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Category Archives: Event

PACE in MM Forum at the NAPCRG Annual Meeting in Cancun, Mexico


By Moira Stewart and Martin Fortin
Co-Principal Investigators of PACE in MM team

Martin Fortin and an international group of collaborators conducted a Forum at the North American Primary Care Research Group Annual Meeting in Cancun, Mexico on October 28, 2015 on “Outcomes for Patient-Centered Interventions for Persons with Multimorbidity.”

Speakers were Maxime Sassville, Elizabeth Bayliss, Chris Salisbury, Martin Fortin and Paul Little.  Moira Stewart summarized the proceedings.

Domhnall MacAuley highlighted this Forum in his CMAJ blog.  Have a look!

http://cmajblogs.com/some-golden-nuggets-and-grumbles-from-napcrg-2015/#more-2703

Personalized Geriatric Medicine. A shift in management approach



By Gunnar Akner

www.gunnar-akner.se

Since aging is the most important risk factor to develop disease(s) and/or injuries, multimorbid elderly people dominate in all parts of the health care system: in hospitals, in primary care and in communal care for the elderly. The multimorbidity phenotype among elderly people is very complex and in combination with great variation on psychosocial context, there are not two multimorbid elderly people alike. This diversity has fundamental consequences for the health care system:

1.    Analysis, evaluation, management/care and follow-up of multimorbid elderly people must be
individualized and based on integrated and targeted multi-domain thinking. National guidelines are not very helpful in the management of multimorbidity, that requires simultaneous health problem specific and integrated management. A strict adherece to guidlines will impose strong risks to multimorbid elderly.

2.    Such individualization requires that the clinical working conditions support qualified management over time. Key elements regard for example team composition (type and number of team-members), team working methods and a medical record that is based on the individual´s health problems, how they have developed over time including the effects of various treatments/care.

3.    The high prevalence of multimorbid elderly people calls for a shift in the education and training of physicians and health care staff, and should have sa strong base in Geriatric Medicine.

4.    Clinical treatment research methodology resides heavily on the randomized controlled trial (RCT). The RCT is based on the assumption of treating homogenous groups av patients with well defined interventions. In multimorbid elderly people, the heterogeneity is profound regarding both the health problems, treatment methods and outcomes. Thus, there is a strong call to develop complementing research methods, for example the n=1 methodology.

These aspects are discussed more in detail in a recent overview article in Clinicak Geriatrics (1).

Similar aspects of multimorbidity in elderly will be discussed during the 3-day international conference (Berzelius-symposium)”Personalized Geriatric Medicine” in Stockholm, Sweden, August 20-22, 2014 organized by The Swedish Society of Medicine, in cooperation with European Union Geriatric Medicine Society (EUGMS), the Swedish Society of Geriatric Medicine, Karolinska Institutet and the Swedish National Research Council http://www.sls.se/Utbildning/Berzeliussymposier/geriatricmedicine/. President of the organizing committee is professor Gunnar Akner.
World leading researchers and clinicians from Geriatric Medicine and elderly care from USA, Japan, Spain, England, Ireland, Norway, Finland and Sweden will provide state-of-the-art-lectures (see list of participants on the conference website). On each day of the conference, there will be group discussions, where lecturers and participants meet and engage in in-depth discussions around different themes.
We hope the conference will attract researchers, clinicians in Geriatric Medicine and other medical specialities from different professional staff groups, stakeholders and decision-makers, politicians, economists etc with interest to improve the quality of care from the individual elderly patient´s point of view. An application has been made to the EACCME® for CME accreditation of this event.

