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Author Archives: Catherine Hudon

Literacy and multimorbidity

By Catherine Hudon

In the wake of prevention and intervention strategies developed to address multimorbidity, the identification of risk factors and of people most at risk, is an important aspect. Aging and low socioeconomic status are already clearly associated with an increased incidence of multimorbidity. Without directly measuring multimorbidity, many studies have also assessed a relationship between low literacy and poorer health status using global health measures which raises the possibility of an independent association between literacy or health literacy and multimorbidity.

We conducted a study to evaluate the relationship between literacy and multimorbidity while controlling for potential confounders. In this research, we used a more detailed instrument to measure patients’ disease burden than the studies supporting the existence of a relationship between health literacy and global health measures. The results of the study, recently published in BMC Family Practice, suggest that low literacy is associated with the presence of multimorbidity in adults consulting in primary care in bivariate analysis, but this association was no longer present when controlling for age and family income.

Patients with multimorbidity may have specific diseases that are associated with low literacy, but further studies are needed to identify individual diseases and combinations of diseases linked to literacy while controlling for potential confounding variables.

Although we did not observe a direct association between literacy and multimorbidity, it is still important to continue taking this variable into account in patient care in order to tailor health information to patient needs and in a format they can understand.

The thematic analysis of patient-centered care: Looking at patients with chronic diseases seen in family medicine

By Catherine Hudon

For the management of patients with multiple chronic conditions, patient-centered care suggests taking a holistic approach to these patients and their health care by considering all aspects of the person’s situation [1-2]. Much patient-centered care evidence in family medicine relies on Stewart et al.’s model [3-5]. Therefore, we decided to present a synthesis of the results of research and discourse lines on main dimensions of patient-centered care in the context of chronic disease management in family medicine, building on Stewart et al.’s model.

We conducted a systematic review of the literature and performed a thematic analysis of the 32 articles included. We identified six majors themes: (1) starting from the patient’s situation; (2) legitimizing the illness experience; (3) acknowledging the patient’s expertise; (4) offering realistic hope; (5) developing an ongoing partnership; (6) providing advocacy for the patient in the health care system.

Our analysis shows that the context of chronic disease management brings forward new dimensions of a patient-centered interaction between the patient and the physician such as legitimizing the illness experience, acknowledging patients’ expertise and offering hope, and proposes the involvement of the family physician in transitions in care as a component of patient-centered care. Chronic disease management also brings a longitudinal component into perspective and all the dimensions of the concept could be better captured with a measure considering a certain period of time, not only the last visit with a physician.

The abstract can be accessed online [6]:

[1] Boyd CM, Fortin M. Future of Multimorbidity research: How Should Understanding of Multimorbidity Inform Health System Design? Public Health Reviews. 2010;32:451-74 (available at http://www.publichealthreviews.eu/upload/pdf_files/8/Boyd_forwebsite.pdf).
[2] Bayliss EA, Edwards AE, Steiner JF, Main DS. Processes of care desired by elderly patients with multimorbidities. Fam Pract. 2008;25:287-93.
[3] Stewart MA, Belle Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR. Patient-Centered Medicine: Transforming the Clinical Method. 2e ed. Cornwall: Radcliffe Medical Press Ltd; 2003.
[4] Stewart M, Belle Brown J, Donner A, McWhinney IR, Oates J, Weston WW, et al. The Impact of Patient-Centered Care on Outcomes. The Journal of Family Practice. 2000;49:796-804.
[5] Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, et al. Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ. 2001;323:908-11.
[6] Hudon C, Fortin M, Haggerty J, Loignon C, Lambert M, Poitras ME. Patient-centered care in chronic disease management: a thematic analysis of the literature in family medicine. Patient Education and Counseling. 2012;8:170-176.

Measuring Patients’ Perceptions of Patient-Centered Care

By Catherine Hudon

As many people affected by multimorbidity frequently interact with a family physician, [1-2] this professional is in a privileged position to play a significant role in their health. In patient-physician interactions, patient-centered care is widely acknowledged as a core value in family medicine [3-5] and has been associated with short term positive outcomes. [6-8] We decided to conduct a systematic review to identify and compare instruments, subscales or items assessing patient perception of patient-centered care in family medicine. We identified two instruments dedicated to measuring patient-centered care and eleven instruments that address some dimensions of this concept. The two instruments dedicated to patient-centered care measure key dimensions of this concept but are visit-based, limiting their applicability for long-term care processes such as chronic illness management. Relevant items from the eleven other instruments provide partial coverage of the concept but these instruments were not designed to provide a specific assessment of patient-centered care.
This article is published in the Mar/Apr 2011 issue of Annals of Family Medicine. To have free access to this article, click on this link:

1. Starfield B, Lemke K, Bernbardt T, Foldes S, Forrest C, Weiner J: Comorbidity: implications for the importance of primary care in case management. Annals of Family Medicine 2003, 1:8-14.
2. Broemeling A, Watson D, Prebtani F: Population patterns of chronic health conditions, co-morbidity and healthcare use in Canada: implication for policy and practices. Healthcare Quaterly 2008, 11:70-76.
3. World Health Organization. Former les personnels de santé du XXe siècle: le défi des maladies chroniques [http://www.who.int/chp/knowledge/publications/workforce_report_fre.pdf]
4. World Health Organization. The Innovative Care for Chronic Condition (ICCC). [http://www.who.int/diabetesactiononline/about/ICCC/en/index.html]
5. Wagner EH, Austin BT, Von Korff M: Organizing care for patients with chronic illness. Milbank Quarterly 1996, 74:511-544.
6. Stewart M, Brown JB, Donner A, McWhinney IR, Oates J, Jordan J: The impact of patient-centered care on outcomes. Journal of Family Practice 2000, 49:796-804.
7. Stewart M, Brown JB, Weston WW, Freeman TR: Patient-centred medicine: transforming the clinical method. 2nd edn. United Kingdom: Radcliffe Medical Press; 2003.
8. Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, Ferrier K, Payne S: Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ 2001, 323:908-911.