International Research Community on Multimorbidity

By Tom Brett

Researchers at the General Practice and Primary Health Care Research Unit at The University of Notre Dame Australia, Fremantle have recently completed extracting patient data from the medical records of attendees at two Perth metropolitan general practices. All patients (over 7000 in total) who attended the practices in a six month period in 2008 were included as were patients who were seen for home visits, hostel and nursing home visits in the same period.

We utilised a similar data extraction process to that employed by Fortin et al.¹ and used the Cumulative Illness Rating Scale (CIRS) ^2-6 to assess both the prevalence of chronic disease presentations and the severity of the disease burden for each patient. We employed ideas from the geriatric version of the CIRS as developed by Miller and Towers (CIRS-G)³  to improve consistency and help with standardisation amongst the data extractors. Three GPs, three practice nurses, a graduate-entry medical student and a senior receptionist were specially trained in the data extraction process.

A combination of electronic medical records and older hard copy files, including hospital discharge and out-patients letters together with radiology and pathology reports, was used to maximise the available data on each patient. Younger attendees were included so as not to discriminate against any age group and because no similar comprehensive information was available in the Australian primary care literature.

We are currently analysing the data and hope to publish some of our findings in 2012. The data extraction process was long and tedious but we are happy with the outcome and appreciate the efforts of the data extractors. We are hoping to expand and develop the study in the future and would welcome input and suggestions from future collaborators.

References

1. Fortin M, Bravo G, Hudon C, Vanasse A, Lapointe L. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med. 2005; 3: 223-228.
2. Linn BS, Linn MW, Gurel L. Cumulative Illness Rating Scale. J Amer Geriatr Soc. 1968; 16: 622-626.
3. Miller MD, Towers A. A manual of guidelines for scoring the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Pittsburg, Pa. University of Pittsburg; 1991.
4. Hudon C, Fortin M, Vanasse A. Cumulative Illness Rating Scale was a reliable and valid index in a family practice context. J Clin Epidemiol. 2005; 58: 603-608.
5. De Groot V, Beckerman H, Lankhorst GJ, Bouter LM. How to measure co-morbidity: a critical review of available methods. J Clin Epidemiol. 2003; 56: 221-229.
6. Hudon C, Fortin M, Soubhi H. Abbreviated guidelines for scoring Cumulative Illness Rating Scale (CIRS) in family practice. J Clin Epidemiol. 2007; 60: 212.