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Monthly Archives: September 2012

Patient-Centered Care for Older Adults with Multiple Chronic Conditions: A Stepwise Approach from the American Geriatrics Society

By Cynthia Boyd

A new report issued by the American Geriatrics Society (AGS) outlines how clinicians can tailor care to better meet the unique needs older adults with multimorbidity.  More than half of adults 65 and older have at least three chronic conditions, such as heart disease, diabetes, and arthritis.

Entitled Patient-Centered Care for Older Adults with Multiple Chronic Conditions: A Stepwise Approach from the American Geriatrics Society, the new report was published in today’s early, online edition of the Journal of the American Geriatrics Society (JAGS) and is available at www.americangeriatrics.org, in conjunction with a longer version of the documents with more complete references.  A wealth of related information, tips, and tools for both clinicians and the public are also available on the AGS website.

To help both clinicians and patients make complex treatment decisions, the expert panel that developed the report has outlined five essential elements, or guiding principles, for quality care for older adults with multimorbidity: 

  • Preferences: Elicit and incorporate patient preferences* into medical decision-making for older adults with multimorbidity.

By using the term “patient” preferences, we aim to keep the patient central to the decision-making process while recognizing that family and social supports play a vital role in management and decision-making whether or not cognitive impairment is present.

  • Interpreting the evidence: Recognizing the limitations of the evidence base, interpret and apply the medical literature specifically to older adults with multimorbidity.
  • Prognosis: Frame clinical management decisions within the context of risks, burdens, benefits, and prognosis (e.g. remaining life expectancy, functional status, quality of life) for older adults with multimorbidity.
    • Clinical Feasibility: Consider treatment complexity and feasibility when making clinical management decisions for older adults with multimorbidity.
    • Optimizing Therapies and Care Plans: Utilize strategies for choosing therapies that optimize benefit, minimize harm, and enhance quality of life for older adults with multimorbidity.

    The report also describes the urgent need for research to develop and implement evidence-based practices for each of these areas.

    Cynthia Boyd, MD MPH
    Associate Professor of Medicine
    Division of Geriatric Medicine and Gerontology
    Johns Hopkins University School of Medicine

    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.