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Monthly Archives: January 2015

How to handle multimorbidity in primary care consultations

By Marjan van den Akker
An international group of scientists working around the themes of multimorbidity and polypharmacy have recently published a paper in BMC Medicine [1] on the management of patients with multimorbidity in primary care consultations. The article aims to support decision making in primary care consultations, through a set of guiding principles. These principles are named after the Greek mythological figure Ariadne, who helped the Greek hero Theseus escape from the labyrinth.
The sharing of realistic treatment goals by physicians and patients is at the core of the Ariadne principles. These result from i) a thorough interaction assessment of the patient’s conditions, treatments, constitution, and context; ii) the prioritization of health problems that take into account the patient’s preferences – his or her most and least desired outcomes; and iii) individualized management realizes the best options of care in diagnostics, treatment, and prevention to achieve the goals. Goal attainment is followed-up in accordance with a re-assessment in planned visits. The occurrence of new or changed conditions, such as an increase in severity, or a changed context may trigger the (re-)start of the process.

1-Muth C, van den Akker M, Blom JW, Mallen CD, Rochon J, Schellevis FG, Becker A, Beyer M, Gensichen J, Kirchner H, Perera R, Prados-Torres A, Scherer M, Thiem U, van den Bussche H, Glasziou PP. The Ariadne principles: how to handle multimorbidity in primary care consultations. BMC Med 2014; 12:223.

Challenges of self-management when living with multiple chronic conditions

By Clare Liddy

In our systematic review of the qualitative literature examining the patient’s perspectives of living with multiple chronic conditions published in Canadian Family Physician [1], we found that patients were able to clearly identify challenges associated with self-management and develop strategies to address these factors. The barriers to self-management are many and yet common between people with many different diseases. However, while most studies were disease-specific, we found that discussion among patients that related to specific medical conditions and disease-specific symptoms was strikingly absent. People did not complain about lack of skill to manage medical tasks such as injecting insulin or blood pressure monitoring; rather, they reported difficulties in dealing with physical and emotional symptoms, with depression, pain and fatigue being prominent. In addition, issues related to knowledge about self-management of conditions commonly arose because of confusing and often contradictory information provided by multiple health care providers. The use of cognitive strategies including reframing, prioritizing, and changing beliefs was reported to improve people’s ability to self-manage their multiple chronic conditions.
This study provides a unique view into the patients’ perspectives of living with multiple chronic conditions which are clearly linked to common functional challenges as opposed to specific diseases. Future policy and programming in self-management support should be better aligned with the patient’s perspectives of living with multiple chronic conditions and this may be achieved by ensuring a more patient-centered approach is adopted by providers and health service organizations.

1. Liddy, C., Blazkho, V. & Mill, K. (2014). “Challenges of self-management when living with multiple chronic conditions. Systematic review of the qualitative literature.” Canadian Family Physician, 60, 1123-1133.

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.