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Monthly Archives: November 2011

“I also want researchers to specialize in me!”

By Maud-Christine Chouinard


Greetings from the NAPCRG Conference in beautiful Banff! I am currently amongst a record assistance of more than 750 attendees who is gathered this week in a most enchanting and wintery site in the Rocky Mountains. As a nursing researcher, I am delighted to be able to present a poster and to get to choose among hundreds of presentations and 3 poster sessions on primary care research!

 For the last two days, I have had the opportunity to meet and greet with researchers and clinicians from various disciplines and to hear and see oral and poster presentations on a vast array of subjects such as evidence based medicine, translational research, chronic disease management, patient-centered care, self-management, etc. The captivating conferences were competing with the majestic peaks of the Rocky Mountains in the background.

 Garnering buzzing interest was the keynote presentation given by Professor Martin Fortin: Multimorbidity in primary care: Recognizing and dealing with the elephant in the room. Professor Martin Fortin presented in English in front of a captive audience including established and new researchers as well as members of the editorial committees of medical journals and representatives of funding agencies.

 Martin Fortin provided a clear message to draw the attention of the research community on the importance of prioritizing the thematic research area of multimorbidity and patient-centered care to continue transforming the healthcare system and thus better contend with the current and future boom in chronic diseases, especially in primary care. He also invited researchers of all disciplines to work together to develop interventions aiming to optimize care for people with multimorbidity. His presentation ended with a genuine plea in the defense of the interests of patients suffering from multiple chronic diseases.

 One line created a buzz on Twitter when Professor Fortin, paraphrasing a patient of Ian McWhinney said “I want a doctor who specializes in me”. However, his message really aims to go further with: “I also want researchers to specialize in me!”

 Finally, although we did not see any elephants in the room, Dr. Fortin convinced us of the importance of taking a real interest in the elephants in primary care with his infectious passion for the subject.

 For a copy of his presentation please contact José Almirall at: jose.almirall@usherbrooke.ca


Summary of Notre Dame multimorbidity TDB

By Tom Brett

Researchers at the General Practice and Primary Health Care Research Unit at The University of Notre Dame Australia, Fremantle have recently completed extracting patient data from the medical records of attendees at two Perth metropolitan general practices. All patients (over 7000 in total) who attended the practices in a six month period in 2008 were included as were patients who were seen for home visits, hostel and nursing home visits in the same period.

We utilised a similar data extraction process to that employed by Fortin et al.1 and used the Cumulative Illness Rating Scale (CIRS) 2-6 to assess both the prevalence of chronic disease presentations and the severity of the disease burden for each patient. We employed ideas from the geriatric version of the CIRS as developed by Miller and Towers (CIRS-G)3  to improve consistency and help with standardisation amongst the data extractors. Three GPs, three practice nurses, a graduate-entry medical student and a senior receptionist were specially trained in the data extraction process.

A combination of electronic medical records and older hard copy files, including hospital discharge and out-patients letters together with radiology and pathology reports, was used to maximise the available data on each patient. Younger attendees were included so as not to discriminate against any age group and because no similar comprehensive information was available in the Australian primary care literature.

We are currently analysing the data and hope to publish some of our findings in 2012. The data extraction process was long and tedious but we are happy with the outcome and appreciate the efforts of the data extractors. We are hoping to expand and develop the study in the future and would welcome input and suggestions from future collaborators.


  1. Fortin M, Bravo G, Hudon C, Vanasse A, Lapointe L. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med. 2005; 3: 223-228.
  2. Linn BS, Linn MW, Gurel L. Cumulative Illness Rating Scale. J Amer Geriatr Soc. 1968; 16: 622-626.
  3. Miller MD, Towers A. A manual of guidelines for scoring the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Pittsburg, Pa. University of Pittsburg; 1991.
  4. Hudon C, Fortin M, Vanasse A. Cumulative Illness Rating Scale was a reliable and valid index in a family practice context. J Clin Epidemiol. 2005; 58: 603-608.
  5. De Groot V, Beckerman H, Lankhorst GJ, Bouter LM. How to measure co-morbidity: a critical review of available methods. J Clin Epidemiol. 2003; 56: 221-229.
  6. Hudon C, Fortin M, Soubhi H. Abbreviated guidelines for scoring Cumulative Illness Rating Scale (CIRS) in family practice. J Clin Epidemiol. 2007; 60: 212.