A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development

Zullig, Leah L.; Whitson, Heather E.; Hastings, S. Nicole; Beadles, Christopher; Kravchenko, Julia; Akushevich, Igor; Maciejewski, Matthew L.

doi:10.1007/s11606-015-3512-2

Cited by 63 publications

(76 citation statements)

References 41 publications

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“…Patient-level interventions can be formulated to encourage and support patient self-management and facilitate discussions about personal preferences and priorities with HCPs, which could involve non-medical factors that may be relevant to their needs, such as the social and environmental context in which they live. 518 A 2016 Cochrane Review identified six studies of patient-level approaches to the management of multimorbidity, which included efforts such as educational support and self-management interventions. 519 The results of these six studies suggested that these interventions had little or no impact on clinical symptoms, mental health, or quality of life, indicating that patient-level interventions have limited impact when delivered in isolation.…”

Section: Patient-level Interventionsmentioning

confidence: 99%

Use of an Electronic Clinical Decision Support System in Primary Care to Assess Inappropriate Polypharmacy in Young Seniors With Multimorbidity: Observational, Descriptive, Cross-Sectional Study

et al. 2020

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Background Multimorbidity is a global health problem that is usually associated with polypharmacy, which increases the risk of potentially inappropriate prescribing (PIP). PIP entails higher hospitalization rates and mortality and increased usage of services provided by the health system. Tools exist to improve prescription practices and decrease PIP, including screening tools and explicit criteria that can be applied in an automated manner. Objective This study aimed to describe the prevalence of PIP in primary care consultations among patients aged 65-75 years with multimorbidity and polypharmacy, detected by an electronic clinical decision support system (ECDSS) following the 2015 American Geriatrics Society Beers Criteria, the European Screening Tool of Older Person’s Prescription (STOPP), and the Screening Tool to Alert doctors to Right Treatment (START). Methods This was an observational, descriptive, cross-sectional study. The sample included 593 community-dwelling adults aged 65-75 years (henceforth called young seniors), with multimorbidity (≥3 diseases) and polypharmacy (≥5 medications), who had visited their primary care doctor at least once over the last year at 1 of the 38 health care centers participating in the Multimorbidity and Polypharmacy in Primary Care (Multi-PAP) trial. Sociodemographic data, clinical and pharmacological treatment variables, and PIP, as detected by 1 ECDSS, were recorded. A multivariate logistic regression model with robust estimators was built to assess the factors affecting PIP according to the STOPP criteria. Results PIP was detected in 57.0% (338/593; 95% CI 53-61) and 72.8% (432/593; 95% CI 69.3-76.4) of the patients according to the STOPP criteria and the Beers Criteria, respectively, whereas 42.8% (254/593; 95% CI 38.9-46.8) of the patients partially met the START criteria. The most frequently detected PIPs were benzodiazepines (BZD) intake for more than 4 weeks (217/593, 36.6%) using the STOPP version 2 and the prolonged use of proton pump inhibitors (269/593, 45.4%) using the 2015 Beers Criteria. Being a woman (odds ratio [OR] 1.43, 95% CI 1.01-2.01; P=.04), taking a greater number of medicines (OR 1.25, 95% CI 1.14-1.37; P<.04), working in the primary sector (OR 1.91, 95% CI 1.25-2.93; P=.003), and being prescribed drugs for the central nervous system (OR 3.75, 95% CI 2.45-5.76; P<.001) were related to a higher frequency of PIP. Conclusions There is a high prevalence of PIP in primary care as detected by an ECDSS in community-dwelling young seniors with comorbidity and polypharmacy. The specific PIP criteria defined by this study are consistent with the current literature. This ECDSS can be useful for supervising prescriptions in primary health care consultations.

