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Author Archives: Martin Fortin

Relevant outcomes of patient-centered interventions in multimorbidity: an invitation to the NAPCRG forum and a preliminary survey



By Martin Fortin, Moira Stewart, Elizabeth Bayliss, Maxime Sasseville, Paul Little, Stewart Mercer, John Furler, Marjan van den Akker, Susan Smith

An activity organized by the PACEinMM international advisory committee

During the 2015 NAPCRG Annual Meeting to be held October 24-28 in Cancun, Mexico, we will be conducting a three hour forum entitled “Think-tank on outcomes for patient-centered interventions for persons with multimorbidity”. The objectives of the forum are to use a group process 1) to identify a set of relevant outcomes for patient-centered interventions for persons with multimorbidity (MM), 2) to share experiences internationally, and 3) to inform the conduct of interventions for persons with multimorbidity in primary care settings.  The Special Interest Group on Comorbidity/multimorbidity endorses the forum and it is open to all.
In order to prepare for the forum, we are conducting a short survey. The questions assess the relevance of types and domains of outcome measures for interventions in multimorbidity.
Please consider completing the survey. Your input is important even if you do not plan to attend the NPCRG conference. If you do plan to attend, we look forward to meeting you at NAPCRG in Cancun, Mexico next October.

Many thanks for your help.

GO TO THE SURVEY

Publications on multimorbidity November 2014-March 2015


By Martin Fortin


Our search for papers on multimorbidity that were published during the period November 2014-March 2015 has been completed. As in previous searches, we found many new papers and the list is too long for this venue. Therefore, 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”, 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.

PACE in MM Website Launched



By Martin Fortin and Moira Stewart

The research team PACE in MM “Patient-Centred Innovations for Persons with Multimorbidity” is happy to report its website (www. paceinmm.recherche.usherbrooke.ca) is now online in both French and English.  The site outlines the PACE in MM research goals, objectives and research plan.


Visitors to the site are able to view the governance, type and structure of Committees within the team as well as review the research team members.  A glossary of key terms related to the topic areas of PACE in MM is presented.
This resource will also allow visitors to keep updated on current news and events.  A special section for output and activities will be updated regularly outlining presentations, publications, and meetings.  A link to other helpful resources has also been developed.
If you have any suggestions or feedback for the website please send your comments to Research Coordinators, Tarek and Louisa.

Tarek.Bouhali@usherbrooke.ca

Louisa.Bestard-Denomme@schulich.uwo.ca

The Journal of Comorbidity is now publishing study protocols



By Martin Fortin

A recent editorial of the Journal of Comorbidity, Susan Smith, Stewart Mercer, Jane Gunn, Marjan van den Akker, and Martin Fortin announced that the journal is now offering authors the opportunity to publish a summary of their study protocols. As the focus and scope of the journal (pathophysiology, prevention, diagnosis and management of comorbidity/multimorbidity) are in line with the interests of the readers of this blog, we considered that it was important to share this information with our readers.

The publication of study protocols in a peer-reviewed journal contributes to increase research quality and transparency, encourages communication and collaboration between research groups, helps avoid research duplication, and engenders the expectation of dissemination of final results.

We think that this new move of the Journal of Comorbidity may contribute to enhance research quality and reporting of studies in the field of multimorbidity.

Publications on multimorbidity July-October 2014



By Martin Fortin


Our search for papers on multimorbidity that were published during the period July-October 2014 has been completed. As in previous searches, we found many new papers and the list is too long for this venue. Therefore, 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”, 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.

Publications on multimorbidity March-June 2014



By Martin Fortin


Our search for papers on multimorbidity that were published during the period March-June 2014 has been completed. As in previous searches, we found many new papers and the list is too long for this venue. Therefore, 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”, 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.

Lifestyle factors and multimorbidity



By Martin Fortin

Many studies have unequivocally shown a close relationship between lifestyle factors and individual chronic diseases. More recently, the association of lifestyle risk factors with multimorbidity has been explored for physical activity, obesity, smoking, alcohol consumption, and nutrition. Some mixed results have been reported. However, the body mass index has been consistently found to be associated with multimorbidity.
In a recent study published in BMC Public Health [1], we analysed the association of accumulating risk factors in the same individual and multimorbidity. We found that accumulating unhealthy lifestyle factors progressively increased the likelihood of multimorbidity. The cross-sectional design of the study did not allow making a causal inference. However, the increase in the likelihood of multimorbidity with the combined effect of unhealthy lifestyle factors may be used to hypothesise that a person-centered approach promoting healthy lifestyles aiming to maximize the number of healthy lifestyles could be an intervention in the fight against multimorbidity.

1. Fortin M, Haggerty J, Almirall J, et al., Lifestyle factors and multimorbidity: a cross sectional study. BMC Public Health 2014;14:686.

