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Publications on multimorbidity July-October 2014

November 27, 2014 – 11:31 am



By Martin Fortin


Our search for papers on multimorbidity that were published during the period July-October 2014 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.

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Others

ABC of multimorbidity

October 22, 2014 – 7:37 am



By Stewart Mercer, Chris Salisbury and Martin Fortin

The ABC of multimorbidity is a book (64 pages) recently published by WILEY Blackwell seeking to explore some important issues on the subject. Contributors to the book were Marjan van den Akker, Elizabeth A. Bayliss, Peter Bower, Sonny Cejic, Peter Coventry, Martin Fortin, Katie I. Gallacher, Linda Gask, Jane Gunn, Karen Kinder, Frances Mair, Carl May, Stewart W. Mercer, Victor Montori, Christiane Muth, Ignacio Ricci-Cabello, Martin Roland, Chris Salisbury, Efrat Shadmi, Moira Stewart, Amanda L. Terry, José M. Valderas, Concepción Violán, and Jonathan P. Weiner.
Divided in 12 chapters, the book addresses the prevalence of multimorbidity, its impact on patients, the relationship between physical and mental health problems, and how managing multiple health problems concurrently can create a heavy burden of treatment for patients. At the heart of the book is the authors’ shared conviction that health care should be person -centered.
Due to space limitations each chapter is rather short. We hope that experts on the subject do not judge us too severely for the limited amount of information we could provide, and that busy physicians looking for an informative and practical source of knowledge will find this book useful.

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Epidemiology and outcomes research

Multimorbidity in patients enrolled in a community-based methadone maintenance programme

October 10, 2014 – 8:28 am



By Tom Brett

The General Practice and Primary Health Care Research Unit at The University of Notre Dame Australia, Fremantle has published a new paper: ‘Multimorbidity in patients enrolled in a community-based methadone maintenance programme delivered through primary care’ (1). The study is a retrospective cohort study using electronic medical record review of patients attending a primary care-based methadone maintenance clinic in Western Australia. The clinic itself is part of a much larger medical centre that offers comprehensive primary health care. Multimorbidity in the methadone cohort was consistently higher across all age groups and contrasted with the comparator group where multimorbidity was positively correlated with age. We found the traditional S-shaped distribution curve of multimorbidity from mainstream practice was replaced by a consistently elevated plateau distribution among the methadone cohort. Our findings suggest challenging implications for the design and delivery of health care services to this population. Diane Arnold-Reed is lead author.

1-Multimorbidity in patients enrolled in a community-based methadone maintenance programme delivered through primary care. Journal of Comorbidity 2014; 4: 46-54.  Doi: 10.15256/joc.2014.4.42

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Intervention

Improving care for patients with multimorbidity

September 16, 2014 – 2:31 pm



By Chris Salisbury

Although there is a fairly clear sense of direction about how care needs to change for patients with multimorbidity, there have been few rigorous studies of new approaches.
Researchers from the Universities of Bristol, Glasgow, Manchester, Dundee, in partnership with the NHS and the Royal College of General Practitioners, have obtained funding for the ‘3D’ study to improve whole person care. This is an ambitious multi-centre cluster randomised trial of a new approach to improve the management of patients with multimorbidity in general practice, led by Professor Chris Salisbury. Funding of £1.78 million study has been obtained from the National Institute of Health Research (NIHR) through its Health Services and Delivery Research (HS&DR) Programme.

Following a pilot and optimisation study in 4 general practices, 32 practices will be recruited to the main trial and randomised to receive the new intervention or continue usual care. The intervention is designed to address the problems of illness burden (poor quality of life, depression) treatment burden (multiple unco-ordinated appointments, polypharmacy, poor primary/secondary care co-ordination) and lack of patient-centred care (low continuity, disregard of patients’ priorities) experienced by patients with multimorbidity.
Patients with multimorbidity will be identified and offered longer appointments with the same GP and nurse whenever possible, to maximise continuity of care. Instead of separate reviews of each of their long term conditions, patients will be invited for a comprehensive ‘3D’ health review every 6 months designed to cover all of their health issues. This will focus on identifying their main concerns and priorities to improve their quality of life, as well as seeking to improve disease control (Dimensions of health). The patients’ Drug regime will be reviewed and simplified, seeking to improve medication adherence.  The clinician will check for and treat Depression. In order to improve integration of care, the practice will have a linked ‘general physician’ at the local hospital.
The aim is to recruit 1382 multimorbid patients into the trial and follow them up for 12 months. The primary outcome is the patient’s quality of life, with secondary outcomes including measures of disease control, the burden of illness and treatment, and measures of patient centred care. A parallel process evaluation using mixed methods will explore how the intervention is implemented and achieves its effects and how it could be improved. Through an economic evaluation we will compare the costs and benefits of the intervention from different perspectives and determine whether it is cost-effective. Further information is available from the study website at http://www.bristol.ac.uk/3d-study.