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Section: Patient-level Interventionsmentioning

confidence: 99%

Use of an Electronic Clinical Decision Support System in Primary Care to Assess Inappropriate Polypharmacy in Young Seniors With Multimorbidity: Observational, Descriptive, Cross-Sectional Study

et al. 2020

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“…Heterogeneity in definition and measurement of multimorbidity is the key issue in most included systematic reviews, which led to difficulties in results comparison and precluded meta-analysis. We detected two systematic reviews focused on definition (Le Reste et al, 2013;Willadsen et al, 2016), and five focused on measurement related topics (Diederichs et al, 2011;Holzer et al, 2014;Huntley et al, 2012;Willadsen et al, 2016;Zullig et al, 2016).…”

Section: Definition and Measurementmentioning

confidence: 99%

Evidence on multimorbidity from definition to intervention: An overview of systematic reviews

Mishra

Jones

2017

Ageing Research Reviews

281

263

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The increasing challenge of multiple chronic diseases (multimorbidity) requires more evidence-based knowledge and effective practice. In order to better understand the existing evidence on multimorbidity, we performed a systematic review of systematic reviews on multimorbidity with pre-established search strategies and exclusion criteria by searching multiple databases and grey literature. Of 8006 articles found, 53 systematic reviews (including meta-analysis and qualitative research synthesis performed in some reviews) that stated multimorbidity as the main focus were included, with 79% published during 2013-2016. Existing evidence on definition, measurement, prevalence, risk factors, health outcomes, clinical practice and medication (polypharmacy), and intervention and management were identified and synthesised. There were three major definitions from three perspectives. Seven studies on prevalence reported a range from 3.5% to 100%. As six studies showed, depression, hypertension, diabetes, arthritis, asthma, and osteoarthritis were prone to be comorbid with other conditions. Four groups of risk factors and eight multimorbidity associated outcomes were explored by five and six studies, respectively. Nine studies evaluated interventions, which could be categorized into either organizational or patient-oriented, the effects of these interventions were varied. Self-management process, priority setting and decision making in multimorbidity were synthesised by evidence from 4 qualitative systematic reviews. We were unable to draw solid conclusions from this overview due to the heterogeneity in methodology and inconsistent findings among included reviews. As suggested by all included studies, there is a need for prospective research, especially longitudinal cohort studies and randomized control trials, to provide more definitive evidence on multimorbidity.

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“…Literature review about the complexity construct [8910111213] has one feature in common: the presence of other dimensions, in addition to multimorbidity, that incorporate socioeconomic determinants of health, culture, environment, patient behaviour and their experience in the use of health services that evidence social inequalities in health [1]. Grant et al suggest different complexity patterns where mental health and substance abuse were identified as the main problems in younger complex patients, while decision-making and care coordination predominated in advanced age [14].…”

Section: Introductionmentioning

confidence: 99%

Complex Care Needs in Multiple Chronic Conditions: Population Prevalence and Characterization in Primary Care. A Study Protocol

Iglesias¹,

Celada²,

Navarro³

et al. 2018

International Journal of Integrated Care

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Background:Chronicity, and particularly complex care needs for people with chronic diseases is one of the main challenges of health systems.Objective:To determine the population prevalence of people with chronic diseases and complex care needs and to characterize these needs considering features of health and social complexity in Primary Care.Design:Cross-sectional population-based study.Scope:Patients who have one or more chronic health conditions from three Primary Care urban centres of a reference population of 43.647 inhabitants older than 14 years old.Methodology:Data will be obtained from the review of electronical medical records. Complexity will be defined by: 1) the independent clinical judgment of primary care physicians and nurses and 2) the aid of three complexity domains (clinical and social). Patients with advanced chronic disease and limited life prognosis will be also described.Conclusions:This research protocol intends to describe and analyse complex care needs from a primary care professional perspective in order to improve knowledge of complexity beyond multimorbidity and previous consumption of health resources. Knowing about health and social complexity with a more robust empirical basis could help for a better integration of social and health policies and a more proactive and differentiated care approach in this most vulnerable population.

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A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development

Cited by 63 publications

References 41 publications

Use of an Electronic Clinical Decision Support System in Primary Care to Assess Inappropriate Polypharmacy in Young Seniors With Multimorbidity: Observational, Descriptive, Cross-Sectional Study

Use of an Electronic Clinical Decision Support System in Primary Care to Assess Inappropriate Polypharmacy in Young Seniors With Multimorbidity: Observational, Descriptive, Cross-Sectional Study

Evidence on multimorbidity from definition to intervention: An overview of systematic reviews

Complex Care Needs in Multiple Chronic Conditions: Population Prevalence and Characterization in Primary Care. A Study Protocol

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