Entete 3
Theory, concept and measure

Measuring Patients’ Perceptions of Patient-Centered Care

April 12, 2011 – 8:57 am

By Catherine Hudon

As many people affected by multimorbidity frequently interact with a family physician, [1-2] this professional is in a privileged position to play a significant role in their health. In patient-physician interactions, patient-centered care is widely acknowledged as a core value in family medicine [3-5] and has been associated with short term positive outcomes. [6-8] We decided to conduct a systematic review to identify and compare instruments, subscales or items assessing patient perception of patient-centered care in family medicine. We identified two instruments dedicated to measuring patient-centered care and eleven instruments that address some dimensions of this concept. The two instruments dedicated to patient-centered care measure key dimensions of this concept but are visit-based, limiting their applicability for long-term care processes such as chronic illness management. Relevant items from the eleven other instruments provide partial coverage of the concept but these instruments were not designed to provide a specific assessment of patient-centered care.
This article is published in the Mar/Apr 2011 issue of Annals of Family Medicine. To have free access to this article, click on this link:
http://www.annfammed.org/cgi/content/full/9/2/155

1. Starfield B, Lemke K, Bernbardt T, Foldes S, Forrest C, Weiner J: Comorbidity: implications for the importance of primary care in case management. Annals of Family Medicine 2003, 1:8-14.
2. Broemeling A, Watson D, Prebtani F: Population patterns of chronic health conditions, co-morbidity and healthcare use in Canada: implication for policy and practices. Healthcare Quaterly 2008, 11:70-76.
3. World Health Organization. Former les personnels de santé du XXe siècle: le défi des maladies chroniques [http://www.who.int/chp/knowledge/publications/workforce_report_fre.pdf]
4. World Health Organization. The Innovative Care for Chronic Condition (ICCC). [http://www.who.int/diabetesactiononline/about/ICCC/en/index.html]
5. Wagner EH, Austin BT, Von Korff M: Organizing care for patients with chronic illness. Milbank Quarterly 1996, 74:511-544.
6. Stewart M, Brown JB, Donner A, McWhinney IR, Oates J, Jordan J: The impact of patient-centered care on outcomes. Journal of Family Practice 2000, 49:796-804.
7. Stewart M, Brown JB, Weston WW, Freeman TR: Patient-centred medicine: transforming the clinical method. 2nd edn. United Kingdom: Radcliffe Medical Press; 2003.
8. Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, Ferrier K, Payne S: Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ 2001, 323:908-911.

Comment (1)
Intervention

Training clinicians in the management of multimorbidity

April 5, 2011 – 9:50 am

By Susan Smith

In considering designing appropriate interventions to improve outcomes for patients with multimorbidity, we are beginning to look at ways of training clinicians in the management of these patients. Our specific intervention is being directed towards GPs or family practitioners. Is anyone aware of any training materials that have been or are being developed for training clinicians? We may focus it around improved medicines management but could also look at case based learning. I would really welcome any comments from others working in the field.

Comment (1)
Others

Online discussions from the early International Research Community on Multimorbidity

March 24, 2011 – 3:03 pm

By Martin Fortin

In the original website of the International Research Community on Multimorbidity, (IRCMo) most parts of the site were open access and visitors were able to navigate through different sections containing information about publications on multimorbidity, events, and links to other websites related to the subject.

However, the virtual community was a private network of researchers and clinicians who shared ideas and knowledge on multimorbidity. Access to the discussion section of the virtual community was restricted to members with a user name and a password.

Discussions within the virtual community were about two main subjects:
1)    Multimorbidity: the concept and its measure
2)    Toward a new care model for patients with multimorbidity.

Comments and ideas written by different IRCMo members in 2007 are still valid in the present time and are now openly accessible on the website of the CIHR Applied Research Chair – Health Services and Policy Research on Chronic Diseases in Primary Care (link) under the heading ‘Archives of discussions in IRCMo’.

Those interested in reading the content of early discussions of the IRCMo can access the above website directly by following this link.

Comment (0)
Theory, concept and measure

Coming soon: A new tool for multimorbidity

February 23, 2011 – 11:32 am

By Martin Fortin

Published data on chronic diseases and multimorbidity prevalence are mainly based on self-report, billing data and registries. Data, so far, show a large gap in their magnitude from one study to the other. Population-based data and primary care practice data show important discrepancies (1). Studies from several countries (2-4) used administrative data, but much variation in results is attributed to different conceptualizations of multimorbidity and various chronic disease definitions and classifications (5). The use of a validated measure or index appears promising but so far, no instrument has been formally identified for measuring multimorbidity and the resulting burden of disease either for the patient or at the practice level (6). Such an instrument would be a major contribution to the study of multimorbidity and for comparison purposes among practices, regions and countries. Resource allocation and policy making would also benefit from a robust measure that could be scored in various ways including the use of Electronic Medical Record (EMR) data.

