Entete 3

Monthly Archives: November 2013

Interventions for people with multimorbidity

By Susan Smith

The limited evidence of the effectiveness of interventions for people with multimorbidity means that there is a need for much more research and trials of potential interventions [1]. We have just published a paper in the Journal of Comorbidity presenting a consensus view from a group of international researchers working to guide future studies of interventions to improve outcomes for people with multimorbidity [2]. We suggest that there is a need for careful consideration of whom to include, how to target interventions that address specific problems and that do not add to treatment burden, and selecting outcomes that matter both to patients and the healthcare system. Innovative design of these interventions will be necessary as many will be introduced in service settings and it will be important to ensure methodological rigour, relevance to service delivery, and generalizability across healthcare systems.
I would welcome any contact from research teams conducting evaluations of interventions for multimorbidity as these could potentially be included in the next update of the Cochrane Review of such interventions.

[1] Smith SM, Soubhi H, Fortin M, Hudon C, O’Dowd T. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev (2):CD003638. 2012;4:CD006560.
[2] Smith SM, Bayliss EA, Mercer SW, et al. How to design and evaluate interventions to improve outcomes for patients with multimorbidity. Journal of Comorbidity. 2013;3:10-17.

The care delivery experience of hospitalized patients with complex chronic disease

By Kerry Kuluski

What is important to individuals with complex chronic conditions when receiving care in a hospital setting? We recently published a paper in the journal Health Expectations [1] on the care delivery experiences of 116 inpatients at a complex continuing care/rehabilitation hospital in Toronto, Canada. Patients had an average of 5 morbidities and several illness symptoms including activity of daily living impairments, physical pain and depressive symptoms. Patients reported what kind of care they wanted delivered as well as how they wanted their care delivered. The findings speak to the importance of having a comprehensive assessment with less redundancy, support for transitions into and out of the hospital as well as greater attention to mental health during the hospital stay. On the staffing side, quicker response times, ongoing patient–provider communication and consistency between providers and across care units were highlighted. The patients noted the importance of feeling like a person, not a “knee replacement,” shedding light on the relational aspect of every care transaction. The study has generated a body of evidence on the important components of care delivery from the perspectives of a diverse group of chronically ill individuals who have spent a considerable amount of time in the health-care system. Moving forward, exploration around the appropriate funding models, skill mix and in-hospital processes (e.g., admission and discharge) are needed to move the evidence into changed practice. The findings can serve as a framework for designing patient centered hospital care for complex patient populations.

[1] Kuluski K, Hoang SN, Schaink AK, et al. The care delivery experience of hospitalized patients with complex chronic disease. Health Expectations. May 27 2013.

A qualitative descriptive study on the alignment of care goals between older persons with multi-morbidities, their family physicians and informal caregivers

By Kerry Kuluski

  Do patients, their family physicians and informal caregivers agree on care goals? In short, rarely. We conducted interviews with 28 older persons with multi-morbidities, their informal caregivers and family physicians to assess and compare patient care goals. Maintaining functional independence was a common goal across all groups when looking at the data at the aggregate level. When comparing findings across patient-caregiver-family physician triads a different picture emerged. Very little alignment was found, particularly when patients were medically unstable and during transition points (e.g., when the patient required care in an alternate setting). While divergence in care goals may reflect the different roles and responsibilities of each of the players involved, these perspectives should be illuminated when building care plans to ensure that trade-offs are explored, the needs of the patient are supported and that quality of care is enhanced. This highly accessed paper was recently published in BMC Family Practice.