Entete 3

Author Archives: Martin Fortin

Publications on multimorbidity January – April 2013

June 4, 2013 – 7:58 am

By Martin Fortin

Our search for papers on multimorbidity that were published during the first quarter of this year has been completed. As in previous searches, we found many new papers and the list is too long for this venue. Therefore, we have prepared a PDF file that can be accessed following this link.

Probably, there are some papers that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expression “multiple chronic diseases”, 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.

Comment (0)

An International Perspective on Designing Interventions for Multimorbidity in Primary Care

May 7, 2013 – 7:58 am

By Martin Fortin, Elizabeth A. Bayliss, Susan M. Smith, Stewart W. Mercer, Mogens Vestergaard, Chris Salisbury

Under the sponsorship of the Agency for Healthcare Research and Quality Multiple Chronic Conditions (AHRQ MCC) Research Network, a panel of six members of the International Research Community on Multimorbidity (CIRMo) presented a webinar on interventions for patients with multimorbidity: “An International Perspective on Designing Interventions for Multimorbidity in Primary Care”. The webinar included three parts:

Context and background for interventions: Dr. Chris Salisbury, University of Bristol, UK, discussed the eligibility criteria in intervention studies for multimorbidity (Who should we include in studies of interventions for multimorbidity?). Dr. Elizabeth A. Bayliss, Kaiser Permanente Colorado, University of Colorado School of Medicine, USA, who acted as the moderator of the webinar, presented “Outcomes for Multimorbidity Interventions” followed by Dr. Susan M. Smith, HRB Centre for Primary Care Research, RCSI Medical School, Dublin, Ireland, who presented a brief summary of a systematic review: “Interventions for improving outcomes in patients with multimorbidity in primary care and community settings”.

Reports on specific research and operational interventions: Senior investigators described three intervention initiatives in three different contexts. Dr. Stewart W. Mercer from the Institute of Health & Wellbeing, University of Glasgow, Scotland, presented “Preliminary findings of an exploratory cluster RCT of a primary care-based complex intervention for multimorbid patients living in deprived areas”. Dr. Martin Fortin, Université de Sherbrooke, Québec, Canada, presented results of an ongoing pragmatic randomized controlled trial: “PR1MaC: Evaluating the integration of chronic disease prevention and management services into primary healthcare” and Dr. Mogens Vestergaard, Aarhus University, Denmark, described a very interesting Danish experience in managing patients with multimorbidity: “The multimorbidity clinic at silkeborg hospital”.

Questions & answers period: At the end of the presentation was a very interesting period of interactions between participants of the webinar and the panel of researchers.

The Webinar was coordinated by James R. Fraser and hosted by Jared Lyle from the AHRQ MCC Research Network.

You can access the webinar presentations and recording through the AHRQ MCC Research Network website:

https://ahrqplexnet.sharepointspace.com/Grantee%20Site%20Pages/Meetings%20and%20Webinars.aspx

Look for the last item under “Webinars & Workshops” entitled “An International Perspective on Designing Interventions for Multimorbidity in Primary Care.”

Comment (0)

Publications on multimorbidity September – December 2012

February 22, 2013 – 9:06 am

By Martin Fortin

You are invited to have at look at the results of our latest literature search for published papers on multimorbidity. We used the search term “multimorbidity”, but also its variant “multi-morbidity” and the expression “multiple chronic diseases”.

As in our previous posting covering the May – August 2012 period, we found many new papers on multimorbidity published from September to December. As the number of publications in the list is too long for this venue, a PDF file can be accessed following this link.

All references are also included in our library. Feel free to share with anyone interested in multimorbidity.

Comment (0)

A survey on the definition of multimorbidity: WE NEED YOUR INPUT!

January 22, 2013 – 4:36 pm

By Martin Fortin and Marcello Tonelli

We have seen many different operational definitions of multimorbidity. In fact, the list of chronic conditions considered by different authors varies from less than 10 to all possible diagnoses. A team of Canadian researchers is submitting a research proposal to a funding agency and need your input in giving weight to the definition of multimorbidity that we propose future studies use. We are conducting a three-question survey that should take you about one minute to complete. The questions are:

1. Where are you from?
Choices: 1) Canada; 2) USA; 3) Europe; 4) Asia; 5) Australia/New Zealand; 6) South/Central America 7) Other

2. Many different definitions of multimorbidity have been used in previous studies. How important is it that future studies use definitions that are similar to those previously used, to allow comparisons with prior and future work?
Choices: 1) Very important; 2) Somewhat important; 3) Neither important nor unimportant; 4) Somewhat unimportant; 5) Not important

3. If asked to recommend an existing list of chronic conditions or diseases that should be more broadly used in future studies on the operational definition of multimorbidity in adult populations, which would you suggest?
Choices: 1) Barnett et al; 2) Bayliss et al; 3) O’Halloran et al; 4) Muggah et al; 5) Canadian Community Health Survey; 6) Other (please specify)

Blog subscribers will receive the link to complete the survey, by email. Those who are not subscribed to the blog, but would like to complete the survey, are invited to contact José Almirall at jose.almirall@usherbrooke.ca to receive the link by email. The deadline to participate in the survey is February 7, 2013.

