By Martin Fortin

Good news! A new journal with a special focus on patients with multimorbidity and comorbidity has been created.

The Journal of Comorbidity (JOC), an international, open-access, peer-reviewed journal for the pathophysiology, diagnosis, prevention and management of comorbidity has been inaugurated and its first issue is already posted online.

Although the name of the journal might suggest that it is devoted exclusively to articles related to the well known definition of comorbidity provided by Feinstein “any distinct additional clinical entity that has existed or may occur during the clinical course of a patient who has the index disease under study”, the first issue of JOC makes it clear that this is not the case. 

The inaugural editorial of the Editor-in-Chief clearly states that “the management of patients with comorbidity needs to consider the patient as a whole, extending beyond the primary medical speciality, and encompassing all of the coexisting complications, not just the principal disease or various conditions in isolation”.

In addition, an editorial authored by José M. Valderas, Stewart W. Mercer, and myself further explains that “the journal has opted to use comorbidity in its name, and a number of well founded reasons explain this choice: for reasons of simplicity; in order to acknowledge both the relevance of research on comorbidity for the treatment of specific conditions and the historical pre-eminence of the construct; and finally, for an awareness of evolving concepts”.

 This journal that clearly invites authors to submit papers related to both comorbidity AND multimorbidity represents another opportunity to publish research of great value.

By Martin Fortin

New papers on multimorbidity have been published during the June-September period of this year. I would like to share with you the titles of the most relevant articles published, along with the links to the abstracts or full texts:

1.    Findley, P., C. Shen, and U. Sambamoorthi, Multimorbidity and persistent depression among veterans with diabetes, heart disease, and hypertension. Health Soc Work, 2011. 36: p. 109-19. [PubMed abstract]
2.    Fried, T.R., et al., Health Outcome Prioritization as a Tool for Decision Making Among Older Persons With Multiple Chronic Conditions. Arch Intern Med. Sep 26. [Epub ahead of print], 2011. [Research letter; no abstract available]
3.    Gulley, S.P., E.K. Rasch, and L. Chan, The complex web of health: relationships among chronic conditions, disability, and health services. Public Health Rep, 2011. 126: p. 495-507. [PubMed abstract]
4.    Harrison, M., 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. Jul 16. [Epub ahead of print], 2011. [PubMed abstract]
5.    Holden, L., et al., Patterns of multimorbidity in working Australians. Popul Health Metr, 2011. 9: p. 15. [Full text]
6.    Hunger, M., et al., Multimorbidity and health-related quality of life in the older population: results from the German KORA-age study. Health Qual Life Outcomes, 2011. 9: p. 53. [Full text]
7.    Khanam, M.A., et al., Prevalence and patterns of multimorbidity among elderly people in rural Bangladesh: a cross-sectional study. J Health Popul Nutr, 2011. 29: p. 406-14. [Full text]
8.    Lehnert, T., et al., Review: health care utilization and costs of elderly persons with multiple chronic conditions. Med Care Res Rev, 2011. 68: p. 387-420. [PubMed abstract]
9.    Parekh, A.K., et al., Managing multiple chronic conditions: a strategic framework for improving health outcomes and quality of life. Public Health Rep, 2011. 126: p. 460-71. [PubMed abstract]
10.    Perruccio, A.V., J.N. Katz, and E. Losina, Health burden in chronic disease: multimorbidity is associated with self-rated health more than medical comorbidity alone. J Clin Epidemiol. Aug 9. [Epub ahead of print], 2011. [PubMed abstract]
11.    Quiñones, A.R., et al., How Does the Trajectory of Multimorbidity Vary Across Black, White, and Mexican Americans in Middle and Old Age? J Gerontol B Psychol Sci Soc Sci. Oct 3. [Epub ahead of print], 2011. [PubMed abstract]
12.    Richardson, K., et al., Variation over time in the association between polypharmacy and mortality in the older population. Drugs Aging, 2011. 28: p.:547-60. [PubMed abstract]
13.    Starfield, B. and K. Kinder, Multimorbidity and its measurement. Health Policy. Sep 30. [Epub ahead of print], 2011. [PubMed abstract]
14.    Tinetti, M.E., et al., Contribution of Multiple Chronic Conditions to Universal Health Outcomes. J Am Geriatr Soc. Aug 30. [Epub ahead of print], 2011. [PubMed abstract]
15.    Tinetti, M.E. and S.A. Studenski, Comparative effectiveness research and patients with multiple chronic conditions. N Engl J Med, 2011. 364(26): p. 2478-81. [Full text]
16.    van Baal, P.H., et al., Co-occurrence of diabetes, myocardial infarction, stroke, and cancer: quantifying age patterns in the Dutch population using health survey data. Popul Health Metr, 2011. 9: p. 51. [Full text]
17.    van den Bussche, H., et al., Patterns of ambulatory medical care utilization in elderly patients with special reference to chronic diseases and multimorbidity – Results from a claims data based observational study in Germany. BMC Geriatrics, 2011. 11: p. 54. [Full text]
18.    Vyas, A. and U. Sambamoorthi, Multimorbidity and depression treatment. Gen Hosp Psychiatry, 2011. 33: p. 238-45. [PubMed abstract]