Reference
1.    Akner G. Frailty and multimorbidity in elderly people: A shift in management approach.
Clin Geriat 2013; 21: published online September 23, 2013.
(see website www.gunnar-akner.se, link ”Multimorbidity/frailty”)

Conference Personalized Geriatric Medicine



Invitation

The Swedish Society of Medicine is inviting to a 3-day international conference called “Personalized Geriatric Medicine”, in Stockholm/Sweden August 20-22, 2014. The conference is arranged in collaboration with the Swedish Society for Geriatric Medicine, European Union Geriatric Medicine Society (EUGMS), Karolinska Institutet and The Swedish Research Council.
The program will focus on management of individual frail, multimorbid elderly people over time in relation to medical quality, patient safety, education/training and research/development. World leading researchers are invited as speakers and will present state-of-the-art lectures. We aim to highlight the potential of Geriatric Medicine to improve the quality of multi-domain analysis, management/care and follow-up over time in individual multimorbid, elderly people. The potential of the medical record to serve as a much longed for “geroscope” will be highlighted. Each symposium day includes group discussions, where the participants and speakers meet to discuss various themes more personal and in-depth.
The conference is hoped to attract scientists, clinicians from different medical specialities, health care staff groups, stakeholders and others with interest in various aspects of improving health care, assessment and managment/care of multimorbid, elderly people.
For more information about the conference and how to register, please visit the conference homepage: http://www.sls.se/Utbildning/Berzeliussymposier/geriatricmedicine/.

Welcome to Stockholm in August 2014!
Stockholm, Sweden March 10, 2014

On behalf of the Organizing committee

Gunnar Akner
Chair
Professor in Geriatric Medicine, Senior physician

An International Perspective on Designing Interventions for Multimorbidity in Primary Care

By Martin Fortin, Elizabeth A. Bayliss, Susan M. Smith, Stewart W. Mercer, Mogens Vestergaard, Chris Salisbury

Under the sponsorship of the Agency for Healthcare Research and Quality Multiple Chronic Conditions (AHRQ MCC) Research Network, a panel of six members of the International Research Community on Multimorbidity (CIRMo) presented a webinar on interventions for patients with multimorbidity: “An International Perspective on Designing Interventions for Multimorbidity in Primary Care”. The webinar included three parts:

Context and background for interventions: Dr. Chris Salisbury, University of Bristol, UK, discussed the eligibility criteria in intervention studies for multimorbidity (Who should we include in studies of interventions for multimorbidity?). Dr. Elizabeth A. Bayliss, Kaiser Permanente Colorado, University of Colorado School of Medicine, USA, who acted as the moderator of the webinar, presented “Outcomes for Multimorbidity Interventions” followed by Dr. Susan M. Smith, HRB Centre for Primary Care Research, RCSI Medical School, Dublin, Ireland, who presented a brief summary of a systematic review: “Interventions for improving outcomes in patients with multimorbidity in primary care and community settings”.

Reports on specific research and operational interventions: Senior investigators described three intervention initiatives in three different contexts. Dr. Stewart W. Mercer from the Institute of Health & Wellbeing, University of Glasgow, Scotland, presented “Preliminary findings of an exploratory cluster RCT of a primary care-based complex intervention for multimorbid patients living in deprived areas”. Dr. Martin Fortin, Université de Sherbrooke, Québec, Canada, presented results of an ongoing pragmatic randomized controlled trial: “PR1MaC: Evaluating the integration of chronic disease prevention and management services into primary healthcare” and Dr. Mogens Vestergaard, Aarhus University, Denmark, described a very interesting Danish experience in managing patients with multimorbidity: “The multimorbidity clinic at silkeborg hospital”.

Questions & answers period: At the end of the presentation was a very interesting period of interactions between participants of the webinar and the panel of researchers.

The Webinar was coordinated by James R. Fraser and hosted by Jared Lyle from the AHRQ MCC Research Network.

You can access the webinar presentations and recording through the AHRQ MCC Research Network website:

https://ahrqplexnet.sharepointspace.com/Grantee%20Site%20Pages/Meetings%20and%20Webinars.aspx

Look for the last item under “Webinars & Workshops” entitled “An International Perspective on Designing Interventions for Multimorbidity in Primary Care.”

Multimorbidity: The need for a consistent and coherent approach

By the Chronic Disease Surveillance and Monitoring Division, Public Health Agency of Canada (CDSMD-PHAC)

The need for a consist and coherent approach to measure multimorbidity was the main message arising from a meeting hosted by the Chronic Disease Surveillance and Monitoring Division of the Public Health Agency of Canada on December 14, 2012 in Ottawa, ON.  The Agency convened several leaders working in the area of multimorbidity in Canada to discuss the conceptualization and definition of multimorbidity from a public health surveillance perspective.

