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Category Archives: Others

Publications on multimorbidity January-April 2019


By Martin Fortin

Our search for papers on multimorbidity that were published during the period January-April 2019 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.

Publications on multimorbidity September – December 2018

By Martin Fortin
Our search for papers on multimorbidity that were published during the period September – December 2018 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.

Articles from a special edition of the Journal of Internal Medicine

By Martin Roland
Following an international symposium on multimorbidity held in Stockholm in 2018, the following papers have been published this month in a special edition of the Journal of Internal Medicine. They’re excellent reviews and worth a read.
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Calderón‐Larrañaga A & L. Fratiglioni L  Multimorbidity research at the crossroads: developing the scientific evidence for clinical practice and health policy  https://onlinelibrary.wiley.com/doi/full/10.1111/joim.12872
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Calderón‐Larrañaga A et al Multimorbidity and functional impairment–bidirectional interplay, synergistic effects and common pathways  https://onlinelibrary.wiley.com/doi/full/10.1111/joim.12843
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Muth C et al. Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus  https://onlinelibrary.wiley.com/doi/full/10.1111/joim.12842
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Valderas JM et al Quality of care assessment for people with multimorbidity  https://onlinelibrary.wiley.com/doi/full/10.1111/joim.12881

Publications on multimorbidity May – August 2018

By Martin Fortin
Our search for papers on multimorbidity that were published during the period May – Agust 2018 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.

Potential notice about Collaborative Doctoral Award in Multimorbidity

By Susan Smith
We think this is a world first – a nationally funded Structured Doctoral Training Programme in Multimorbidity, for a cohort of clinical and non-clinical researchers in primary care in Ireland. The programme is supported by a consortium of international, experienced inter-disciplinary multimorbidity researchers and PhD educators, including Prof Martin Fortin, Prof Cynthia Boyd, Prof Frances Mair, Prof Pete Bower, Prof Mogens Vestergaard and Prof Olov Rolandsson.
Patients with complex multimorbidity experience treatment burden and challenges around adhering to treatment advice, managing medicines, coordination of health and social care and patient related costs of care. The proposed PhD projects will address these interlinked but distinct areas within multimorbidity research. Cross project working will ensure exposure to a wide range of methodologies and disciplines. We will synthesise evidence from all projects at a programmatic level. The programme is supported by a specially convened Patient and Public Participation Panel and the consortium will provide an appropriate blend of research methodology skills, supervision and peer support and an opportunity for national and international PhD placements.
This doctoral programme will generate a national cohort of skilled post-doctoral students who can make a significant future international impact across a range of settings having developed expertise in the generation of research evidence to support cost-effective and patient-centred management of complex multimorbidity.

Publications on multimorbidity January-April 2018

By Martin Fortin
Our search for papers on multimorbidity that were published during the period January – April 2018 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 Primary Care Outcomes Questionnaire: a new generic instrument for measuring outcomes in primary care

