September 4, 2015 – 8:28 am
By Sara Afshar
Multimorbidity defined as the “the coexistence of two or more chronic diseases” in one individual, is
increasing in prevalence globally. Despite the growing recognition of the prevalence of multimorbidity amongst older adults, global prevalence have largely remained single-disease focused. Internationally, there is still limited evidence on the prevalence and social determinants of multimorbidity, particularly in low and middle income countries (LMICs).
In collaboration with the University of Southampton and the World Health Organisation, we examined the global patterns of multimorbidity and compared prevalence across different countries including LMICs. We extracted chronic disease data from 28 countries of the World Health Survey (2003) and examined the inter-country socio-economic differences by gross domestic product (GDP). Regression analyses were applied to examine associations of education with multimorbidity by region adjusted for age and sex distributions.
We found that the mean world standardized multimorbidity prevalence for LMICs was 7.8 % (95 % CI, 7.79 % – 7.83 %). In all countries, multimorbidity increased significantly with age. A positive but non–linear relationship was found between country GDP and multimorbidity prevalence. Trend analyses of multimorbidity by education suggested that there are intergenerational differences, with a more inverse education gradient for younger adults compared to older adults. Furthermore, higher education was significantly associated with a decreased risk of multimorbidity in the all-region analyses.
We concluded that multimorbidity is a global phenomenon, not just affecting older adults in high income countries. Policy makers worldwide therefore need to address these health inequalities, and support the complex service needs of a growing multimorbid population.
Reference:
Afshar S, Roderick PJ, Kowal P, Dimitrov B and Hill AG. Multimorbidity and the inequalities of global ageing: a cross-sectional study of 28 countries using the World Health Surveys. BMC Public Health. 2015. 15:776
To access the full article: http://www.biomedcentral.com/1471-2458/15/776
August 28, 2015 – 10:21 am
By Michelle L.A. Nelson
What proportion of the stroke rehabilitation evidence is relevant to patients with multimorbidity?
Current evidence syntheses serving as the foundation for stroke rehabilitation best practice recommendations do not categorize or report data extraction related to multimorbidity. This may be problematic for the design of stroke clinical practice recommendations. Although it may be expected (based on prevalence data) that multimorbid patients were included in reported rehabilitation intervention studies, by not having an explicit understanding of the patients included or excluded in the evidence, we may be faced with a mismatch between the research participants used to generate evidence, the best practice recommendations, and the patient seen in practice.
We are conducting a systematic scoping review of the stroke rehabilitation intervention literature to identify the evidence relevant to patients with multimorbidity. The study protocol was published in the Journal of Comorbidity [1]. The publication of protocols supports transparency in scoping approaches through the publication of the original proposed study, serving as a baseline from which we can discuss any methodological modifications and subsequently study results. Additionally, a second contribution of publishing this protocol is providing guidance to other researchers in the key elements of scoping protocols and proposals, a clear gap in the literature we discovered during the development of the funding proposal.
The full article can be accessed at: http://www.jcomorbidity.com/index.php/test/article/view/47
1. Nelson, Michelle LA, et al. Stroke rehabilitation and patients with multimorbidity: a scoping review protocol. J Comorbidity 2015:5(1):1-10. doi: http://dx.doi.org/10.15256/joc.2015.5.47
August 21, 2015 – 8:49 am
By Dr Katie Gallacher, Prof Stewart Mercer and Prof Frances Mair
Our paper in BMC Medicine http://www.biomedcentral.com/1741-7015/12/151 examines the prevalence of multimorbidity and polypharmacy in a large, nationally representative sample of primary care patients, comparing those with and without stroke, adjusting for age, gender and deprivation. In this cross-sectional study of 1,424,378 adult participants from 314 primary care practices in Scotland, we analysed data on the presence of stroke and 39 other long-term conditions, as well as prescriptions for regular medications.
We found that both multimorbidity and polypharmacy were markedly more common in those with stroke compared to those without. Additionally, number of morbidities were very high in the stroke group (45% had 4 or more) as were numbers of prescriptions (13% had 11 or more). Both multimorbidity and polypharmacy put patients at risk of treatment burden, defined as the workload of healthcare for patients, and the impact of this on wellbeing. The findings from our study therefore have important implications for the redesign of stroke health services and clinical guidelines.
