Our search for papers on multimorbidity that were published during the period January-April 2022 has been completed. As in previous searches, we have prepared a PDF file that can be accessed following this link. Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expressions “multiple chronic diseases” and “multiple long-term conditions” in PubMed (https://www.ncbi.nlm.nih.gov/pubmed), but we are sure that most publications on the subject are included in the list. All references are also included in our library. Feel free to share with anyone interested in multimorbidity.
Our search for papers on multimorbidity that were published during the period September-December 2021 has been completed. As in previous searches, we have prepared a PDF file that can be accessed following this link.
Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expressions “multiple chronic diseases” and “multiple long-term conditions” in PubMed (https://www.ncbi.nlm.nih.gov/pubmed), but we are sure that most publications on the subject are included in the list. All references are also included in our library. Feel free to share with anyone interested in multimorbidity.
By Martin Fortin, Moira Stewart, José Almirall, and Priscilla Beaupré
Patients with multimorbidity need a new kind of health care. Numerous rigorous studies using randomized controlled designs (RCTs) have been conducted to demonstrate effectiveness of interventions aimed at improving outcomes for patient with multimorbidity in primary care, but most of them have reported neutral effects or mixed results. Nevertheless, these studies offer a valuable source of information to learn from in order to pave the way for future research in this area in primary care. We conducted a scoping review [1] to include current up-to-date state-of-the-art studies in primary care published from 2019 until 2021 in order to synthesize and analyze the most recent RCTs and to identify the factors that may have contributed to the success or lack of success. Special attention was given to four elements of the intervention: 1) its description and content; 2) the context in which it was deployed; 3) the evaluation design chosen to test the effectiveness, and 4) the intervention’s implementation. Nine articles reporting on six RCTs studies were included in the review. The findings were mixed, with primary outcomes showing no differences between intervention and control groups in four of the six but differences in secondary outcomes in all six. All studies involved family practice patients but interventions took place at different sites, and the time between the beginning of the intervention and the time of evaluation of outcomes varied across studies. Authors reported issues regarding the need for training of care teams, the roles and composition of the teams, the selection of patients and implementation barriers of the complex interventions in trying contexts with not enough time for the changes required. This scoping review identified several lessons on planning for future intervention studies on multimorbidity in primary care. Interdisciplinary teams as the basis for most interventions, while recommended, may need more support by policy and practice leadership to be successfully deployed and evaluated. The randomized controlled design may not be the best evaluation design given the complexity of the interventions; alternative designs should be considered in which qualitative components are included. Special attention should be given to outcome measures ensuring that they are better aligned to patient goals. Selection of patients was prone to bias toward the less needy and this may hamper the ability to document effectiveness and raises questions about equity in research. Implementation of the interventions needs special attention and enough time to gel.
1-Fortin M, Stewart M, Almirall J and Beaupré P (2022) Challenges in Multimorbidity Research: Lessons Learned From the Most Recent Randomized Controlled Trials in Primary Care. Front. Med. 9:815783. doi: 10.3389/fmed.2022.815783
Different attempts have been made to create effective interventions in primary care for people with multimorbidity, being the predominant intervention element a change to the organization of care delivery. However, these interventions have obtained mixed results. We recently reported the results of a trial assessing the effectiveness of a multifaceted intervention based on a change in care delivery for patients with three or more chronic conditions [1]. After four months, the intervention showed a neutral effect on the primary outcomes and substantial improvement in two health behaviors as secondary outcomes. However, the effect of the intervention after a longer period of time was not known. We have now reported the one-year outcomes after exposure to the intervention, combining all participants in one single group that received the intervention, to document its long-term association with measures of self-care, quality of life and health-related behaviors [2]. Changes in these measures were also analyzed across age-, number of chronic conditions-, income-, and gender-based subgroups to explore factors potentially associated with variation in response to the intervention and help guide the development of more targeted interventions in the future.
We observed that one year after the
intervention, the domain of emotional wellbeing of the Health Education
Questionnaire (heiQ), improved significantly. However, we also observed
deterioration in the domain of health services navigation of the heiQ. Improvement
was also observed for the measures of the VR-12 (Veteran RAND-12 Health Survey)
physical component, VR-12 mental component, in moderate to severe psychological
distress measured with the Kessler six item Psychological Stress Scale (K6), and
healthy eating.
Subgroup analyses in this exploratory study
suggest that younger patients, those with lower number of chronic conditions or
higher incomes may respond better in relation to self-management, health status
and health behaviors. This suggests that future interventions should be
tailored to patients’ characteristics including age, sex, income and number of
conditions.
1. Fortin M, Stewart
M, Ngangue P, Almirall J, Belanger M, Brown JB, et al. Scaling Up
Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic
Mixed-Methods Randomized Controlled Trial. Ann
Fam Med (2021) 19(2):126-34. doi: 10.1370/afm.2650.
2. Fortin
M, Stewart M, Almirall J, Berbiche D, Belanger M, Katz A, et al. One year
follow-up and exploratory analysis of a patient-centered interdisciplinary care
intervention for multimorbidity. J Comorb
(2021) 11:26335565211039780. doi: 10.1177/26335565211039780.
Our search for papers on multimorbidity that were published during the period May-August 2021 has been completed. As in previous searches, we have prepared a PDF file that can be accessed following this link.
Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expression “multiple chronic diseases” in PubMed (https://www.ncbi.nlm.nih.gov/pubmed), but we are sure that most publications on the subject are included in the list.
