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Monthly Archives: December 2011

Epidemiology and outcomes research

“Multimorbidity: epidemiology, utilization patterns and the response of the healthcare system”. A project funded by the Spanish Ministry of Science and Innovation (2012-2014)

December 21, 2011 – 11:53 am

By Alexandra Prados-Torres, Beatriz Poblador-Plou and Amaia Calderón-Larrañaga (from left to right)

The improvement of living conditions and the scientific-technological advancements have led to an increased prevalence of multimorbidity, especially, but not only, in the elderly population. It is also higher than expected in younger aged individuals [1]. Although multimorbidity has a significant impact on population health and healthcare systems, these are still mainly focused on diseases instead of patients, offering fragmented care (i.e. primary vs. specialized, health vs. social, etc.) and lacking evidence-based guidelines and/or appropriate clinical interventions for managing patients with multimorbidity [2,3].

Multimorbidity has not been sufficiently investigated in terms of its underlying pathophysiological mechanisms, specific diseases interactions, its consequences on health services utilization and outcomes, or even its definition and measurement.

This project, which will be carried out by researchers from the Aragon Health Research Institute (IIS Aragón, Spain) between 2012 and 2014 will focus on:

1- Epidemiology of multimorbidity based on methods that help identify the simultaneous non-random occurrence of health problems (i.e. multimorbidity patterns) in different population groups.

2- Health services utilization patterns among patients with multimorbidity which may reveal an unjustified variability among providers regarding prescription drug costs, scheduled visits and referrals to specialty care as a clear sign of inefficiency.

3- Potential ineffective or unsafe healthcare received by patients with multimorbidity due to preventable hospitalizations, in-hospital complications and readmissions, and polypharmacy-driven adverse drug reactions.

To this end, a retrospective cohort study has been designed including the entire population assigned to any of the 119 primary care centres in the region of Aragon (i.e. over 1,200,000 inhabitants). Thus, a person-based integrated database will be generated containing clinical and administrative information from primary care, specialized care and emergency care. This strategy, which has not been sufficiently exploited in the Spanish context to date, will enable the linking of patients’ health services utilization patterns with their multimorbidity profile.

This project is expected to provide evidence in relation to the causes and consequences of multimorbidity so that this hidden public health problem is recognised and urgently addressed by the various actors of healthcare systems.

The research group led by Dr. Alexandra Prados-Torres (sprados.iacs@aragon.es) is interested in establishing international collaborations and would very much appreciate the feedback of any of the members of the “IRCMo”.

1.- van den Akker M, Buntinx F, Metsemakers JF, Roos S, Knottnerus JA: Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemiol 1998, 51:367-375.
2.- Fortin M, Lapointe L, Hudon C, Vanasse A: Multimorbidity is common to family practice: is it commonly researched? Can Fam Physician 2005, 51:244-245.
3.- Fortin M, Dionne J, Pinho G, Gignac J, Almirall J, Lapointe L: Randomized controlled trials: do they have external validity for patients with multiple comorbidities? Ann Fam Med 2006, 4:104-108.

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Event

“The Impact of Primary Care Teams on Multimorbidity (IMPCT): Optimizing care for patients living with multiple chronic conditions” meeting

December 14, 2011 – 8:55 am

By Tarek Bouhali

On December 8-9, 2011, the first meeting of “The Impact of Primary Care Teams on Multimorbidity (IMPCT): Optimizing care for patients living with multiple chronic conditions” team was held at the INSPQ (Institut national de santé publique du Québec) offices in Montréal (Quebec, Canada). Over the two days, we have greatly benefited from the very animated discussions among our panel of speakers and discussants. We would therefore like to thank and congratulate each one of them for sharing their wide-ranging perspectives.

This gathering of 28 team members and collaborators from various disciplines including academic researchers, policy-makers, public health practitioners, program specialists and representatives from government agencies was convened to examine issues related to multimorbidity in various Canadian jurisdictions (Quebec, Ontario, Alberta) as well as in many other countries such as the USA, the UK, the Netherlands and Australia.

During the consultation process and workshops, we received input and recommendations on intervention strategies that will help the IMPCT team enhance its efforts focused on patients with or at highest risk for multimorbidity and complexity. Although IMPCT interventions will be patient-centered, the IMPCT Panel has paid attention to recommendations of policy-makers to expand the reach to organizational levels.

The team’s leads (Martin Fortin, Jean-Frédéric Levesque and Renée F. Lyons) take pride in having hosted this meeting. They hope that the presentations given and the discussions that followed during this meeting have generated a better appreciation of the nuances on key issues and objectives, as well as research questions and strategic decisions that will be included in the team grant application to the Canadian Institutes of Health Research (CIHR).

Thanks again to all the participants and international collaborators for taking the time to be a part of this important meeting. We value members’ expertise and appreciate their continued support and commitment to the upcoming team grant proposal. A special thank you is owed to Meghan McMahon from CIHR for taking the time to present the details of the Canadian Institutes of Health Research – Community-Based Primary Health Care (CIHR CBPHC) Team Grant Competition to the meeting participants. We would also like to thank our international collaborators (Grant Russell, Australia; Jane Gunn, Australia; Michel Wensing, The Netherlands; Stewart Mercer, UK; Stephen Peckham, UK) who shared their views and experiences via telephone conferences.

The IMPCT team is preparing a meeting summary report that will be made available to all participants by next week.

Top row left to right: Christine Loignon, Guillaume Ruel, William L. Miller, Erin Strumpf, Antoine Boivin, Frances Gallagher, Debbie Feldman, Cecile Bensimon, Maud-Christine Chouinard, Sylvie Provost, Mary Byrnes, William Hogg, Benjamin F. Crabtree, Maxime Ouellette. Front row, left to right: Martin Fortin, Jean-Frédéric Lévesque, Renee F. Lyons, Catherine Hudon, Moira Stewart, Denise Campbell-Scherer. Meeting participants missing from the picture: Jeannie Haggerty, Robert Salois, Marie-Dominique Beaulieu.

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