Entete 3

Publications on multimorbidity September-December 2021

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By Martin Fortin

Our search for papers on multimorbidity that were published during the period September-December 2021 has been completed. As in previous searches, we have prepared a PDF file that can be accessed following this link.

Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expressions “multiple chronic diseases” and “multiple long-term conditions” in PubMed (https://www.ncbi.nlm.nih.gov/pubmed), but we are sure that most publications on the subject are included in the list. All references are also included in our library. Feel free to share with anyone interested in multimorbidity.

A New Multimorbidity PhD Programme for Health Professionals

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By Frances Mair, Programme Director

A new Multimorbidity PhD programme for health professionals, funded by Wellcome Trust, has recently been launched in Scotland. The new PhD programme is led by the University of Glasgow in collaboration with the Universities of Dundee, Edinburgh and St Andrews, and aims to train a new generation of healthcare professionals with transferable skills for academic, clinical and policy roles, with a focus on generation of evidence that will enhance understanding of the determinants of multimorbidity and inform development of patient-focused interventions to improve care and outcomes. The PhD Fellows will be recruited from a range of clinical and health professional backgrounds and be offered exceptional opportunities for clinical research across a range of specialisms, from data science and epidemiology, to applied clinical research in a unique collaborative training environment. Our vision is to create a cohort of academic health professionals, including doctors, nurses, pharmacists, dentists, clinical psychologists and allied health professionals, for whom interdisciplinary and integrated thinking is the norm, with the skills to bridge research gaps and overcome the challenges posed by multimorbidity. Hosted in the Scottish societal context, where multimorbidity is a key health concern, but examining globally relevant problems, it will promote development of a critical mass of multimorbidity researchers empowered to find ways to prevent multimorbidity, discover pathways tractable to novel intervention and optimise management. The programme builds on the strengths of the partner institutions, to create a rich, multidisciplinary environment that will equip a new generation of researchers with a broad range of methodological skills that will enable them to promote new thinking on this complex topic. The programme has three research themes: Prevention and Management; Physical and Mental Health Multimorbidity and Polypharmacy with Inequalities as a cross-cutting theme.

Fellows will participate in a range of cohort-building activities aimed at developing a community and broadening understanding of research and interdisciplinary collaboration. Patient and Public Involvement (PPI) and Knowledge Exchange (KE) skill development are core elements of the planned development programme for Fellows. The Programme will be recruiting for new Fellows annually for the next 5 years, during this time we expect to support 34 Fellows, making this the largest Multimorbidity PhD Programme for Health Professionals globally. We have just recruited our first cohort of Fellows who will commence in November 2022. Further details of the programme and the types of research projects being offered can be found here: https://www.gla.ac.uk/colleges/mvls/graduateschool/multimorbidity/.

Challenges in multimorbidity research: lessons learned from the most recent randomized controlled trials in primary care

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By Martin Fortin, Moira Stewart, José Almirall, and Priscilla Beaupré

Patients with multimorbidity need a new kind of health care. Numerous rigorous studies using randomized controlled designs (RCTs) have been conducted to demonstrate effectiveness of interventions aimed at improving outcomes for patient with multimorbidity in primary care, but most of them have reported neutral effects or mixed results. Nevertheless, these studies offer a valuable source of information to learn from in order to pave the way for future research in this area in primary care.
We conducted a scoping review [1] to include current up-to-date state-of-the-art studies in primary care published from 2019 until 2021 in order to synthesize and analyze the most recent RCTs and to identify the factors that may have contributed to the success or lack of success. Special attention was given to four elements of the intervention: 1) its description and content; 2) the context in which it was deployed; 3) the evaluation design chosen to test the effectiveness, and 4) the intervention’s implementation.
Nine articles reporting on six RCTs studies were included in the review. The findings were mixed, with primary outcomes showing no differences between intervention and control groups in four of the six but differences in secondary outcomes in all six. All studies involved family practice patients but interventions took place at different sites, and the time between the beginning of the intervention and the time of evaluation of outcomes varied across studies. Authors reported issues regarding the need for training of care teams, the roles and composition of the teams, the selection of patients and implementation barriers of the complex interventions in trying contexts with not enough time for the changes required.
This scoping review identified several lessons on planning for future intervention studies on multimorbidity in primary care. Interdisciplinary teams as the basis for most interventions, while recommended, may need more support by policy and practice leadership to be successfully deployed and evaluated. The randomized controlled design may not be the best evaluation design given the complexity of the interventions; alternative designs should be considered in which qualitative components are included. Special attention should be given to outcome measures ensuring that they are better aligned to patient goals. Selection of patients was prone to bias toward the less needy and this may hamper the ability to document effectiveness and raises questions about equity in research. Implementation of the interventions needs special attention and enough time to gel.