Please consider completing the survey and helping us out. Your input is important. Many thanks for your help.

Click here to see the responses to the survey.

Comments (3)

International collaborative research initiative to design interventions for patients with multimorbidity in primary health care

January 18, 2013 – 9:35 am

By Martin Fortin

As part of the 2012 Annual Meeting of the North American Primary Care Research Group (NAPCRG), participants from different disciplines and fields of expertise had the opportunity to take part in the “International collaborative research initiative to design interventions for patients with multimorbidity in primary health care” to discuss and share ideas and perspectives with each other.

This forum was initiated and organized by six researchers: Martin Fortin, MD, MSc; Elizabeth A. Bayliss, MD, MSPH; Stewart Mercer, MBChB, PhD; Susan Smith, MD, MSc; Jane Gunn, MBBS, FRACGP, PhD, DRANZCOG; Mogens Vestergaard, MD, PhD. The forum aimed to use a group process to identify a set of attributes relevant to interventions in multimorbidity, to share findings and to identify potentially important future directions for improving generalist patient-centered care of persons with multimorbidity in primary care settings.

Participants came from different organizations across the USA, Canada, Australia, Denmark, Ireland and the UK which fostered discussions enlightened by different perspectives and experiences. The forum’s organizers gave very short presentations on a number of topics (list presented below*) before handing the floor over to participants for very enthusiastic small group and plenary discussions.

The organizers would like to thank and congratulate each one of the participants for so generously sharing their wide-ranging perspectives and to inform them that the lead group is planning to write a paper based on the forum’s discussions and the work leading up to it.

*Presentation list (summary):
-Concepts and definitions for multimorbidity interventions (M Fortin)
-Systematic review of interventions to improve outcomes for patients with multimorbidity in primary care and community settings (S Smith)
-Outcomes for multimorbidity interventions (E Bayliss)
-Preliminary findings of an exploratory cluster RCT of a primary care-based complex intervention for multimorbid patients living in areas of high deprivation in Scotland: The CARe Plus Study (S Mercer)
-Co-designing an intervention for improving care for those with severe and enduring mental health problems (J Gunn)
-Integration of chronic disease prevention and management services into primary health care: The PR1MaC Study (M Fortin)
-Interventions for multimorbid patients in Denmark (M Vestergaard)

From left to right:
Chris Salisbury, Stewart Mercer, Susan Smith, Mogens Vestergaard,
Martin Fortin, Jane Gunn, Elizabeth A. Bayliss and Sally Wyke. 

Comments (2)

The impact of Multiple Chronic Diseases on ambulatory care use

January 4, 2013 – 8:48 am

By Elizabeth Muggah

Our paper, The impact of Multiple Chronic Diseases on ambulatory care use; a population based study in Ontario, Canada, was recently published in BMC Health Services Research. This study is an important addition to what we know about the burden of multimorbidity on the primary care system as we focused specifically on ambulatory health care use and looked at the burden of disease on both the patient and on the health system more broadly.

This research was completed using health administrative data housed at the Institute of Clinical Evaluative Sciences (ICES) in Toronto, Canada. We used well validated methods to search administrative data in one large province of Canada to identify persons who had at least one of nine common chronic diseases (diabetes, congestive heart failure, acute myocardial infarction, stroke, hypertension, asthma, chronic obstructive lung disease, peripheral vascular disease and end stage renal failure).  We then identified the number of outpatient primary care and specialist visits over a 2 year period.

We found that multiple chronic diseases were common among the Ontario population, (in 2009, 26.3% of Ontarians had one chronic disease, 10.3% had two diseases, and 5.6% had three or more diseases). The annual number of primary health care visits per patient increased significantly with each additional chronic disease and patients with two or more diseases made more than twice as many visits each year to primary health care providers compared to specialists. At the extremes of age we saw an increase in the number of primary care visits across all groups while specialist care dropped off. Looking from a health system perspective we found the largest total number of visits were made by those with no or one chronic disease compared to those with multiple diseases.

This study reinforces what we know about the considerable burden of illness felt by persons with multiple chronic diseases and confirms that these patients seek care disproportionately from their primary care providers.  However from a health system perspective those with no or one chronic disease are responsible for the largest number of ambulatory health care visits.  In our view continued investment in primary health care is needed both to care for those with multiple diseases as well as to maintain a focus on preventing the accumulation of chronic diseases with advancing age.  It would be important to explore these trends over time to see if the pattern of health care use we found is changing given the predicted rise in the prevalence of multiple chronic diseases with the aging of our population.

