By Martin Fortin
Different attempts have been made to create effective interventions in primary care for people with multimorbidity, being the predominant intervention element a change to the organization of care delivery. However, these interventions have obtained mixed results. We recently reported the results of a trial assessing the effectiveness of a multifaceted intervention based on a change in care delivery for patients with three or more chronic conditions [1]. After four months, the intervention showed a neutral effect on the primary outcomes and substantial improvement in two health behaviors as secondary outcomes. However, the effect of the intervention after a longer period of time was not known. We have now reported the one-year outcomes after exposure to the intervention, combining all participants in one single group that received the intervention, to document its long-term association with measures of self-care, quality of life and health-related behaviors [2]. Changes in these measures were also analyzed across age-, number of chronic conditions-, income-, and gender-based subgroups to explore factors potentially associated with variation in response to the intervention and help guide the development of more targeted interventions in the future.
We observed that one year after the intervention, the domain of emotional wellbeing of the Health Education Questionnaire (heiQ), improved significantly. However, we also observed deterioration in the domain of health services navigation of the heiQ. Improvement was also observed for the measures of the VR-12 (Veteran RAND-12 Health Survey) physical component, VR-12 mental component, in moderate to severe psychological distress measured with the Kessler six item Psychological Stress Scale (K6), and healthy eating.
Subgroup analyses in this exploratory study suggest that younger patients, those with lower number of chronic conditions or higher incomes may respond better in relation to self-management, health status and health behaviors. This suggests that future interventions should be tailored to patients’ characteristics including age, sex, income and number of conditions.
1. Fortin M, Stewart M, Ngangue P, Almirall J, Belanger M, Brown JB, et al. Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial. Ann Fam Med (2021) 19(2):126-34. doi: 10.1370/afm.2650.
2. Fortin M, Stewart M, Almirall J, Berbiche D, Belanger M, Katz A, et al. One year follow-up and exploratory analysis of a patient-centered interdisciplinary care intervention for multimorbidity. J Comorb (2021) 11:26335565211039780. doi: 10.1177/26335565211039780.