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Monthly Archives: June 2015

Psychosocial, musculoskeletal and somatoform comorbidity in patients with chronic low back pain in primary care

By Aline Ramond-Roquin

This recently published study (1) is part of my thesis in public health untitled “Risk factors, comorbidity and management of non-specific low back pain in general practice”, undertaken in the University of Angers, France, in partnership with the Department of Primary and Community Care of Nijmegen, The Netherlands.
Literature has suggested that patients with chronic low back pain (CLBP) presented higher level of psychosocial, musculoskeletal and somatoform comorbidity than general population. As such morbidity is particularly common in primary care, we were interested in the following question: in general practice, do patients presenting with CLBP more often present psychosocial, musculoskeletal and somatoform problems than patients presenting with other problems?
We extracted data from the Transition Project, a long-standing, experienced primary care practice-based network that has been systematically and prospectively coding the diagnoses related to all the encounters between the patients and their general practitioners, using the international classification of primary care. We compared the prevalence of the problems presented by 1511 patients with CLBP with those of their 1511 matched patients without CLBP, focusing on the period from one year before the beginning of an episode of care for CLBP to two years after it. Patients with CLBP presented higher prevalence of musculoskeletal problems but similar prevalence of psychosocial and non-musculoskeletal somatoform problems, compared to other patients consulting in the same setting. Therefore we concluded that:

1)    General practitioners should be aware of the frequency of multi-site musculoskeletal disorders, whether synchronous or metachronous, and adopt an integrated approach when caring for patients with such problems.
2)    Rather than  systematically screening for specific psychological, social or somatoform disorders, they should consider with the patient how CLBP and any type of potential comorbidity interfere with his/her daily functioning.

1) Ramond-Roquin A, Pecquenard F, Schers H, Van Weel C, Oskam S, Van Boven K. Psychosocial, musculoskeletal and somatoform comorbidity in patients with chronic low back pain: original results from the Dutch Transition Project. Fam Pract. 2015 Jun;32(3):297–304

Call special issue Biomed Research International on multimorbidity

By Alessandra Marengoni

Despite the increasing interest of the researchers in the topic of multimorbidity, there is still a remarkable gap between the harmful impact of multimorbidity at the individual and societal level and the amount of scientific and clinical research devoted to this topic. To (partly) cover for this lack of multimorbidity research Alessandra Marengoni (lead guest editor, Brescia, Italy), Alexandra Prados Torres (Zaragosa, Spain), Graziano Onder (Rome, Italy) and René Melis (Nijmegen, the Netherlands) are guest editing a special issue with Biomed Research International on the topic of multimorbidity. We believe that this maybe a very nice opportunity to provide a comprehensive, impactful overview of this highly relevant topic. We warmly welcome original research articles as well as review articles that seek to address epidemiology of multimorbidity both in the general population and in clinical settings.

Do not hesitate to contact one of us for any questions you may have related to this call or pre-submission inquiries.

For details on the call:

Take a stand on complexity and gain a better understanding of the roles of professionals in care coordination!

By Anne Doessing

We recently published a scoping study addressing two issues: what are the conditions of care coordination for patients with multimorbidity; and which factors promote or inhibit care coordination in provider organizations and among healthcare professionals [1].
The central theme emerging was complexity: The specific medical conditions of patients with multimorbidity are highly complex as is the organization of care delivery.
What are the implications for care coordination then? One approach is to reduce complexity and the other is to embrace complexity. Either way, future research in care coordination interventions in multimorbidity must take a more explicit stand on complexity.
In the included studies there was a significant lack of clarity regarding the role of different professionals in care coordination. It is unclear what role the various health professions play in care coordination, what coordination tasks different professions perform and whether some professions are more suited for care coordination than others. Also, it is unclear how different organizations and sectors affect the coordination carried out by different professions.
The research on care coordination interventions for patients with multimorbidity seems to focus on organizing healthcare without paying much attention to the role of professions in frontline care coordination. However, this ought to be a prerequisite for the development of care coordination interventions.
Therefore there is a need for more research to uncover the role of different professions in care coordination. This must comprehend both their actions and the health professionals’ own understanding of their role in care coordination.
Perhaps some of the failures of existing care coordination interventions can be explained by the fact that the specific delegation of coordination is at odds with the health professionals’ own understanding of their professional domain?

The complete article can be accessed at: http://www.jcomorbidity.com/index.php/test/article/view/39

1: Doessing A, Burau V. Care coordination of multimorbidity: a scoping study. J Comorbidity 2015;5:15-28