Comment (0)

Publications on multimorbidity May – August 2012

October 10, 2012 – 7:47 am

By Martin Fortin

Since last year, I have been sharing with you blog visitors the results of literature searches for the latest published papers on multimorbidity that we do on a regular basis. Many new papers on multimorbidity have been published during the May-August period of this year. Usually, the titles of all publications are listed here in the post. However, this time the number of publications in the list is too long for this venue so instead of listing the publications here, a pdf document including the publications has been prepared and can be accessed following this link.

All references are also included in our library. Feel free to share with anyone interested in multimorbidity.

It is nice to note that an important body of information covering different aspects of the subject is growing each year. To provide an idea of the increase of the number of publications on multimorbidity we did a simple search in Medline using the word multimorbidity. Articles published in any language were considered. The graph below shows how the number of publications at least mentioning multimorbidity has increased since the year 2000.

It looks like the many challenges of multimorbidity are attracting more researchers on the subject.

Comment (0)

An International collaborative research initiative to design interventions for patients with multimorbidity in primary health care

September 14, 2012 – 7:08 am

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: https://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.

Comment (0)

Multimorbidity publications January – April 2012

June 13, 2012 – 9:07 am

By Martin Fortin

Dear colleagues,

I would like to share with you the results of our latest literature search for papers on multimorbidity published between January and April 2012, along with the links to the abstracts or full texts:

1. Hudon C, Fortin M, Poitras M-E, Almirall J. The relationship between literacy and multimorbidity in a primary care setting. BMC Family Practice. 2012;13:33. [Full Text]

2. France EF, Wyke S, Gunn JM, Mair FS, McLean G, Mercer SW. Multimorbidity in primary care: a systematic review of prospective cohort studies. Br J Gen Pract. Apr 2012;62(597):297-307.[Abstract]

3. Smith SM, Soubhi H, Fortin M, Hudon C, O’Dowd T. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev (2):CD003638. 2012;4:CD006560.[Abstract]

4. Schafer I, Hansen H, Schon G, et al. The influence of age, gender and socio-economic status on multimorbidity patterns in primary care. first results from the multicare cohort study. BMC Health Serv Res. 2012;12:89.[Full Text]

5. Spruit-van Eijk M, Zuidema SU, Buijck BI, Koopmans RT, Geurts AC. To what extent can multimorbidity be viewed as a determinant of postural control in stroke patients? Arch Phys Med Rehabil 2012.93(6):1021-1026.[Abstract]

6. Fuchs J, Busch M, Lange C, Scheidt-Nave C. Prevalence and patterns of morbidity among adults in Germany. Results of the German telephone health interview survey German Health Update (GEDA) 2009. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. Apr 2012;55(4):576-586. [Abstract]

7. Agborsangaya CB, Lau D, Lahtinen M, Cooke T, Johnson JA. Multimorbidity prevalence and patterns across socioeconomic determinants: a cross-sectional survey. BMC Public Health. 2012;12:201.[Full text]

8. Diederichs CP, Wellmann J, Bartels DB, Ellert U, Hoffmann W, Berger K. How to weight chronic diseases in multimorbidity indices? Development of a new method on the basis of individual data from five population-based studies. J Clin Epidemiol. Jun 2012;65(6):679-685.[Abstract]

9. Fortin M, Stewart M, Poitras M-E, Almirall J, Maddocks H. A Systematic Review of Prevalence Studies on Multimorbidity: Toward a More Uniform Methodology. Ann Fam Med. 2012;10:142-151.[Full Text]

10. Huntley AL, Johnson R, Purdy S, Valderas JM, Salisbury C. Measures of multimorbidity and morbidity burden for use in primary care and community settings: a systematic review and guide. Ann Fam Med. Mar-Apr 2012;10(2):134-141.[Full Text]

11. Goodman RA, Parekh AK, Koh HK. Toward a more cogent approach to the challenges of multimorbidity. Ann Fam Med. Mar-Apr 2012;10(2):100-101. [Full Text]

12. Schneider F, Kaplan V, Rodak R, Battegay E, Holzer B. Prevalence of multimorbidity in medical inpatients. Swiss Med Wkly. 2012;142:w13533. [Full Text]

13. Prados-Torres A, Poblador-Plou B, Calderon-Larranaga A, et al. Multimorbidity patterns in primary care: interactions among chronic diseases using factor analysis. PLoS One. 2012;7(2):e32190. [Full Text]

14. Bower P, Harkness E, Macdonald W, Coventry P, Bundy C, Moss-Morris R. Illness representations in patients with multimorbid long-term conditions: Qualitative study. Psychol Health. Mar 5 2012. [Abstract]