The definition of multimorbidity: looking for a consensus



By Martin Fortin

We published recently a bibliometric study of English language publications indexed from 1970 to 2012 that showed a diversity of terms used to describe the presence of multiple concurrent diseases: comorbidity, multimorbidity, polymorbidity, polypathology, pluripathology, multipathology, multicondition [1]. Comorbidity was overwhelmingly used when one disease/condition was designated as index, as described by Feinstein [2]. Multimorbidity was the term most often used when no disease/condition was designated as index, but several different definitions exist.
We would like to invite you to have a look at the results of the bibliometric study and then to complete a two-question survey that should take you approximately one minute to complete. The questions are:
1-Which definition do you think should be used for multimorbidity?
a) Multiple co-occurring chronic or long-term diseases or conditions, none considered as index disease.
b) Multiple co-occurring diseases or conditions, none considered as index disease.
c) Any of the above definitions.
d) Another definition (please, provide a definition or a reference):

________________________________________________________________________________________

2-What is your country of origin? ____________________________

The deadline to participate in the survey is January 31, 2014. We would like to receive input from as many people as possible. Please consider completing the survey as your input is very important. Many thanks for your help.
Results of the survey will be posted in February 2014.

Click here to complete the survey

[1] Almirall J, Fortin M. The coexistence of terms to describe the presence of multiple concurrent diseases. Journal of Comorbidity. 2013;3(1):4-9.
[2] Feinstein AR. The pre-therapeutic classification of co-morbidity in chronic diseases. J Chronic Diseases. 1970;23:455-469.

PACE in multimorbidity. Patient-Centred Innovations for Persons with Multimorbidity

By Moira Stewart and Martin Fortin

A Canadian research group led by Drs. Moira Stewart and Martin Fortin recently received funding in the amount of 2.5 million dollars over five years to improve the delivery of primary health care for people with multimorbidity. Awarded by the Canadian Institutes of Health Research (CIHR), this important grant is part of a government initiative to support research on community-based primary health care (CBPHC) across Canada.

Based on a partnership between the respective research teams of Dr. Fortin (Université de Sherbrooke, Québec) and Dr. Moira Stewart (Western University, Ontario), as well as partners from three other Canadian provinces and collaborators from five countries, this group will use a programmatic research approach and timeline to develop, implement and compare innovative models of integrated chronic disease prevention and management (CDPM). The research Team competed with 95 teams from across Canada to obtain this funding. The Team is called “PACE in multimorbidity” for “Patient-Centred Innovations for Persons with Multimorbidity”.

The Team proposes innovations in CDPM that will: reorient care from a single disease focus to a multimorbidity focus; centre on not only disease but also the patient in context; and realign the health care system from separate silos to coordinated collaborations in care. The proposed multifaceted innovations will be grounded in the current realities of CDPM (i.e. chronic care models including self-management programs) that are linked to primary care reform efforts. The Team will build on this firm foundation, will design and test promising innovations and will achieve transformation by creating structures to sustain relationships among researchers, health professionals, patients and decision-makers. The Team will conduct cross-jurisdictional comparisons and is mainly a Quebec – Ontario collaboration with participation from three other provinces: British Columbia, Manitoba and Nova Scotia.

The program will identify factors responsible for the success or failure of current CDPM initiatives linked to the primary care reform, by conducting a realist synthesis of their quantitative and qualitative evaluations and transform consenting CDPM initiatives by aligning them to promising innovations on patient-centred care for multimorbidity patients. The Team will test these new innovations in at least two jurisdictions and compare among jurisdictions. In addition, the program aims to foster the scaling up of innovations and to conduct research on different approaches to scaling up.

The Team’s objectives are based on the concerns expressed by decision-makers and will create new capacity for CBPHC research in Canada by building sustainable networks of interdisciplinary researchers and policy makers, including mentoring junior Team members to build future capacity. The Team is confident that some of the innovations studied over the five years will improve patient self-rated health outcomes while at the same time reduce costs to the system.

Research Team:

Moira A. Stewart, Martin Fortin, Martine Couture, Paul Huras, Onil Bhattacharyya, Antoine Boivin, Judith Brown, Maud-Christine Chouinard, Frances Gallagher, Richard Glazier, William Hogg, Catherine Hudon, Alan Katz, Christine Loignon, Jonathan Sussman, Amardeep Thind, Walter Wodchis, Sabrina Wong, Merrick Zwarenstein, Roxane Borgès Da Silva, Rick Glazier, Fred Burge.

International Advisory Committee

Stewart Mercer (UK), Marjan van den Akker (The Netherlands), John Furler (Australia), Paul Little (UK), Elizabeth A. Bayliss (USA).

Other national collaborators: decision-makers, researchers, collaborators for capacity building and patient advisory committee.

For further information, please do not hesitate to contact Team coordinators: Louisa Bestard Denomme (lbestar@uwo.ca) and Tarek Bouhali (tarek.bouhali@usherbrooke.ca).

Publications on multimorbidity January – April 2013

By Martin Fortin

Our search for papers on multimorbidity that were published during the first quarter of this year has been completed. As in previous searches, we found many new papers and the list is too long for this venue. Therefore, we have prepared a PDF file that can be accessed following this link.

Probably, there are some papers that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expression “multiple chronic diseases”, 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.