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Patient-centered innovation for multimorbidity care: the Ontario trial

By Moira Stewart

As part of the research program entitled Patient-Centered Innovations for Persons with Multimorbidity (PACE in MM), research trials were conducted simultaneously in the Canadian provinces of Quebec and Ontario. The aim of the trials was to assess the effectiveness of a patient-centered, multi-provider intervention for patients with multimorbidity, and understand under what circumstances it worked, and did not work. The report about the Quebec trial was recently published [1], and it is our pleasure to announce that the report of the trial in Ontario is now published too [2].

Both trials used mixed-methods design with a pragmatic randomized trial and qualitative study, involving primary care sites. Outcome measures were the same: two primary outcome measures representing patient education, empowerment, and agency (the Health Education Impact Questionnaire (heiQ); and the Self-Efficacy for Managing Chronic Disease scale), and four secondary outcome measures (VR12 Health Status; EQ-5D quality of life; Kessler Psychological Distress Scale; and Health Behaviour Survey). Outcomes were assessed at baseline and at 4 months after the intervention, a period considered long enough for follow-up to the trial.

A total of 86 patients in the intervention group and 77 in the control group participated in the Ontario trial. The intervention had a neutral effect on the primary outcomes, although one subgroup (those with an income of ≥C$50 000) significantly benefitted in terms of the mental health outcome. Qualitative and fidelity findings revealed aspects of the intervention that could be improved. For example, the qualitative study found patients’ enthusiasm for a coalesced action plan, but their frustration in its absence.

As a consequence of these findings, policymakers and clinicians are encouraged to seek ways to enhance care for patients with annual incomes of <C$50 000, to optimize team composition based on an individual patient’s preferences and abilities, and to enhance and tailor follow-up care by ensuring the creation of a coherent plan with actionable steps.

  1. Fortin M, Stewart M, Ngangue P, et al. Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial. Ann Fam Med 2021;19:126-34. doi: https://doi.org/10.1370/afm.2650
  2. Stewart M, Fortin M, Brown JB, et al. Patient-centred innovation for multimorbidity care: a mixed-methods, randomised trial and qualitative study of the patients’ experience. Br J Gen Pract 2021;71(705):e320-e30. doi: 10.3399/bjgp21X714293

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