August 14, 2015 – 8:19 am
By Martin Fortin, Moira Stewart, Elizabeth Bayliss, Maxime Sasseville, Paul Little, Stewart Mercer, John Furler, Marjan van den Akker, Susan Smith
An activity organized by the PACEinMM international advisory committee
During the 2015 NAPCRG Annual Meeting to be held October 24-28 in Cancun, Mexico, we will be conducting a three hour forum entitled “Think-tank on outcomes for patient-centered interventions for persons with multimorbidity”. The objectives of the forum are to use a group process 1) to identify a set of relevant outcomes for patient-centered interventions for persons with multimorbidity (MM), 2) to share experiences internationally, and 3) to inform the conduct of interventions for persons with multimorbidity in primary care settings. The Special Interest Group on Comorbidity/multimorbidity endorses the forum and it is open to all.
In order to prepare for the forum, we are conducting a short survey. The questions assess the relevance of types and domains of outcome measures for interventions in multimorbidity.
Please consider completing the survey. Your input is important even if you do not plan to attend the NPCRG conference. If you do plan to attend, we look forward to meeting you at NAPCRG in Cancun, Mexico next October.
Many thanks for your help.
GO TO THE SURVEY
August 10, 2015 – 10:29 am
By Marcello Tonelli
From a list of 40 common chronic conditions, we identified validated algorithms that use ICD-9 CM/ICD-10 data for 30 of these [1]. Algorithms with both positive predictive value and sensitivity ≥70% were graded as “high validity”; those with positive predictive value ≥70% and sensitivity <70% were graded as “moderate validity”. Of the 40 morbidities, we identified 30 that could be identified with high to moderate validity. We then applied the algorithms to a large cohort of Alberta residents to show proof of concept. In our opinion, using a standard set of algorithms could facilitate the study and surveillance of multimorbidity across jurisdictions. We encourage other groups to consider using this scheme in their studies.
1. Marcello Tonelli et al. Methods for identifying 30 chronic conditions: application to administrative data. BMC Medical Informatics and Decision Making. 2015;15:31.
By Jess Garvey, Deirdre Connolly and Susan Smith
We investigated the effectiveness of an occupational therapy led self-management support programme, OPTIMAL, designed to address the challenges of living with multiple chronic conditions or multimorbidity in a primary care setting. We conducted a pragmatic feasibility randomised controlled trial including fifty participants with multimorbidity recruited from family practice and primary care settings in Dublin in Ireland. OPTIMAL is a six-week community-based programme, led by occupational therapy facilitators and focuses on problems associated with managing multimorbidity. The primary outcome was frequency of activity participation. Secondary outcomes included self-perception of, satisfaction with and ability to perform daily activities, independence in activities of daily living, anxiety and depression, self-efficacy, health-related quality of life, self-management support, healthcare utilisation and individualised goal attainment. Outcomes were collected within two weeks of intervention completion.
At immediate post intervention follow-up we found significant improvements in frequency of activity participation, measured using the Frenchay Activities Index, for the intervention group compared to the control group (Adjusted Mean Difference at follow up 4.22. 95% Confidence Interval 1.59-6.85). There were also significant improvements in perceptions of activity performance and satisfaction, self-efficacy, independence in daily activities and quality of life. Additionally, the intervention group demonstrated significantly higher levels of goal achievement, following the intervention. No significant differences were found between the two groups in anxiety, depression, self-management scores or healthcare utilisation.
OPTIMAL significantly improved frequency of activity participation, self-efficacy and quality of life for patients with multimorbidity. Further work is required to test the sustainability of these effects over time but this study indicates that it is a promising intervention that can be delivered in primary care and community settings.
Full details of this article can be found at http://www.biomedcentral.com/1471-2296/16/59/abstract
We would welcome contact and collaboration with other researchers looking to test the feasibility and effectiveness of the OPTIMAL programme in other healthcare settings.
By Aline Ramond-Roquin
This recently published study (1) is part of my thesis in public health untitled “Risk factors, comorbidity and management of non-specific low back pain in general practice”, undertaken in the University of Angers, France, in partnership with the Department of Primary and Community Care of Nijmegen, The Netherlands.
