Clinical assessment and management of multimorbidity: NICE guideline

Kernick, David; Chew‐Graham, Carolyn; O’Flynn, Norma

doi:10.3399/bjgp17x690857

Cited by 91 publications

(84 citation statements)

References 5 publications

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“…Multimorbidity is defined as the presence of more than one health condition in an individual [1][2][3][4]. A person with numerous long-term health conditions has an increased risk of depression, hospitalizations, polypharmacy, loss of physical functioning, and even premature death [5,6]. In addition, multimorbidity places a substantial economic burden on the healthcare system [7][8][9][10], especially in the world's most populous country, China [11,12], because patients with multimorbidity often require additional intensive treatment and monitoring by nurses, physicians and other healthcare staff [13,14].…”

Section: Introductionmentioning

confidence: 99%

Multimorbidity Analysis of 13 Systemic Diseases in Northeast China

Song

et al. 2020

IJERPH

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Background: Multimorbidity not only affects the quality of patients’ lives, but can also bring a heavy economic burden to individuals, families and society. The purpose of this study was to reveal the connections between diseases, especially the important role each disease played in the entire multimorbidity network. Methods: A total of 1,155,734 inpatients were enrolled through multistage stratified random sampling in Jilin Province in 2017. Categorical variables were compared using the Rao–Scott-χ2 test. Weighted networks were adopted to present the complex relationships of multimorbidity. Results: The distributions of the number of diseases differed significantly by gender, age and health insurance scheme (P < 0.001). Diseases of the respiratory system had the highest weight in multimorbidity in young people. Endocrine, nutritional and metabolic diseases and circulatory system diseases were often associated with other systemic diseases in middle aged and old people. Conclusions: Multimorbidity with respiratory system diseases in young people should not be overlooked. Additionally, effective prevention efforts that target endocrine, nutritional and metabolic diseases and circulatory system diseases are needed in middle aged and old people.

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Section: Introductionmentioning

confidence: 99%

Multimorbidity Analysis of 13 Systemic Diseases in Northeast China

Song

et al. 2020

IJERPH

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“…Both professionals and patients experience patients' engagement in self-management as a balance between the triangle of patients' resources, patients' motivation, and shared responsibility between professionals and patients (18). To succeed, self-management support should be aligned with patients' abilities, strengths, and value systems, and respond to changes in their clinical conditions (16,17,19,20).…”

Section: Introductionmentioning

confidence: 99%

“Standing on Common Ground” - A Qualitative Study of Self-management Support for Patients With Multimorbidity in Primary Health Care

Freilich

Nilsson

Ekstedt

et al. 2020

Preprint

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Abstract Background: Multimorbidity, the co-existence of two or more chronic conditions in an individual, is present in most patients over 65 years. Primary health care (PHC) is uniquely positioned to provide the holistic and continual care recommended for this group of patients, including support for self-management. The aim of this study was to explore professionals’, patients’, and family caregivers’ perspectives on how PHC professionals should support self-management in patients with multimorbidity. This study also includes experiences of using telemedicine to support self-management. Methods: A mixed qualitative method was used to explore regular self-management support and telemedicine as a tool to support self-management. A total of 42 participants (20 physicians, 3 registered nurses, 12 patients, and 7 family caregivers) were interviewed using focus group interviews (PHC professionals), pair interviews (patients and family caregivers), and individual interviews (registered nurses, patients, and family caregivers). The study was performed in urban areas in central Sweden and rural areas in southern Sweden between April 2018 and October 2019. Data were analyzed using content analysis. Results: The main theme that emerged was “Standing on common ground enables individualized support.” To achieve such support, professionals needed to understand their own views on who bears the primary responsibility for patients’ self-management, as well as patients’ self-management abilities, needs, and perspectives. Personal continuity and trustful relationships facilitated this understanding. The findings also indicated that professionals should be accessible for patients with multimorbidity, function as knowledge translators (help patients understand their symptoms and how the symptoms correlated with diseases), and coordinate between levels of care. Telemedicine supported continual monitoring and facilitated patient access to PHC professionals.Conclusion: Through personal continuity and patient-centered consultations, professionals could collaborate with patients to individualize self-management support. For some patients, this means that PHC professionals are in control and monitor symptoms. For others, PHC professionals play a less controlling role, empowering patients’ self-management. Development and improvement of eHealth tools for patients with multimorbidity should focus on improving the ability to set mutual goals, strengthening patients’ inner motivation, and including multiple caregivers to enhance information-sharing and care coordination.

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“…The National Institute for Health and Care Excellence (NICE) defines multimorbidity as the cooccurrence of two or more long term illness conditions [15][16].The NICE, on its first guideline to manage multimorbidity, encourages to identify people who would benefit from an individualized approach [16]. In general, the presence of multimorbidity no alters COPD treatment and, as suggested by the GOLD report 2019, comorbidities should be treated per usual standard regardless of the presence of COPD [1].The NICE recommends to identify those patients who may take advantage of a "multimorbidity approach" evaluating treatment burden by discussing with the patient by what means his/her health problems and how treatments affect their day-to-day life [17].…”

Section: Introductionmentioning

confidence: 99%

FKBP5 Polymorphism, Coping and Emotional Status in Chronic Obstructive Pulmonary Disease Patients Undergoing Pulmonary Rehabilitation

Prinzi¹,

Tomino²,

Santoro³

et al. 2019

Preprint

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Background: COPD is characterized by dyspnea, chronic cough, sputum production and extra pulmonary multimorbidity including depression, anxiety and cognitive problems. Methods: Cognitive and psychological clinical alterations/disorders; QoL/Health-related QoL; and Coping strategies were evaluated in 71 COPD patients characterized for FKBP5 gene (rs4713916). Instruments: MMSE, MoCA, ROCF, BDI-II, CES-D, SAS, SF-36, ADL, IADL, SGRQ, MRF 26, CIRS, Brief COPE. Results: Carriers of the rs4713916 polymorphisms (G:A) show better cognitive performances, higher degree of independence in the ADL and IADL, better QoL before and after rehabilitation, no presence of depressive mood and anxiety symptoms, no family history of psychiatric disorder, more ability to cope with stressors by avoiding emotions but demanding emotional support, and lesser use of anti-anxiety, anti-depressant anti-psychotic, hypnotic-sedative drugs. On the other hand, no difference was found as regards the number of comorbidities. Conclusions: Our study shows that rs4713916 is positively associated with better outcome for COPD. These results offer valuable insights into the role of FKBP5 in the complex network of mechanisms associated to clinical and behavioral features of COPD patients.. Our data may be used as initial benchmark for future clinical studies.

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Clinical assessment and management of multimorbidity: NICE guideline

Cited by 91 publications

References 5 publications

Multimorbidity Analysis of 13 Systemic Diseases in Northeast China

Multimorbidity Analysis of 13 Systemic Diseases in Northeast China

“Standing on Common Ground” - A Qualitative Study of Self-management Support for Patients With Multimorbidity in Primary Health Care

FKBP5 Polymorphism, Coping and Emotional Status in Chronic Obstructive Pulmonary Disease Patients Undergoing Pulmonary Rehabilitation

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