February 22, 2016 – 2:09 pm
By Aline Ramond-Roquin and Martin Fortin
In a recent
provocative blogpost [1] hosted by the Canadian Medical Association Journal, the associate editor Domhnall MacAuley initiated an interesting discussion on the challenges general practice research currently faces. We would like to extend the reflection and to discuss some issues relevant for multimorbidity research.
First, we somewhat disagree on the fact that academic general practitioners have “become less and less embedded in daily patient care”. Many of them still deliver “personal, primary and continuing care”. The traditional model of single-handed practitioners offering “twenty four hour access to patients” is quite obsolete, but this reflects the evolution of general practice rather than a specific characteristic of academics.
Indeed, general practitioners can no longer single-handedly fill the increasingly complex needs of their patients. Patients living with multimorbidity, who are now considered the rule in primary care, need interdisciplinary care. The current evolution towards increasing interdisciplinary work has generated specific research questions which require lowering some traditional barriers in the academic setting and developing interdisciplinary research, to appropriately address them. In this regard, having non-doctor primary care researchers in academic departments of general practice should neither be reduced to a question of “cost-effectiveness”, nor be considered as a threat for general practice research, as suggested in the CMAJ blogpost. Rather, collaborations within interdisciplinary teams are definitely an advantage to undertake research in complex fields such as multimorbidity. In these teams, general practitioners with significant clinical activity have a crucial and irreplaceable role.
Finally, meaningful research for people living with multimorbidity is often based on complex designs, such as multi-level epidemiological studies or pragmatic trials. We therefore strongly argue for scientific journals not neglecting research grounded in the real world of practice. They should not only focus on “sample size” and “international generalizability”, but should also be concerned by clinical relevance and potential for implementation and transferability in different contexts. Producing and publishing practice-based evidence is required to practice evidence-based medicine relevant to the context, with the potential to eventually improve the life of our patients.
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[1] http://cmajblogs.com/thinking-the-unthinkable-about-general-practice-research/
February 3, 2016 – 2:31 pm
By Bruno P. Nunes, Elaine Thumé, and Luiz A. Facchini
We are very satisfied to disseminate our recent paper in International Research Community on Multimorbidity (IRCMo) site. This community was and continues to be very important for our studies related to this topic in Brazil.
Despite worldwide importance of multimorbidity and the specific Brazilian context (more than 200 million inhabitants, rapid epidemiologic and demographic transitions, and relatively new universal health system), populational information about occurrence of multiple health problems is scarce in the country. Thus, data from a population-based survey that we conducted in 2008 were used to provide information and start works about multimorbidity in Brazilian context. The sample was comprised by 1593 elderly (≥60 years old) who lived in Bagé, a medium-sized city in Southern Brazil. The individuals were interviewed in their households through face-to-face interviews. In total, 17 morbidities were used and we measured multimorbidity according to two cutoff points: ≥2 and ≥3 morbidities. Descriptive analysis, and dyads and triads of diseases were calculated. We found that 94% of the sample presented, at least, one morbidity. High blood pressure – HBP – (55.3%) and spinal column disease (37.4%) were the diseases most frequent. Multimorbidity reached 81.3% (95 % CI: 79.3; 83.3) and 64.0 % (95% CI: 61.5; 66.4) of the individuals for ≥2 and ≥3 morbidities, respectively. As found in others studies, most vulnerable elderly presented higher occurrence of multiple diseases. For example, 87.1% of the elderly without schooling presented 2 or more diseases (22.3 percentage points higher than elderly which studied 8 years or more). Another challenge to public health system was demonstrated by higher frequency of multimorbidity between individuals without health private plan and those who are living in Family Health Strategy (organizational axis of primary health care) catchment areas.
These results about multimorbidity in older adults from Brazil may provide initial information to address multiple diseases in clinical protocols and contribute to subsidize actions in health services to management of multimorbidity.
Furthermore, we are drafting others papers about multimorbidity in Brazil, including evaluation of national-based studies. Therefore, we would like to invite researchers interested in cross-country comparisons about a wide range of issues related to multimorbidity (prevalence, patterns, inequalities, use of health services and others) to contact us. Contact e-mail for further information: nunesbp@gmail.com.
- Reference: Nunes BP, Thumé E, Facchini LA: Multimorbidity in older adults: magnitude and challenges for the Brazilian health system. BMC Public Health 2015, 15(1):1172
