How do general practitioners recognize the definition of multimorbidity? A European qualitative study

Reste, Jean Yves Le; Nabbe, Patrice; Lazić, Đurđica Kašuba; Assenova, Radost; Lingner, Heidrun; Czachowski, Sławomir; Argyriadou, Stella; Sowińska, Agnieszka; Lygidakis, Charilaos; Doerr, Christa; Clavería, Ana Murcia; Floch, Bernard Le; Derriennic, Jeremy; Marwijk, Harm van; Royen, Paul Van

doi:10.3109/13814788.2015.1136619

Cited by 11 publications

(12 citation statements)

References 32 publications

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“…as 'simple' medical problems complicated by social and psychological issues, 13 by suggesting that multimorbid patients differ and that some of them live relatively unproblematic with their diseases 7 or by suggesting a functional rather than a solely disease-centred approach to accommodate the complexities met by GPs among these patients. 20,21 Such considerations correspond with the present study, which finds that 'multimorbidity' is not a category used in the daily practice of the GPs. Rather, the GPs' approach is based on individual patients' functional ability associated with their needs and wishes for everyday life before the number, combination or clinical severity of their conditions.…”

Section: Discussionsupporting

confidence: 89%

General practitioners’ considerations of and experiences with multimorbidity patients: A qualitative study

Ørtenblad¹,

Nissen²

2019

International Journal of Care Coordination

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Introduction General practitioners’ management of multimorbid patients is mostly described as a burden, although it is also indicated that fundamental characteristics of general practice are well-suited to accommodate appropriate management of multimorbidity. However, little is known about actual practices among general practitioners. This study explores general practitioners’ management of their multimorbid patients. Methods A qualitative methodological design using participant observation and interviews. Interpretive description was used as the analytical framework. The study took place in a provincial town in Denmark. Three general practices with a total of 12 general practitioners participated. Results ‘Multimorbidity’ as general terminology does not reflect the practice of the general practitioners. Their approach is based on the functional capacity of individual patients. The heterogeneity of the group was classified into three categories determining the general practitioners’ approach: the well-functioning patients, the surprising patients and the fragile patients. Three core characteristics were identified as pivotal for the general practitioners’ approach: holistic view of the patient’s situation, patient-centred focus and coordinator and facilitator. These are fundamental characteristics of general practice, but become especially significant because they accommodate the complexity and heterogeneity of multimorbid patients. Discussion This study expands the subject field by exploring the general practitioners’ actual practices, thereby providing new perspectives into features that support appropriate management of multimorbid patients. General practitioners balance administrative and clinical regulations in their considerations of accommodating the heterogeneity and complexity of multimorbid patients. This suggests that better possibilities must be provided to realize the fundamental characteristics of general practice to support their management of multimorbid patients.

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Section: Discussionsupporting

confidence: 89%

General practitioners’ considerations of and experiences with multimorbidity patients: A qualitative study

Ørtenblad¹,

Nissen²

2019

International Journal of Care Coordination

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“…1 This situation is usually a consequence of multimorbidity, which is defined as the presence of 3 or more chronic diseases in an individual. 2,3 Rheumatoid arthritis (RA) is an autoimmune, chronic, systemic disease with preferential involvement in the third to fifth decade of life. Typically, it presents with articular manifestations that can progress to deformities and functional limitation, if not properly treated.…”

Section: Introductionmentioning

confidence: 99%

“…1 This situation is usually a consequence of multimorbidity, which is defined as the presence of 3 or more chronic diseases in an individual. 2,3…”

Section: Introductionmentioning

confidence: 99%

High Levels of Polypharmacy in Rheumatoid Arthritis—A Challenge Not Covered by Current Management Recommendations: Data From a Large Real-Life Study