Multimorbidity leaders agreed that while some efforts have been made to establish standardised tools and techniques to assess multimorbidity, there has been a lack of consensus and multimorbidity measures to date have been characterized by high heterogeneity.  Without consistent methodologies to measure multimorbidity, public health practitioners and clinicians may receive little or inconsistent information about the scope and burden of multimorbidity and what can be done to address the problem.

Leaders emphasized the need to define multimorbidity in a way that will resonate with both public health policy makers and clinicians and they encouraged continued attention toward the issues at the heart of multimorbidity in Canada, such as complexity of clinical care, cases of concurrent mental illness, and the common risk factors and determinants which precipitate development of multiple diseases.

The Chronic Disease Surveillance and Monitoring Division is looking forward to working with other multimorbidity leaders to help meet this challenge, and to advance the measurement and reporting of multimorbidity in Canada.

International collaborative research initiative to design interventions for patients with multimorbidity in primary health care

By Martin Fortin

As part of the 2012 Annual Meeting of the North American Primary Care Research Group (NAPCRG), participants from different disciplines and fields of expertise had the opportunity to take part in the “International collaborative research initiative to design interventions for patients with multimorbidity in primary health care” to discuss and share ideas and perspectives with each other.

This forum was initiated and organized by six researchers: Martin Fortin, MD, MSc; Elizabeth A. Bayliss, MD, MSPH; Stewart Mercer, MBChB, PhD; Susan Smith, MD, MSc; Jane Gunn, MBBS, FRACGP, PhD, DRANZCOG; Mogens Vestergaard, MD, PhD. The forum aimed to use a group process to identify a set of attributes relevant to interventions in multimorbidity, to share findings and to identify potentially important future directions for improving generalist patient-centered care of persons with multimorbidity in primary care settings.

Participants came from different organizations across the USA, Canada, Australia, Denmark, Ireland and the UK which fostered discussions enlightened by different perspectives and experiences. The forum’s organizers gave very short presentations on a number of topics (list presented below*) before handing the floor over to participants for very enthusiastic small group and plenary discussions.

The organizers would like to thank and congratulate each one of the participants for so generously sharing their wide-ranging perspectives and to inform them that the lead group is planning to write a paper based on the forum’s discussions and the work leading up to it.

*Presentation list (summary):
-Concepts and definitions for multimorbidity interventions (M Fortin)
-Systematic review of interventions to improve outcomes for patients with multimorbidity in primary care and community settings (S Smith)
-Outcomes for multimorbidity interventions (E Bayliss)
-Preliminary findings of an exploratory cluster RCT of a primary care-based complex intervention for multimorbid patients living in areas of high deprivation in Scotland: The CARe Plus Study (S Mercer)
-Co-designing an intervention for improving care for those with severe and enduring mental health problems (J Gunn)
-Integration of chronic disease prevention and management services into primary health care: The PR1MaC Study (M Fortin)
-Interventions for multimorbid patients in Denmark (M Vestergaard)

From left to right:
Chris Salisbury, Stewart Mercer, Susan Smith, Mogens Vestergaard,
Martin Fortin, Jane Gunn, Elizabeth A. Bayliss and Sally Wyke. 

Multimorbidity: a hidden epidemic that challenges European health services

By Christiane Muth, Amaia Calderón-Larrañaga, Marjan van den Akker, Beatriz Poblador-Plou and Alexandra Prados-Torres (from left to right)

A workshop on multimorbidity was held in Malta the 9th November in the context of the 20th Annual European Public Health Conference (EUPHA).

This workshop was organized by researchers of the Aragon Institute of Health Sciences (IACS) in Spain and the CAPHRI School for Public Health and Primary Care in the Netherlands, and supported by the EUPHA Section on Chronic Diseases. The aim was to shed light on future research and action strategies for patients with multiple chronic conditions.