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Epidemiology and outcomes research

Multimorbidity in a marginalised, street-health Australian population

September 2, 2014 – 10:30 am



By Tom Brett

A recent publication from The University of Notre Dame Australia, Fremantle in BMJ Open (1) deals with patterns, prevalence and disease severity of multimorbid chronic conditions among a street-based vulnerable and marginalized population.
Our research brings new information on a disadvantaged cohort of patients who access an innovative, accredited, mobile outreach primary care medical service.
We have again used the Cumulative Illness Rating Scale among the 2587 patients seen over a six year period in the Fremantle area of Western Australia.
Disease patterns and severity were compared with 4583 mainstream patients from a similar geographical area.
A key finding from our research is that this population develops chronic conditions at a much earlier age especially when compared with earlier research worldwide from mainstream practices.
A positive outcome from our research was the willingness of Aboriginal patients to engage with the mobile, outreach primary care medical service. This compares very favourably with the traditional low attendance patterns of Aboriginal patients with mainstream practices.

(1) Brett T, Arnold-Reed DE, Troeung L, Bulsara MK, Williams A, Moorhead RG. Multimorbidity in a marginalised, street-health Australian population: a retrospective cohort study. BMJ Open. 2014 Aug 19;4(8):e005461. doi: 10.1136/bmjopen-2014-005461.

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Others

Publications on multimorbidity March-June 2014

July 11, 2014 – 8:46 am



By Martin Fortin


Our search for papers on multimorbidity that were published during the period March-June 2014 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.

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Epidemiology and outcomes research

Lifestyle factors and multimorbidity

July 8, 2014 – 1:05 pm



By Martin Fortin

Many studies have unequivocally shown a close relationship between lifestyle factors and individual chronic diseases. More recently, the association of lifestyle risk factors with multimorbidity has been explored for physical activity, obesity, smoking, alcohol consumption, and nutrition. Some mixed results have been reported. However, the body mass index has been consistently found to be associated with multimorbidity.
In a recent study published in BMC Public Health [1], we analysed the association of accumulating risk factors in the same individual and multimorbidity. We found that accumulating unhealthy lifestyle factors progressively increased the likelihood of multimorbidity. The cross-sectional design of the study did not allow making a causal inference. However, the increase in the likelihood of multimorbidity with the combined effect of unhealthy lifestyle factors may be used to hypothesise that a person-centered approach promoting healthy lifestyles aiming to maximize the number of healthy lifestyles could be an intervention in the fight against multimorbidity.

1. Fortin M, Haggerty J, Almirall J, et al., Lifestyle factors and multimorbidity: a cross sectional study. BMC Public Health 2014;14:686.

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Event

Personalized Geriatric Medicine. A shift in management approach

June 23, 2014 – 2:33 pm



By Gunnar Akner

www.gunnar-akner.se

Since aging is the most important risk factor to develop disease(s) and/or injuries, multimorbid elderly people dominate in all parts of the health care system: in hospitals, in primary care and in communal care for the elderly. The multimorbidity phenotype among elderly people is very complex and in combination with great variation on psychosocial context, there are not two multimorbid elderly people alike. This diversity has fundamental consequences for the health care system:

1.    Analysis, evaluation, management/care and follow-up of multimorbid elderly people must be
individualized and based on integrated and targeted multi-domain thinking. National guidelines are not very helpful in the management of multimorbidity, that requires simultaneous health problem specific and integrated management. A strict adherece to guidlines will impose strong risks to multimorbid elderly.

2.    Such individualization requires that the clinical working conditions support qualified management over time. Key elements regard for example team composition (type and number of team-members), team working methods and a medical record that is based on the individual´s health problems, how they have developed over time including the effects of various treatments/care.

3.    The high prevalence of multimorbid elderly people calls for a shift in the education and training of physicians and health care staff, and should have sa strong base in Geriatric Medicine.