Literature has suggested that patients with chronic low back pain (CLBP) presented higher level of psychosocial, musculoskeletal and somatoform comorbidity than general population. As such morbidity is particularly common in primary care, we were interested in the following question: in general practice, do patients presenting with CLBP more often present psychosocial, musculoskeletal and somatoform problems than patients presenting with other problems?
We extracted data from the Transition Project, a long-standing, experienced primary care practice-based network that has been systematically and prospectively coding the diagnoses related to all the encounters between the patients and their general practitioners, using the international classification of primary care. We compared the prevalence of the problems presented by 1511 patients with CLBP with those of their 1511 matched patients without CLBP, focusing on the period from one year before the beginning of an episode of care for CLBP to two years after it. Patients with CLBP presented higher prevalence of musculoskeletal problems but similar prevalence of psychosocial and non-musculoskeletal somatoform problems, compared to other patients consulting in the same setting. Therefore we concluded that:
1) General practitioners should be aware of the frequency of multi-site musculoskeletal disorders, whether synchronous or metachronous, and adopt an integrated approach when caring for patients with such problems.
2) Rather than systematically screening for specific psychological, social or somatoform disorders, they should consider with the patient how CLBP and any type of potential comorbidity interfere with his/her daily functioning.
Reference
1) Ramond-Roquin A, Pecquenard F, Schers H, Van Weel C, Oskam S, Van Boven K. Psychosocial, musculoskeletal and somatoform comorbidity in patients with chronic low back pain: original results from the Dutch Transition Project. Fam Pract. 2015 Jun;32(3):297–304
By Alessandra Marengoni
Despite the increasing interest of the researchers in the topic of multimorbidity, there is still a remarkable gap between the harmful impact of multimorbidity at the individual and societal level and the amount of scientific and clinical research devoted to this topic. To (partly) cover for this lack of multimorbidity research Alessandra Marengoni (lead guest editor, Brescia, Italy), Alexandra Prados Torres (Zaragosa, Spain), Graziano Onder (Rome, Italy) and René Melis (Nijmegen, the Netherlands) are guest editing a special issue with Biomed Research International on the topic of multimorbidity. We believe that this maybe a very nice opportunity to provide a comprehensive, impactful overview of this highly relevant topic. We warmly welcome original research articles as well as review articles that seek to address epidemiology of multimorbidity both in the general population and in clinical settings.
Do not hesitate to contact one of us for any questions you may have related to this call or pre-submission inquiries.
For details on the call:
http://www.hindawi.com/journals/bmri/si/217914/cfp/
By Anne Doessing
We recently published a scoping study addressing two issues: what are the conditions of care coordination for patients with multimorbidity; and which factors promote or inhibit care coordination in provider organizations and among healthcare professionals [1].
The central theme emerging was complexity: The specific medical conditions of patients with multimorbidity are highly complex as is the organization of care delivery.
What are the implications for care coordination then? One approach is to reduce complexity and the other is to embrace complexity. Either way, future research in care coordination interventions in multimorbidity must take a more explicit stand on complexity.
In the included studies there was a significant lack of clarity regarding the role of different professionals in care coordination. It is unclear what role the various health professions play in care coordination, what coordination tasks different professions perform and whether some professions are more suited for care coordination than others. Also, it is unclear how different organizations and sectors affect the coordination carried out by different professions.
The research on care coordination interventions for patients with multimorbidity seems to focus on organizing healthcare without paying much attention to the role of professions in frontline care coordination. However, this ought to be a prerequisite for the development of care coordination interventions.
Therefore there is a need for more research to uncover the role of different professions in care coordination. This must comprehend both their actions and the health professionals’ own understanding of their role in care coordination.
Perhaps some of the failures of existing care coordination interventions can be explained by the fact that the specific delegation of coordination is at odds with the health professionals’ own understanding of their professional domain?
The complete article can be accessed at: http://www.jcomorbidity.com/index.php/test/article/view/39
1: Doessing A, Burau V. Care coordination of multimorbidity: a scoping study. J Comorbidity 2015;5:15-28
By Martin Fortin
Our search for papers on multimorbidity that were published during the period November 2014-March 2015 has been completed. As in previous searches, we found many new papers and the list is too long for this venue. Therefore, we have prepared a PDF file that can be accessed following this link.
Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expression “multiple chronic diseases”, but we are sure that most publications on the subject are included in the list.
All references are also included in our library. Feel free to share with anyone interested in multimorbidity.
