Unit for Family and Community Primary Care Health District
Málaga/Guadalhorce, Andalusian Health Service, Málaga, Spain
- Biomedical Research Institute of Málaga –IBIMA-, Univesity of
Malaga, Malaga, Spain
- Health Services and Chronic conditions Research Network (REDISSEC),
Health Institute Carlos III, Madrid, Spain
| | - Fuensanta Casas-Galán
- Teaching Unit for Family and Community Primary Care Health District
Málaga/Guadalhorce, Andalusian Health Service, Málaga, Spain
- Biomedical Research Institute of Málaga –IBIMA-, Univesity of
Malaga, Malaga, Spain
| | - Eva García-Domingo
- Teaching Unit for Family and Community Primary Care Health District
Málaga/Guadalhorce, Andalusian Health Service, Málaga, Spain
- Biomedical Research Institute of Málaga –IBIMA-, Univesity of
Malaga, Malaga, Spain
| | - Paula Ortiz-Suárez
- Teaching Unit for Family and Community Primary Care Health District
Málaga/Guadalhorce, Andalusian Health Service, Málaga, Spain
- Biomedical Research Institute of Málaga –IBIMA-, Univesity of
Malaga, Malaga, Spain
| | - Juan Antonio López-Rodríguez
- Health Services and Chronic conditions Research Network (REDISSEC),
Health Institute Carlos III, Madrid, Spain
- Research Unit, Primary Health Care Management of Madrid, Madrid
Health Service, Madrid, Spain
- Public Health and Preventive Medicine Area, University Rey Juan
Carlos, Madrid, Spain
| | - Maria Victoria Pico-Soler
- Health Services and Chronic conditions Research Network (REDISSEC),
Health Institute Carlos III, Madrid, Spain
- EpiChron Research Group, Aragon Health Sciences Institute (IACS),
IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
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