BackgroundMultimorbidity is an intuitively appealing, yet challenging, concept for Family Medicine (FM). An EGPRN working group has published a comprehensive definition of the concept based on a systematic review of the literature which is closely linked to patient complexity and to the biopsychosocial model. This concept was identified by European Family Physicians (FPs) throughout Europe using 13 qualitative surveys. To further our understanding of the issues around multimorbidity, we needed to do innovative research to clarify this concept. The research question for this survey was: what research agenda could be generated for Family Medicine from the EGPRN concept of Multimorbidity?MethodsNominal group design with a purposive panel of experts in the field of multimorbidity. The nominal group worked through four phases: ideas generation phase, ideas recording phase, evaluation and analysis phase and a prioritization phase.ResultsFifteen international experts participated. A research agenda was established, featuring 6 topics and 11 themes with their corresponding study designs. The highest priorities were given to the following topics: measuring multimorbidity and the impact of multimorbidity. In addition the experts stressed that the concept should be simplified. This would be best achieved by working in reverse: starting with the outcomes and working back to find the useful variables within the concept.ConclusionThe highest priority for future research on multimorbidity should be given to measuring multimorbidity and to simplifying the EGPRN model, using a pragmatic approach to determine the useful variables within the concept from its outcomes.

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BackgroundIn 2019, cardiovascular diseases (CVD) caused 32% of deaths worldwide. The SPICES survey involved five countries in an international primary CVD prevention implementation study in the general population. The French SPICES survey was implemented in the Centre Ouest Bretagne area (COB), which is a rural, economically deprived, medically underserved territory with high cardiovascular mortality. A CVD screening in the general population was needed to select the implementation population without overburdening family practitioner (FP) workforces. The efficacy and the replicability of such a screening were unknown. The aims of this study were to identify the characteristics of the individuals undergoing CVD risk assessment with the Non-Laboratory Interheart risk score (NL-IHRS), and to identify barriers and explore facilitators when screening the general population.MethodsAn implementation study combining a cross-sectional descriptive study with qualitative interviews was undertaken. The NL-IHRS was completed by trained screeners selected from health students, pharmacists, nurses, and physiotherapists in the area with a dedicated e-tool in sport and cultural events and public places. After the screening, all screener groups were interviewed until theoretical saturation for each group. Thematic analysis was performed using double-blind coding.ResultsIn 5 months, 3,384 assessments were undertaken in 60 different places, mostly by health students. A total of 1,587, 1,309, and 488 individuals were at low, moderate, and high CVD risk. Stressed or depressed individuals were remarkably numerous (40.1 and 24.5% of the population, respectively). Forty-seven interviews were conducted. The main facilitators were willingness of the population, trust between screeners and the research team, and media publicity. The main barriers were lack of motivation of some screeners, some individuals at risk, some stakeholders and difficulties in handling the e-tool.ConclusionThe efficacy of CVD risk screening while using mostly health students was excellent and preserved the FP workforce. Replicability was highly feasible if research teams took great care to establish and maintain trust between screeners and researchers. The e-tools should be more user-friendly.