By Mairead Murphy and Chris Salisbury
The majority of primary care consultations are by patients with multiple long-term conditions [1]. With ninety percent of all patient interaction with health services in the UK going through primary care, it’s not surprising that primary care clinicians and researchers try to figure out ways to improve services for their patients. Interventions are many and varied, and result in important questions about their effectiveness. Do electronic consultations offer a good service to patients? If GPs introduce advice on healthy lifestyles into the consultation, does it make patients healthier? What about increasing the duration of GP appointments to ten minutes – does this improve outcomes for patients? Or ensuring that patients always see the same named doctor? Or painting the waiting room green?
Questions like these are normally answered by administration of a generic patient-reported questionnaire. By comparing the responses of groups of patients (say those with eight-minute consultations and those with ten-minute consultations), researchers can see which group has the highest scores, and therefore whether one method of delivering care is better than the other.
Although this might sound a simple process, in practice it is not so easy. The problem is that primary care delivers a range of outcomes, some of which are more directly health-related than others. The recent blog on this site by Susan Smith (Identifying key outcomes for multimorbidity research April 19th) found that 17 core outcomes were important to measure in people with long-term conditions. These included outcomes related to mortality, health-related quality of life, patient behaviours, shared decision making and quality of health services. When we explored this issue in 2015, we similarly found that primary care patients, both those with and without long term conditions want broad range of outcomes [2]. Some of these, such as reduction in pain or depression, are captured on most generic patient-reported questionnaires. But others, such as reduction in concern, a sense of confidence in health plan, or an understanding of illnesses/problems and an ability to manage symptoms, are less well-captured.
This is why we have designed a new questionnaire, called the Primary Care Outcomes Questionnaire, or the PCOQ. The PCOQ was designed in consultation with patients [3] specifically to measure outcomes which many primary care patients seek, and which GPs seek to deliver. It contains 24 questions in four areas: health and well-being; health knowledge and understanding; confidence in health plan; and confidence in health provision. We quantitatively tested the PCOQ in a sample of primary care patients and found that it was easy for patients to complete, had construct validity, and able to show change in each of the four areas. We published these findings in March in the BJGP [4]. We have made the PCOQ available free of charge for non-commercial use and hope that researchers will find it useful for assessing the effectiveness of interventions in primary care. In the future, we plan to test the PCOQ for use in routine clinical practice.
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1. Salisbury, C., et al., Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study. British Journal of General Practice, 2011. 61(582): p. e12-21.
2. Murphy M, Hollinghurst S, Turner K, Salisbury C. Patient and practitioners’ views on the most important outcomes arising from primary care consultations: a qualitative study. BMC Fam Practice 2015;16:108. Doi: 10.1186/s12875-015-0323-9
3. Murphy M, Hollinghurst S, Salisbury C. Qualitative assessment of the primary care outcomes questionnaire: a cognitive interview study, BMC Health Services Research 2018 10.1186/s12913-018-2867-6
4. Murphy M, Hollinghurst S, Cowlishaw S, Salisbury C. Psychometric Testing of the Primary Care Outcomes Questionnaire, British Journal of General Practice, 26th March 2018,10.3399/bjgp18X695765

Publications on multimorbidity September- December 2017

By Martin Fortin
Our search for papers on multimorbidity that were published during the period September – December 2017 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.

Multimorbidity has become a Medical Subject Heading (MeSH) in 2018

By Martin Fortin
Medical Subject Headings (MeSH®) is the National Library of Medicine (NLM)’s controlled vocabulary thesaurus. It consists of sets of terms naming descriptors in a hierarchical structure that permits searching at various levels of specificity.
The MeSH thesaurus is used by NLM for indexing articles from the world’s leading biomedical journals for the MEDLINE®/PubMED® database.
Until the end of 2017, the term multimorbidity was not a MeSH. The term was a subheading under the term comorbidity. As a consequence, a search for the term multimorbidity in PubMED yielded thousands of publications that included those using the term multimorbidity and/or comorbidity.
Starting in January 2018, multimorbidity is now a MeSH heading:
This will facilitate the indexing and search of articles on this subject.
We believe that the ever increasing number of publications on multimorbidity, which includes articles from those participating in this community, has led to the recognition of the importance of the term, and deserves a congratulation to all those who have contributed to making the term achieve this important recognition.

A portrayal of the patient-reported outcomes used in multimorbidity intervention research

By Maxime Sasseville
Heterogeneity in outcome measures used in multimorbidity intervention research currently leads to a lack of consistent evidence to support clinical implementation. Understanding the current state of patient-reported outcome assessment is an important endeavor for multimorbidity research and policy-making, as its use contributes to a patient-centered approach.
This scoping review [1] aimed to describe patient-reported outcomes in the context of chronic disease management interventions for people with multimorbidity. Specifically, the objectives of the review were 1) to portray the current use of patient-reported outcomes in multimorbidity interventions; and 2) to propose a descriptive classification system according to the different types of outcomes identified.
Twenty-two studies were identified from which 56 outcomes measures were reported. The measures were grouped into 18 categories and six emergent domains of outcomes: General health, Psychosocial, Disease management, Health-related behaviours, Functional and Health services. Quality of life, health-related behaviors and self-efficacy were the most reported outcome categories, while patient satisfaction, communication with providers and adverse outcomes were rarely reported.
The organization proposed in this paper could contribute to improving outcome selection for research, clinical care and policy and lead to the creation of adapted patient-related outcome measures. Consistent design of outcome assessment between multimorbidity intervention study could lead to a more coherent body of evidence for clinical implementation.
The article can be freely accessed until December 15 2017 by following this link:
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[1] Sasseville, M., Chouinard, M. C., & Fortin, M. (2017). Patient-reported outcomes in multimorbidity intervention research: A scoping review. International Journal of Nursing Studies. 77 145-153