We validated and used the Cumulative Illness Rating Scale (CIRS) in previous studies for the measure of multimorbidity using chart review (7-10).  Advantages were its exhaustive quality and the built-in assessment of severity. We have shown it to be a better predictor of health related quality of life (HRQoL) and psychological distress than the simple count of chronic diseases and it compared advantageously with other morbidity indexes when HRQoL was the outcome of interest (11-13). Others have used the count of CIRS domains as a measure of multimorbidity and have linked the domain to International Classification of Primary Care (ICPC) rubrics thus facilitating the link with EMR (14). We have shown that some domains of the CIRS did not correlate with outcomes for patients. Based on previous studies on multimorbidity (7-9, 12, 14-15) and our experience with the use of the CIRS, we developed the Multimorbidity Assessment Tool (MAT) aimed at measuring the burden of disease at patient level and to reflect on the burden for practices. The tool builds on the CIRS structure but redefines the domains to facilitate scoring. We removed the domains that were not associated with HRQoL (15). We also added other domains that were deemed more appropriate. For each domain, the score may vary from 0 to 3 depending on the number of conditions affecting the domain and their severity. The tool may generate various continuous scores depending on its use. The tool will be assessed for reliability and validity and is expected to be available in 2012..

References
1. Fortin M, Hudon C, Haggerty J, van den Akker M, Almirall J. Prevalence estimates of multimorbidity: a comparative study of two sources. BMC Health Services Research, 2010;10:111.
2. van den Akker, M., et al., Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemiol, 1998. 51: p. 367-375.
3. Macleod, U., et al., Comorbidity and socioeconomic deprivation: an observational study of the prevalence of comorbidity in general practice. European Journal of General Practice, 2004. 10(1): p. 24-6.
4. Uijen AA, van de Lisdonk EH. Multimorbidity in primary care: prevalence and trend over the last 20 years. Eur J Gen Pract. 2008;14 Suppl 1:28-32.
5. Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009 Jul-Aug;7(4):357-63.
6. van den Akker, M., et al., Problems in determining occurrence rates of multimorbidity. J Clin Epidemiol, 2001. 54: p. 675-9.
7. Hudon C, Fortin M, Vanasse A. Cumulative Illness Rating Scale was a reliable and valid index in the family practice context. J Clin Epidemiol. 2005;58:603-8.
8. Hudon C, Fortin M, Soubhi H. Abbreviated guidelines for scoring the Cumulative Illness Rating Scale (CIRS) in family practice. Disponible à : www.elsevier.com/locate/clinepi J Clin Epidemiol. 2007; 60 :212.e1-e3.
9.  Fortin M, Bravo G, Hudon C, Vanasse A, Lapointe L. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med. 2005;3:223-28.
10. Fortin M, Steenbakkers K, Hudon C, Poitras ME, Almirall J, van den Akker M. The electronic Cumulative Illness Rating Scale: a reliable and valid tool to assess multimorbidity in primary care. Journal of Evaluation in Clinical Practice. Published online June 25th, 2010.
11. Fortin M, Bravo G, Hudon C, Lapointe L, Dubois MF, Almirall J. Psychological distress and multimorbidity in primary care. Ann Fam Med. 2006;4:417-22.
12. Fortin M, Bravo G, Hudon C, Lapointe L, Almirall J, Dubois M-F, Vanasse A. Relationship between multimorbidity and health-related quality of life of patients in primary care. Quality of Life Research. 2006;15:83-91.
13. Fortin M, Hudon C, Dubois MF, Almirall J, Lapointe L, Soubhi H. Comparative assessment of three different indices of multimorbidity for studies on health-related quality of life. Health and Quality of Life Outcomes. 2005;3:74. Disponible à: http://www.hqlo.com/content/3/1/74/abstract.
14. Britt HC, Harrison CM, Miller GC, Knox SA. Prevalence and patterns of multimorbidity in Australia. Med J Aust. 2008. 189(2):72-7.
15.Fortin M, Dubois MF, Hudon C, Soubhi H, Almirall J. Multimorbidity and quality of life: a closer look. HQLO 2007; 5 :52.

Comment (1)
Event

International Workshop on Collaborative Strategies in Multimorbidity

February 22, 2011 – 11:23 am

By Dr. Med. Christiane Muth

Seventeen experts from five countries (Canada, Ireland, the UK, the Netherlands and Germany) participated in an interdisciplinary workshop that took place at the Institute for General Practice on February 4/5, 2011. Those that took part included research scientists from the fields of general practice, clinical pharmacology and gerontology, as well as a number of methodologists.

The focus of the meeting was on multimorbidity and particularly on the increasing use of multimedication resulting from the demographic ageing of the population. Intensive discussions took place on model creation, concept development, epidemiology, the development of interventions, and improving healthcare for multimorbid patients. Two trials currently being conducted in Maastricht (PIL: Polypharmacy Intervention Limburg [link]) and Frankfurt (PRIMUM: PRIorization of MUltimedication in Multimorbidity [link]) were of central importance for the optimization of multimedication therapies. Special attention was also paid to specific methodological aspects characterizing the development, evaluation and implementation of complex interventions. Ways in which the participants can continue to cooperate in the future were also discussed.

The workshop was supported by the Association of Patrons and Friends of the Johann Wolfgang Goethe University Frankfurt am Main e.V.

Comment (1)

« Previous Page