Publication number 15 on the list is an article by Mary E. Tinetti and Stephanie A. Studenski published in the ‘Perspective’ section of the New England Journal of Medicine. I would like to bring to your attention its most important statements in my opinion:

“Primary outcomes tend to be disease-specific… Such outcomes work well in efficacy studies, which reveal a therapy’s effect on a specific outcome under ideal circumstances in a homogeneous population. They make less sense, however, for comparing treatments in patients with multiple chronic conditions.”

“Researchers have largely shied away from the complexity of multiple chronic conditions — avoidance that results in expensive, potentially harmful care of unclear benefit. We cannot improve health care’s quality, effectiveness, and efficiency without addressing its greatest consumers.”

It is well worth the read.

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

Martin

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By Martin Fortin

Professor Barbara Starfield, a prominent figure in primary care and other fields, died suddenly in California on Friday 10 June 2011. My colleagues and I would like to express our sincere condolences to her family, friends and colleagues.

Dr. Starfield made landmark contributions in primary care. The coexistence of multiple diseases did not escape her attention. Before the introduction of the concept of multimorbidity, Dr. Starfield realized that people should be characterized by their morbidity burden, and her work led to the development of an important methodological tool for assessing diagnosed morbidity burden: the Adjusted Clinical Groups system.¹ With its use, populations can be described according to the mix of types of all conditions they experience in any given time period (including signs and symptoms as well as all types of diagnoses).

The subjects of comorbidity and multimorbidity are present in several of her publications,^2-5 and my colleagues and I had the privilege of motivating her to write an editorial on one of our publications.⁶

In the June 9, 2011 posting that precedes this one, I brought to your attention the essential ideas I found in her last editorial published this year, which was also dedicated to co- and multi-morbdity.⁷ In essence, she alerted us to the fact that “it is not chronicity per se that creates a burden on the health-care system… it is the number of types of conditions, that is, multi-morbidity “.⁷ I believe it is our duty to honour her visionary statement and carry on her legacy.

Thank you Dr. Starfield for your inspiration.

1. Starfield B, Weiner J, Mumford L, Steinwachs D. Ambulatory care groups: a categorization of diagnoses for research and management. Health Services Research. 1991;26(1):53-74.
2. Starfield B, Lemke KW, Bernhardt T, Foldes SS, Forrest CB, Weiner JP. Comorbidity: implications for the importance of primary care in ‘case’ management. Ann Fam Med. May-Jun 2003;1(1):8-14.
3. Starfield B, Lemke KW, Herbert R, Pavlovich WD, Anderson G. Comorbidity and the use of primary care and specialist care in the elderly. Ann Fam Med. 2005;3:215-222.
4. Valderas JM, Starfield B, Roland M. Multimorbidity’s many challenges: A research priority in the UK. BMJ. Jun 2 2007;334(7604):1128.
5. Starfield B. Co-morbidity and its challenges for quality of primary care. Rev Port Clin Geral. 2007;223:179-180.
6. Starfield B. Threads and yarns: weaving the tapestry of comorbidity. Ann Fam Med. 2006;4:101-103.
7. Starfield B. Challenges to primary care from co- and multi-morbidity. Prim Health Care Res Dev. 2011;12:1-2.