1-Fortin M, Stewart M, Almirall J and Beaupré P (2022) Challenges in Multimorbidity Research: Lessons Learned From the Most Recent Randomized Controlled Trials in Primary Care. Front. Med. 9:815783. doi: 10.3389/fmed.2022.815783

One-year follow-up and exploratory analysis of a patient-centered interdisciplinary care intervention for multimorbidity

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By Martin Fortin

Different attempts have been made to create effective interventions in primary care for people with multimorbidity, being the predominant intervention element a change to the organization of care delivery. However, these interventions have obtained mixed results. We recently reported the results of a trial assessing the effectiveness of a multifaceted intervention based on a change in care delivery for patients with three or more chronic conditions [1]. After four months, the intervention showed a neutral effect on the primary outcomes and substantial improvement in two health behaviors as secondary outcomes. However, the effect of the intervention after a longer period of time was not known. We have now reported the one-year outcomes after exposure to the intervention, combining all participants in one single group that received the intervention, to document its long-term association with measures of self-care, quality of life and health-related behaviors [2]. Changes in these measures were also analyzed across age-, number of chronic conditions-, income-, and gender-based subgroups to explore factors potentially associated with variation in response to the intervention and help guide the development of more targeted interventions in the future.

We observed that one year after the intervention, the domain of emotional wellbeing of the Health Education Questionnaire (heiQ), improved significantly. However, we also observed deterioration in the domain of health services navigation of the heiQ. Improvement was also observed for the measures of the VR-12 (Veteran RAND-12 Health Survey) physical component, VR-12 mental component, in moderate to severe psychological distress measured with the Kessler six item Psychological Stress Scale (K6), and healthy eating.

Subgroup analyses in this exploratory study suggest that younger patients, those with lower number of chronic conditions or higher incomes may respond better in relation to self-management, health status and health behaviors. This suggests that future interventions should be tailored to patients’ characteristics including age, sex, income and number of conditions.

1.           Fortin M, Stewart M, Ngangue P, Almirall J, Belanger M, Brown JB, et al. Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial. Ann Fam Med (2021) 19(2):126-34. doi: 10.1370/afm.2650.

2.           Fortin M, Stewart M, Almirall J, Berbiche D, Belanger M, Katz A, et al. One year follow-up and exploratory analysis of a patient-centered interdisciplinary care intervention for multimorbidity. J Comorb (2021) 11:26335565211039780. doi: 10.1177/26335565211039780.

Publications on multimorbidity May-August 2021

By Martin Fortin

Our search for papers on multimorbidity that were published during the period May-August 2021 has been completed. As in previous searches, we have prepared a PDF file that can be accessed following this link.

Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expression “multiple chronic diseases” in PubMed (https://www.ncbi.nlm.nih.gov/pubmed), but we are sure that most publications on the subject are included in the list.

All references are also included in our library. Feel free to share with anyone interested in multimorbidity.

A systematic a review on the instruments used for measuring the association of the level of multimorbidity and clinically important outcomes

By Eng Sing Lee

Multimorbidity, defined as the co-occurrence of several chronic conditions in an individual [1, 2], is increasingly common. In 2018, the Academy of Medical Sciences has declared multimorbidity a priority in global health research as it has become a norm rather than an exception for an individual to have multimorbidity [3]. Multimorbidity is a growing public health challenge as it accounts for the highest expenditure in the healthcare system [4]. In addition, multimorbidity brings about many profound implications such as decreased quality of life, functional decline, and increased healthcare utilisation among many other negative outcomes.

However, many researchers define multimorbidity differently and many different instruments were used to measure multimorbidity. For this reason, we conducted a systematic a review on the instruments used for measuring the association of the level of multimorbidity and clinically important outcomes [5]. The main objective of the systematic review was to provide a list of instruments that are suitable for use in studies aiming to measure multimorbidity in association with or for prediction of a specific outcome in community-dwelling individuals. We also provided details of the requirements, strengths and limitations of these instruments, and the chosen outcomes.

In total, we found 33 unique instruments. The most commonly used instrument was ‘Disease Count’ and it was also the only instrument that was associated with the three essential outcomes from the core outcomes set of multimorbidity research (COSmm) [6], which are quality of life, mental health and mortality. Other instruments included weighted indices and case-mix or pharmaceutical-based instruments. We hope that by describing these instruments in detail, researchers would be able to choose a suitable instrument for their research in multimorbidity.

References

  1. Fortin M, Stewart M, Poitras ME, et al. A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. Ann Fam Med 2012;10(2):142–51. doi: https://doi.org/10.1370/afm.1337 [published Online First: 2012/03/14]
  2. WHO. The World Health Report 2008. Primary Care – Now more than ever. 2008.
  3. Multimorbidity: a priority for global health research The Academy of Medical Sciences 2018
  4. Huber M, Knottnerus JA, Green L, et al. How should we define health? BMJ 2011;343:d4163. doi: 10.1136/bmj.d4163
  5. Lee ES, Koh HL, Ho EQ, et al. Systematic review on the instruments used for measuring the association of the level of multimorbidity and clinically important outcomes. BMJ Open 2021;11(5):e041219. doi: 10.1136/bmjopen-2020-041219
  6. Smith SM, Wallace E, Salisbury C, et al. A Core Outcome Set for Multimorbidity Research (COSmm). Ann Fam Med 2018;16(2):132-38. doi: 10.1370/afm.2178

Publications on multimorbidity January-April 2021

By Martin Fortin

Our search for papers on multimorbidity that were published during the period January-April 2021 has been completed. As in previous searches, we have prepared a PDF file that can be accessed following this link.

Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expression “multiple chronic diseases” in PubMed (https://www.ncbi.nlm.nih.gov/pubmed), but we are sure that most publications on the subject are included in the list.

All references are also included in our library. Feel free to share with anyone interested in multimorbidity.

International Symposium on Multimorbidity 2021

This hybrid, one-day symposium covers three key areas in the field of multimorbidity: 1) definitions of multimorbidity, 2) Multimorbidity and clinical practice and 3) Prevention of multimorbidity, and health policy & healthcare utilization. 

Registration (it’s free for AIOS / PhD students):
NIV non-members: https://lnkd.in/dz2hgAU
NIV members: https://lnkd.in/dS-Ckaq

The event can be attended either online or physically. For now, Dutch COVID countermeasures allow 50 places available in “Het Trippenhuis”, in Amsterdam, you are most welcome to join online – that is always possible 🙂

Leading (inter)national experts will inform you about the most recent advances in these areas – accompanied by interactive panel discussions with the audience. Plenary speakers among others include prof. dr. Barbara van Munster, prof. dr. Cynthia Boyd, prof. dr. Maureen Rutten-van Mölken.

Chaired by prof. dr. Jako Burgers

Upcoming new research talents will pitch their research, and poster presentations will facilitate inspiring discussions during the breaks.

Multimorbidity in the context of Neurodegenerative Disorders

By Rafael Linden

Dear colleagues,

The Frontiers Platform has launched a Research Topic, aimed at basic research, epidemiology, clinical, neuropathological and modelling studies in the field of Multimorbidity in the context of Neurodegenerative Disorders. We encourage authors to submit either Original Articles or Reviews on this subject.

I would appreciate should IRCMo help inform scientists interested in this subject, and we encourage submission of articles related with the field.

More information:
https://www.frontiersin.org/research-topics/17133/multimorbidity-in-the-context-of-neurodegenerative-disorders

Best regards,

Rafael Linden, M.D., Ph.D.
Associate Editor
Frontiers in Neuroscience

Professor of Neuroscience
Instituto de Biofísica Carlos Chagas Filho
Universidade Federal do Rio de Janeiro
Brasil

Patient-centered innovation for multimorbidity care: the Ontario trial

By Moira Stewart

As part of the research program entitled Patient-Centered Innovations for Persons with Multimorbidity (PACE in MM), research trials were conducted simultaneously in the Canadian provinces of Quebec and Ontario. The aim of the trials was to assess the effectiveness of a patient-centered, multi-provider intervention for patients with multimorbidity, and understand under what circumstances it worked, and did not work. The report about the Quebec trial was recently published [1], and it is our pleasure to announce that the report of the trial in Ontario is now published too [2].

Both trials used mixed-methods design with a pragmatic randomized trial and qualitative study, involving primary care sites. Outcome measures were the same: two primary outcome measures representing patient education, empowerment, and agency (the Health Education Impact Questionnaire (heiQ); and the Self-Efficacy for Managing Chronic Disease scale), and four secondary outcome measures (VR12 Health Status; EQ-5D quality of life; Kessler Psychological Distress Scale; and Health Behaviour Survey). Outcomes were assessed at baseline and at 4 months after the intervention, a period considered long enough for follow-up to the trial.

A total of 86 patients in the intervention group and 77 in the control group participated in the Ontario trial. The intervention had a neutral effect on the primary outcomes, although one subgroup (those with an income of ≥C$50 000) significantly benefitted in terms of the mental health outcome. Qualitative and fidelity findings revealed aspects of the intervention that could be improved. For example, the qualitative study found patients’ enthusiasm for a coalesced action plan, but their frustration in its absence.

As a consequence of these findings, policymakers and clinicians are encouraged to seek ways to enhance care for patients with annual incomes of <C$50 000, to optimize team composition based on an individual patient’s preferences and abilities, and to enhance and tailor follow-up care by ensuring the creation of a coherent plan with actionable steps.

  1. Fortin M, Stewart M, Ngangue P, et al. Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial. Ann Fam Med 2021;19:126-34. doi: https://doi.org/10.1370/afm.2650
  2. Stewart M, Fortin M, Brown JB, et al. Patient-centred innovation for multimorbidity care: a mixed-methods, randomised trial and qualitative study of the patients’ experience. Br J Gen Pract 2021;71(705):e320-e30. doi: 10.3399/bjgp21X714293