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Author Archives: Marjan van den Akker

How to handle multimorbidity in primary care consultations

By Marjan van den Akker
An international group of scientists working around the themes of multimorbidity and polypharmacy have recently published a paper in BMC Medicine [1] on the management of patients with multimorbidity in primary care consultations. The article aims to support decision making in primary care consultations, through a set of guiding principles. These principles are named after the Greek mythological figure Ariadne, who helped the Greek hero Theseus escape from the labyrinth.
The sharing of realistic treatment goals by physicians and patients is at the core of the Ariadne principles. These result from i) a thorough interaction assessment of the patient’s conditions, treatments, constitution, and context; ii) the prioritization of health problems that take into account the patient’s preferences – his or her most and least desired outcomes; and iii) individualized management realizes the best options of care in diagnostics, treatment, and prevention to achieve the goals. Goal attainment is followed-up in accordance with a re-assessment in planned visits. The occurrence of new or changed conditions, such as an increase in severity, or a changed context may trigger the (re-)start of the process.

1-Muth C, van den Akker M, Blom JW, Mallen CD, Rochon J, Schellevis FG, Becker A, Beyer M, Gensichen J, Kirchner H, Perera R, Prados-Torres A, Scherer M, Thiem U, van den Bussche H, Glasziou PP. The Ariadne principles: how to handle multimorbidity in primary care consultations. BMC Med 2014; 12:223.

Evidence-Based Medicine Meets Multimorbidity: A Blind Date?

By Marjan van den Akker and Christiane Muth

On Wednesday, October 17, 2012, an international symposium took place at the ´Deutsche Nationalbibliothek´ in Frankfurt am Main, Germany.

The focus of the symposium was on questions that keep family doctors and general practice researchers busy, such as: What should and can be done when my patient has several illnesses simultaneously? What are the problems of multimorbidity and polypharmacy that confront us today? What clinical decision-support does evidence-based medicine (EbM) currently provide, and how can EbM contribute in the future? Leading researchers representing both disciplines – EbM and multimorbidity research – discussed the dilemmas and challenges that multimorbidity entails, as well as strategies to overcome them.

The symposium garnered attention, both from Germany and abroad. There were over 130 registrations. For further detail on the program and speakers, see [link to the Institute of General Practice, Goethe-University, Frankfurt, Germany:

The Symposium was part of the Friedrich Merz Foundation’s 22nd visiting professorship, to which Professor Marjan van den Akker from Maastricht University was appointed this year.

Subsequent to the symposium a 2-day international workshop on ´How to handle patients with multimorbidity in primary care´ was conducted. Twenty participants from the UK, Canada, Australia, Germany, the Netherlands and Spain exchanged on this subject. Although there is a growing body of knowledge regarding multimorbidity, it seems to mainly focus on observational, epidemiological studies. There remains a lack of research studying and supporting every day clinical practice for patients with multimorbidity.

A collaborative report on the workshop will follow.