15. Garcia-Olmos L, Salvador CH, Alberquilla A, et al. Comorbidity patterns in patients with chronic diseases in general practice. PLoS One. 2012;7(2):e32141. [Full Text]

16. Nagl A, Witte J, Hodek JM, Greiner W. Relationship between multimorbidity and direct healthcare costs in an advanced elderly population. Results of the PRISCUS trial. Z Gerontol Geriatr. Feb 2012;45(2):146-154. [Abstract]

17. Poitras M-E, Fortin M, Hudon C, Haggerty J, Almirall J. Validation of the disease burden morbidity assessment by self-report in a French-speaking population. BMC Health Service Research. 2012;12:35. [Full Text]

18. Cheung CL, Nguyen US, Au E, Tan KC, Kung AW. Association of handgrip strength with chronic diseases and multimorbidity : A cross-sectional study. Age (Dordr). Feb 8 2012. [Abstract]

19. Freund T, Kunz CU, Ose D, Szecsenyi J, Peters-Klimm F. Patterns of multimorbidity in primary care patients at high risk of future hospitalization. Popul Health Manag. Apr 2012;15(2):119-124. [Abstract]

20. Kirchberger I, Meisinger C, Heier M, et al. Patterns of multimorbidity in the aged population. Results from the KORA-Age study. PLoS One. 2012;7(1):e30556. [Full Text]

21. Perruccio AV, Katz JN, Losina E. Health burden in chronic disease: multimorbidity is associated with self-rated health more than medical comorbidity alone. J Clin Epidemiol. Jan 2012;65(1):100-106. [Abstract]

22. Harrison M, Reeves D, Harkness E, et al. A secondary analysis of the moderating effects of depression and multimorbidity on the effectiveness of a chronic disease self-management programme. Patient Educ Couns. Apr 2012;87(1):67-73. [Abstract]

23. Schuz B, Wurm S, Warner LM, Ziegelmann JP. Self-efficacy and multiple illness representations in older adults: a multilevel approach. Psychol Health. Jan 2012;27(1):13-29. [Abstract]

24. Gunn JM, Ayton DR, Densley K, et al. The association between chronic illness, multimorbidity and depressive symptoms in an Australian primary care cohort. Soc Psychiatry Psychiatr Epidemiol. Feb 2012;47(2):175-184. [Abstract]

25. McCann L, Lloyd F, Parsons C, et al. “They come with multiple morbidities”: a qualitative assessment of pharmacist prescribing. J Interprof Care. Mar 2012;26(2):127-133. [Abstract]

26. Vogel I, Miksch A, Goetz K, Ose D, Szecsenyi J, Freund T. The impact of perceived social support and sense of coherence on health-related quality of life in multimorbid primary care patients. Chronic Illn. Apr 19 2012. [Epub ahead of print] [Abstract]

27. Henninger DE, Whitson HE, Cohen HJ, Ariely D. Higher medical morbidity burden is associated with external locus of control. J Am Geriatr Soc. Apr 2012;60(4):751-755. [Abstract]

28. Kamerow D. How can we treat multiple chronic conditions? BMJ. 2012;344:e1487. (No abstract available)

All references are included in our library. Feel free to share with anyone interested in multimorbidity!

Comment (0)

The prevalence of multimorbidity

March 13, 2012 – 7:46 am

By Martin Fortin

 

Multimorbidity is associated with negative outcomes and increased resource use. Both create a burden on the health-care system.

 Concerned healthcare professionals and decision-makers aware of this information may wonder: 

  • What is the magnitude of this problem in our region?
  • What is the prevalence of multimorbidity in our population?

 Some researchers have attempted to answer these questions with studies involving either nation-wide populations or smaller groups. However, studies in different populations have yielded results with differences in prevalence estimates as important as 95% for a given age. Is this information reliable? Can it be used to determine the allocation of resources to deal with the problem of multimorbidity? Differences of this magnitude are unlikely to reflect real differences between populations and more likely due to methods biases.

 In a systematic review recently published in the Annals of Family Medicine  we identified and compared studies reporting the prevalence of multimorbidity in primary care settings and in the general population. Apart from differences in location, we identified differences in recruitment method and sample size, data collection, and in the operational definition of multimorbidity including the number of conditions and the conditions selected. All of these factors may affect prevalence estimates.

 In this review we discussed differences among studies and possible explanations for variations in the results of prevalence estimates. We also promoted the adoption of a more uniform methodology in this type of research by suggesting methodological aspects to be considered in the conduct of such studies.

 Availability of strong epidemiological data for multimorbidity would benefit both the research and care of this problem.

Comment (0)

« Previous Page — Next Page »