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Monthly Archives: February 2012

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

February 28, 2012 – 4:25 pm

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.

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Theory, concept and measure

The Disease Burden Morbidity Assessment (DBMA) by self-report

February 15, 2012 – 2:49 pm

By Marie-Eve Poitras, RN. M.Sc.

Studies on multimorbidity should rely on valid and robust measurement to assess the disease burden experienced by patients with chronic diseases. There are many instruments designed to measure multimorbidity, however, most of them have to be administered by professionals because of the medical background required to complete them. This is a limitation to using these instruments in large samples of patients either in primary care settings or the general population.

Previous studies have shown that a measure that includes a weighting for severity is a better predictor of patient-related outcomes than a measure based on a simple disease count [1-2]. Severity can be judged on purely clinical grounds by health professionals or on the basis of the illness experienced by patients themselves. However, impact on daily living seems to be best evaluated by the patient because self-reported disease burden correlates with quality of life outcomes more strongly than measures of comorbidity based on other methods of data collection [3].

 The Disease Burden Morbidity Assessment (DBMA) is a self-report questionnaire that seems promising because: 1) it can be administered to large samples of patients and 2) it judges severity on the basis of the illness experienced by patients themselves [3].

 We conducted a study to test and to measure the properties of the French translation of the DBMA (DBMA-Fv). The DBMA-Fv’s properties were similar to its English counterpart as to its median sensitivity and specificity compared to chart reviews. It correlated moderately with an established index of multimorbidity, the Cumulative Illness Rating Scale (CIRS). A high percentage of patients were able to complete the test correctly as a mail questionnaire and it showed high test-retest reliability.

 The article describing the study can be accessed freely on line [4], where the readers can also find both the English and French versions of the DBMA questionnaire as appendices to the paper.

 1. Fortin, M., et al., Comparative assessment of three different indices of multimorbidity for studies on health-related quality of life. Health Qual Life Outcomes, 2005. 3:74.
2.Fortin, M., et al., Relationship between multimorbidity and health-related quality of life of patients in primary care. Qual Life Res, 2006. 15:83-91.
3. Bayliss, E.A., J.L. Ellis, and J.F. Steiner, Subjective assessments of comorbidity correlate with quality of life health outcomes: Initial validation of a comorbidity assessment instrument. Health and Quality of life Outcomes, 2005. 3:51.
4. Poitras, M.-E., et al., Validation of the disease burden morbidity assessment by self-report in a French-speaking population. BMC Health Service Research, 2012. 12:35.

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