The analysis was performed from three complementary perspectives. During the first part of the workshop, coordinated by Alexandra Prados and Amaia Calderón from the EpiChron Research Group on Chronic Diseases of the IACS, results from epidemiological research were presented regarding the systematic association between diseases or medications into so-called multimorbidity and polypharmacy patterns. The role of adverse drug events on increased morbidity burden was discussed.

The second part, led by Marjan van den Akker from CAPHRI School at Maastricht University, focused on the role to be played by health services in face of this reality, and the need to reorient them to give a global response to patient’s health problems. Specific interventions involving the patient (e.g. shared decision making, patient centred care), but also at the level of the organization of care (e.g. case managers, reorganizing chains of care) were reviewed.

Finally, Christiane Muth from the Institute of General Practice at Frankfurt’s Goethe University suggested a methodological framework to systematically address multimorbidity in clinical practice guidelines. Taking chronic heart failure (CHF) as an example, the importance of identifying relevant interactions between CHF and its common comorbidities, as well as potential drug-disease and drug-drug interactions was highlighted, as a necessary precondition and a first step to optimize health care in patients with multiple conditions.

For further detail on the program and speakers, see:

http://www.eupha.org/site/upcoming_conference.php

Evidence-Based Medicine Meets Multimorbidity: A Blind Date?

By Marjan van den Akker and Christiane Muth

On Wednesday, October 17, 2012, an international symposium took place at the ´Deutsche Nationalbibliothek´ in Frankfurt am Main, Germany.


The focus of the symposium was on questions that keep family doctors and general practice researchers busy, such as: What should and can be done when my patient has several illnesses simultaneously? What are the problems of multimorbidity and polypharmacy that confront us today? What clinical decision-support does evidence-based medicine (EbM) currently provide, and how can EbM contribute in the future? Leading researchers representing both disciplines – EbM and multimorbidity research – discussed the dilemmas and challenges that multimorbidity entails, as well as strategies to overcome them.

The symposium garnered attention, both from Germany and abroad. There were over 130 registrations. For further detail on the program and speakers, see [link to the Institute of General Practice, Goethe-University, Frankfurt, Germany:
http://www.allgemeinmedizin.uni-frankfurt.de/forschung2/ebm_symposium.html.

The Symposium was part of the Friedrich Merz Foundation’s 22nd visiting professorship, to which Professor Marjan van den Akker from Maastricht University was appointed this year.

Subsequent to the symposium a 2-day international workshop on ´How to handle patients with multimorbidity in primary care´ was conducted. Twenty participants from the UK, Canada, Australia, Germany, the Netherlands and Spain exchanged on this subject. Although there is a growing body of knowledge regarding multimorbidity, it seems to mainly focus on observational, epidemiological studies. There remains a lack of research studying and supporting every day clinical practice for patients with multimorbidity.

A collaborative report on the workshop will follow.

An International collaborative research initiative to design interventions for patients with multimorbidity in primary health care

By Martin Fortin

2012 North American Primary Care Research Group (NAPCRG) Annual Meeting Forum

Martin Fortin, MD, MSc, Université de Sherbrooke, Québec (Canada); Elizabeth A. Bayliss, MD, MSPH, University of Colorado School of Medicine, USA; Stewart W. Mercer, MBChB, PhD, University of Glasgow, UK; Susan M. Smith,  MD, MSc, Royal College of Surgeons, Ireland; Jane Gunn, MBBS, FRACGP, PhD, DRANZCOG, The University of Melbourne, Australia; Mogens Vestergaard, MD, PhD, Aarhus University, Denmark.