4.    Clinical treatment research methodology resides heavily on the randomized controlled trial (RCT). The RCT is based on the assumption of treating homogenous groups av patients with well defined interventions. In multimorbid elderly people, the heterogeneity is profound regarding both the health problems, treatment methods and outcomes. Thus, there is a strong call to develop complementing research methods, for example the n=1 methodology.

These aspects are discussed more in detail in a recent overview article in Clinicak Geriatrics (1).

Similar aspects of multimorbidity in elderly will be discussed during the 3-day international conference (Berzelius-symposium)”Personalized Geriatric Medicine” in Stockholm, Sweden, August 20-22, 2014 organized by The Swedish Society of Medicine, in cooperation with European Union Geriatric Medicine Society (EUGMS), the Swedish Society of Geriatric Medicine, Karolinska Institutet and the Swedish National Research Council http://www.sls.se/Utbildning/Berzeliussymposier/geriatricmedicine/. President of the organizing committee is professor Gunnar Akner.
World leading researchers and clinicians from Geriatric Medicine and elderly care from USA, Japan, Spain, England, Ireland, Norway, Finland and Sweden will provide state-of-the-art-lectures (see list of participants on the conference website). On each day of the conference, there will be group discussions, where lecturers and participants meet and engage in in-depth discussions around different themes.
We hope the conference will attract researchers, clinicians in Geriatric Medicine and other medical specialities from different professional staff groups, stakeholders and decision-makers, politicians, economists etc with interest to improve the quality of care from the individual elderly patient´s point of view. An application has been made to the EACCME® for CME accreditation of this event.

Reference
1.    Akner G. Frailty and multimorbidity in elderly people: A shift in management approach.
Clin Geriat 2013; 21: published online September 23, 2013.
(see website www.gunnar-akner.se, link ”Multimorbidity/frailty”)

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Qualitative research

The experience of adults with multimorbidity: a qualitative study

May 29, 2014 – 10:17 am



By Cynthia Duguay

Some studies indicate that the many challenges associated with multiple chronic diseases represent more than just the sum of each individual’s diseases. People with multimorbidity perceive their state of health as a series of medical and emotional crises that inevitably lead to physical loss and limitations, and can also create difficult social relationships. The literature does not provide sufficient evidence for us to determine whether the experiences of adults with multimorbidity are similar to those of the older population, despite multimorbidity also being common in younger adults whose social and family situations differ from those of their elders.
We conducted a qualitative study to have a deeper understanding of patients’ experiences from their own perspective (1). The purpose of this phenomenological study was to describe the fundamental structure of adults’ experience with multimorbidity.
The results of the study showed that at the core of the multimorbidity experience are the impression of aging prematurely, difficulties with self-care management, and issues with access to the healthcare system, which contribute to the problem’s complexity. Despite these issues, participants with multimorbidity report attempting to take control of their situation and adjusting to daily living. The whole article about this study is available at the website of the Journal of Comorbidity.

Reference
(1) Cynthia Duguay, Frances Gallagher, Martin Fortin. The unique experience of adults with multimorbidity: a qualitative study. Journal of Comorbidity 2014;4(1):11–21.

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Event

Conference Personalized Geriatric Medicine

March 12, 2014 – 8:24 am



Invitation

The Swedish Society of Medicine is inviting to a 3-day international conference called “Personalized Geriatric Medicine”, in Stockholm/Sweden August 20-22, 2014. The conference is arranged in collaboration with the Swedish Society for Geriatric Medicine, European Union Geriatric Medicine Society (EUGMS), Karolinska Institutet and The Swedish Research Council.
The program will focus on management of individual frail, multimorbid elderly people over time in relation to medical quality, patient safety, education/training and research/development. World leading researchers are invited as speakers and will present state-of-the-art lectures. We aim to highlight the potential of Geriatric Medicine to improve the quality of multi-domain analysis, management/care and follow-up over time in individual multimorbid, elderly people. The potential of the medical record to serve as a much longed for “geroscope” will be highlighted. Each symposium day includes group discussions, where the participants and speakers meet to discuss various themes more personal and in-depth.
The conference is hoped to attract scientists, clinicians from different medical specialities, health care staff groups, stakeholders and others with interest in various aspects of improving health care, assessment and managment/care of multimorbid, elderly people.
For more information about the conference and how to register, please visit the conference homepage: http://www.sls.se/Utbildning/Berzeliussymposier/geriatricmedicine/.

Welcome to Stockholm in August 2014!
Stockholm, Sweden March 10, 2014

On behalf of the Organizing committee

Gunnar Akner
Chair
Professor in Geriatric Medicine, Senior physician

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