By Martin Fortin

Searching for articles published on multimorbidity this year, it has been nice to note that already there is an important new body of information covering different aspects of the subject. I would like to share with you blog visitors the titles of the most relevant publications found, along with the links to the abstracts:

–          Marengoni A et al. Aging with multimorbidity: A systematic review of the literature. Ageing Res Rev Mar 23 [Epub ahead of print] 2011. [PubMed abstract]

–          Salisbury C et al. Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study. Br J Gen Pract 2011;61:e12-21. [PubMed abstract]

–          Bower P et al. Multimorbidity, service organization and clinical decision making in primary care: a qualitative study. Fam Pract May 25 [Epub ahead of print] 2011. [PubMed abstract]

–          Tucker-Seeley RD et al. Lifecourse socioeconomic circumstances and multimorbidity among older adults. BMC Public Health 2011;11:313. [PubMed abstract]

–          Wong A et al. Longitudinal administrative data can be used to examine multimorbidity, provided false discoveries are controlled for. J Clin Epidemiol Mar 29 [Epub ahead of print] 2011. [PubMed abstract]

–          Galenkamp H et al. Somatic Multimorbidity and Self-rated Health in the Older Population. J Gerontol B Psychol Sci Soc Sci 2011;66:380-6. [PubMed abstract]

–          Glynn LG et al. The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. Fam Pract Mar 24 [Epub ahead of print] 2011. [PubMed abstract]

–          Drewes YM et al. The effect of cognitive impairment on the predictive value of multimorbidity for the increase in disability in the oldest old: the Leiden 85-plus Study. Age Ageing 2011;40:352-7. [PubMed abstract]

–          Holzhausen M et al. Operationalizing multimorbidity and autonomy for health services research in aging populations–the OMAHA study. BMC Health Serv Res 2011;11:47. [PubMed abstract]

–          Morris RL et al. Shifting priorities in multimorbidity: a longitudinal qualitative study of patient’s prioritization of multiple conditions. Chronic Illn 2011;7:147-61. [PubMed abstract]

–          van den Bussche H et al. Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany. BMC Public Health 2011;11:101. [PubMed abstract]

–          Schüz B et al. Medication beliefs predict medication adherence in older adults with multiple illnesses. J Psychosom Res 37(6):565-74 2011;70:179-87. [PubMed abstract]

–          Schäfer I et al. Multimorbidity patterns in the elderly: a new approach of disease clustering identifies complex interrelations between chronic conditions. PLoS ONE 2010;5:e15941. [PubMed abstract]

–          Gunn JM et al. The association between chronic illness, multimorbidity and depressive symptoms in an Australian primary care cohort. Soc Psychiatry Psychiatr Epidemiol Dec 25 [Epub ahead of print] 2010. [PubMed abstract]

–          Thiem U et al. Prerequisites for a new health care model for elderly people with multimorbidity: the PRISCUS research consortium. Z Gerontol Geriatr 2011;44:115-20. [PubMed abstract]

–          Naessens JM et al. Effect of multiple chronic conditions among working-age adults. Am J Manag Care 2011;17:118-22. [PubMed abstract]

–          Diederichs C et al. The Measurement of Multiple Chronic Diseases–A Systematic Review on Existing Multimorbidity Indices. J Gerontol A Biol Sci Med Sci 2011;66:301-11. [PubMed abstract]

–          Lupari M et al. We’re just not getting it right’–how should we provide care to the older person with multi-morbid chronic conditions? J Clin Nurs 2011;20. [PubMed abstract]

–          Starfield B. Challenges to primary care from co- and multi-morbidity. Prim Health Care Res Dev 2011;12:1-2. [Full text]

A comment on each of these publications is not possible here. However, I want to bring to your attention the main idea I found in the last publication on the list, which is an editorial by Barbara Starfield:

“…it is not chronic conditions by themselves that raise resource use. Rather, it is the number of types of conditions, that is, multi-morbidity.”

“…despite the attention to chronic diseases in many countries of the world, it is not chronicity per se that creates a burden on the health-care system.”

It’s worth reading entirely!

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

Martin

By Martin Fortin

In the original website of the International Research Community on Multimorbidity, (IRCMo) most parts of the site were open access and visitors were able to navigate through different sections containing information about publications on multimorbidity, events, and links to other websites related to the subject.

However, the virtual community was a private network of researchers and clinicians who shared ideas and knowledge on multimorbidity. Access to the discussion section of the virtual community was restricted to members with a user name and a password.

Discussions within the virtual community were about two main subjects:
1)    Multimorbidity: the concept and its measure
2)    Toward a new care model for patients with multimorbidity.

Comments and ideas written by different IRCMo members in 2007 are still valid in the present time and are now openly accessible on the website of the CIHR Applied Research Chair – Health Services and Policy Research on Chronic Diseases in Primary Care (link) under the heading ‘Archives of discussions in IRCMo’.

Those interested in reading the content of early discussions of the IRCMo can access the above website directly by following this link.