A recent Cochrane systematic review on the impact of interventions for patients with multimorbidity (MM) found that there was a paucity of studies and a need for the consideration of appropriate outcomes and further pragmatic studies based in primary care settings (S. Smith et al. see S. Smith posting in IRCMo Blog, April 9, 2012: http://crmcspl-blog.recherche.usherbrooke.ca/?author=10 ). During this NAPCRG annual meeting forum, we will expand on an ongoing dialogue within an existing international community of researchers, decision-makers and health care providers interested in MM (International Research Community on Multimorbidity – IRCMo) and follow-up on discussions initiated during the NAPCRG 2007 meeting, and continued during sessions in Frankfurt, 2011; Glasgow, 2011-2012; and Aarhus, 2012. We aim to accomplish the following tasks in order to lay the groundwork for interventions to improve outcomes for persons with MM:

1) Identify key elements for interventions aimed at improving outcomes for MM;

2) Create a list of patient-centered outcomes relevant to interventions in this population and based on patient input;

3) Propose suitable intervention research designs;

4) Discuss specific evaluation methods;

5) Solicit input on potential national and international collaborations including funding opportunities.

The forum will include short presentations to outline the current focus and direction of interventions in MM followed by group discussions, each of which will address one specific topic. Finally we will synthesize the discussions into a report that will subsequently be shared among forum participants and with members of the IRCMo.

We welcome members to take part in this forum scheduled on Wednesday, December 5 from 9:30 am. to 12:30 pm.

Please visit: http://www.napcrg.org/ for more information about the forum.

“The Impact of Primary Care Teams on Multimorbidity (IMPCT): Optimizing care for patients living with multiple chronic conditions” meeting

By Tarek Bouhali

On December 8-9, 2011, the first meeting of “The Impact of Primary Care Teams on Multimorbidity (IMPCT): Optimizing care for patients living with multiple chronic conditions” team was held at the INSPQ (Institut national de santé publique du Québec) offices in Montréal (Quebec, Canada). Over the two days, we have greatly benefited from the very animated discussions among our panel of speakers and discussants. We would therefore like to thank and congratulate each one of them for sharing their wide-ranging perspectives.

This gathering of 28 team members and collaborators from various disciplines including academic researchers, policy-makers, public health practitioners, program specialists and representatives from government agencies was convened to examine issues related to multimorbidity in various Canadian jurisdictions (Quebec, Ontario, Alberta) as well as in many other countries such as the USA, the UK, the Netherlands and Australia.

During the consultation process and workshops, we received input and recommendations on intervention strategies that will help the IMPCT team enhance its efforts focused on patients with or at highest risk for multimorbidity and complexity. Although IMPCT interventions will be patient-centered, the IMPCT Panel has paid attention to recommendations of policy-makers to expand the reach to organizational levels.

The team’s leads (Martin Fortin, Jean-Frédéric Levesque and Renée F. Lyons) take pride in having hosted this meeting. They hope that the presentations given and the discussions that followed during this meeting have generated a better appreciation of the nuances on key issues and objectives, as well as research questions and strategic decisions that will be included in the team grant application to the Canadian Institutes of Health Research (CIHR).

Thanks again to all the participants and international collaborators for taking the time to be a part of this important meeting. We value members’ expertise and appreciate their continued support and commitment to the upcoming team grant proposal. A special thank you is owed to Meghan McMahon from CIHR for taking the time to present the details of the Canadian Institutes of Health Research – Community-Based Primary Health Care (CIHR CBPHC) Team Grant Competition to the meeting participants. We would also like to thank our international collaborators (Grant Russell, Australia; Jane Gunn, Australia; Michel Wensing, The Netherlands; Stewart Mercer, UK; Stephen Peckham, UK) who shared their views and experiences via telephone conferences.

The IMPCT team is preparing a meeting summary report that will be made available to all participants by next week.

Top row left to right: Christine Loignon, Guillaume Ruel, William L. Miller, Erin Strumpf, Antoine Boivin, Frances Gallagher, Debbie Feldman, Cecile Bensimon, Maud-Christine Chouinard, Sylvie Provost, Mary Byrnes, William Hogg, Benjamin F. Crabtree, Maxime Ouellette. Front row, left to right: Martin Fortin, Jean-Frédéric Lévesque, Renee F. Lyons, Catherine Hudon, Moira Stewart, Denise Campbell-Scherer. Meeting participants missing from the picture: Jeannie Haggerty, Robert Salois, Marie-Dominique Beaulieu.