All references are also included in our library. Feel free to share with anyone interested in multimorbidity.
Our search for papers on multimorbidity that were published during the period January-April 2021 has been completed. As in previous searches, we have prepared a PDF file that can be accessed following this link.
Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expression “multiple chronic diseases” in PubMed (https://www.ncbi.nlm.nih.gov/pubmed), but we are sure that most publications on the subject are included in the list.
All references are also included in our library. Feel free to share with anyone interested in multimorbidity.
Our search for papers on multimorbidity that were published during the period September-December 2020 has been completed. As in previous searches, we have prepared a PDF file that can be accessed following this link.
Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expression “multiple chronic diseases” in PubMed (https://www.ncbi.nlm.nih.gov/pubmed), but we are sure that most publications on the subject are included in the list.
All references are also included in our library. Feel free to share with anyone interested in multimorbidity.
The Patient-Centered Innovations for Persons with Multimorbidity research program, funded by the Canadian Institutes of Health Research, had an overall goal to build on existing structures and initiatives to evaluate patient-centered innovations relevant to multimorbidity in primary care. As part of this program, trials were conducted in 2 Canadian provinces, Quebec and Ontario. We reported the Quebec trial where the research team collaborated with a regional health care organization to implement an integrated chronic disease prevention and management program into family medicine groups (FMG), the most prevalent type of primary care practice in Quebec [1].
We conducted a concurrent triangulation mixed methods study, with convergent quantitative and qualitative components. The first component was a pragmatic randomized controlled trial with a delayed intervention in the control group to evaluate the effect of the intervention on patient’s self-management and self-efficacy for managing chronic diseases. The second concurrent component used a descriptive qualitative approach.
Primary outcomes were the Health Education Impact Questionnaire (heiQ) and Self-Efficacy for Managing Chronic Diseases. Secondary outcomes included health status measured by the Veterans RAND 12 Item Health Survey (VR-12), quality of life measured with the EuroQol 5-dimensions questionnaire, psychological distress, measured with the Kessler 6-item Psychological Distress Scale Questionnaire (K6), and health behaviors (tobacco smoking, physical activity, healthy eating, and high risk alcohol consumption) assessed with specific questions from the Enquête de santé du Saguenay–Lac-Saint Jean 2007 and the Behavioral Risk Factor Surveillance System.
The trial randomized 284 patients (144 in intervention group, 140 in control group). After 4 months, the intervention showed a neutral effect for the primary outcomes, but there was significant improvement in 2 health behaviors (healthy eating, and physical activity).
The descriptive qualitative evaluation revealed that the patients reinforced their self-efficacy and improved their self-management which was divergent from the quantitative results. Qualitatively, the intervention was evaluated as positive.
The combination of qualitative and quantitative designs proved to be a good design for evaluating this complex intervention.
Formerly, we could find in the description of the Journal of Comorbidity that it published “original clinical and experimental research articles on the pathophysiology, diagnosis, prevention and management of patients with comorbidity/multimorbidity.” Now, in the description of the Journal of Multimorbidity and Comorbidity, one reads that it publishes the same type of articles on “comorbidity and multimorbidity.”
The change in the name of the journal and the change in the description from “comorbidity/multimorbidity” to “comorbidity and multimorbidity” may seem natural for those working on multimorbidity or those who are familiar with its meaning. However, for many who still consider both words as interchangeable, writing “comorbidity/multimorbidity” could have been seen as normal and the separation in “comorbidity and multimorbidity” could be seen as redundant.
In 1996, van den Akker and colleagues [1] pointed out the prevailing ambiguity around the use of both terms at that time, and suggested distinct definitions for them. Since then, there has been an increasing awareness about the difference between both terms and the importance of using them correctly. A benefit in using both terms adequately is that publications are then correctly classified, leading to an improvement in the quality of search queries and ultimately to better research.
However, although the first alert on the ambiguity in the use of the terms was published 25 years ago, it has taken a long time for the recognition of the difference between both terms and its effect in slowing down the advance of our knowledge on the subject. For example, in the National Library of Medicine of the National Institutes of Health (NIH), the term “multimorbidity” was a subheading under the Medical Subject Heading (MeSH) “comorbidity” until 2017. It was only in 2018 that the term “multimorbidity” appeared with the hierarchy of a MeSH.
In the editorial of the Journal of Multimorbidity and Comorbidity explaining the change in the name of the journal [2], it is well explained that multimorbidity and comorbidity are distinct concepts in research design, intervention development and healthcare delivery. However, there is not a universal recognition of this distinction yet.
We welcome the change in the name of the journal as another step in clarifying the use of the terms, hoping that it will contribute to our main goal which is to improve the health outcomes of our patients.
van den Akker M, Buntinx F and Knottnerus JA. Comorbidity or multimorbidity: what’s in a name? A review of literature. Eur J Gen Pract 1996; 2: 65-70.
Harrison C, Fortin M, van den Akker M, et al. Comorbidity versus multimorbidity: Why it matters. Journal of Multimorbidity and Comorbidity 2021; 11. Article first published online: March 2, 2021. DOI: https://doi.org/10.1177/2633556521993993.
Our search for papers on multimorbidity that were published during the period May-August 2020 has been completed. As in previous searches, we have prepared a PDF file that can be accessed following this link. Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expression “multiple chronic diseases” in PubMed (https://www.ncbi.nlm.nih.gov/pubmed), but we are sure that most publications on the subject are included in the list. All references are also included in our library. Feel free to share with anyone interested in multimorbidity.