Gomides

Albuquerque

Santos

et al. 2019

Journal of Pharmacy Practice

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Background: Rheumatoid arthritis (RA) is associated with high frequency of comorbidities and increased risk of polypharmacy. Although there is a great potential for complications, there is a gap in literature on polypharmacy in patients with rheumatic arthritis. Objective: To evaluate the prevalence and factors associated with polypharmacy in a population in a real-life setting. Methods: A cross-sectional multicenter study was conducted in Brazil. Patients underwent clinical evaluation and medical records analysis. Polypharmacy was considered as a dependent variable. To test independent variables, we used Poisson regression. Results: We evaluated 792 patients (89% female, median age 56.6 years). Median duration of disease was 12.7 years, 78.73% had a positive rheumatoid factor. The median of disease activity score-28 was 3.5 (disease with mild activity), median of the clinical disease activity index score was 9, and median of health assessment questionnaire-disability index was 0.875; 47% used corticosteroids, 9.1% used nonsteroidal anti-inflammatory drugs, 90.9% used synthetic disease-modifying antirheumatic drugs, 35.7% used biologic disease-modifying antirheumatic drugs (DMARDs). In total, 537 (67.9%) patients used 5 or more drugs. Polypharmacy showed a relationship with a number of comorbidities and use of specific drugs (corticosteroids, methotrexate, and biological DMARDs). Conclusion: We found a high prevalence of polypharmacy (67.9%) in RA. Solutions to management this problem should be stimulated.

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“…In 2012, the EGPRN presented a comprehensive definition of multimorbidity in family medicine and long-term care. (16) It was the first attempt to define multimorbidity which benefited from the FP's pragmatic point of view (17) . According to the EGPRN, multimorbidity is defined as « any combination of chronic disease with at least one other disease (acute or chronic) or psychosocial factor (associated or not) or somatic risk factor, any bio-psychosocial factor, any somatic risk factor, the social network, the burden of diseases, the health care consumption and the patient's coping strategies may function as modifiers (of the effects of Multimorbidity).…”

Section: Introductionmentioning

confidence: 99%

A high number of diseases and consultations: a warning signal for GPs when following up a multimorbid patient

Aujoulat

NABBE

Lalande

et al. 2019

Preprint

Self Cite

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Background: the European General Practitioners Research Network (EGPRN) designed and validated a comprehensive definition of multimorbidity using a systematic literature review and qualitative research throughout Europe. Detecting risk factors for decompensation would be an interesting challenge for family physicians (FPs) in the management of multimorbid patients. The purpose of the survey was to assess which items belonging to the EGPRN multimorbidity definition could help to identify patients at risk of decompensation in a cohort pilot study over a 24-month follow-up among primary care outpatients. Method : 131 patients meeting the multimorbidity definition were included using two inclusion periods between 2014 and 2015. Over a 24-month follow-up, the « decompensation » or « nothing to report » status was collected. A logistic regression, following a Cox model, was then performed to identify risk factors for decompensation. Results : After 24 months of follow-up, 120 patients were analyzed. 3 clusters were identified. 44 patients, representing 36.6 % of the population, were still alive and had not been hospitalized for a period exceeding 6 days. Two variables were significantly linked to decompensation: the number of visits to the FP per year (HR 1.06, IC 95 %, 1,03-1,10, p-value <0,001) and the total number of diseases (HR 1,12, IC 95 %, 1,013-1,33, p-value = 0,039). Conclusion: FPs should be aware that a high number of consultations and a high total number of diseases are linked to severe outcomes such as death or unplanned hospitalization. A large-scale cohort in primary care seems feasible to confirm these results.

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How do general practitioners recognize the definition of multimorbidity? A European qualitative study

Cited by 11 publications

References 32 publications

General practitioners’ considerations of and experiences with multimorbidity patients: A qualitative study

General practitioners’ considerations of and experiences with multimorbidity patients: A qualitative study

High Levels of Polypharmacy in Rheumatoid Arthritis—A Challenge Not Covered by Current Management Recommendations: Data From a Large Real-Life Study

A high number of diseases and consultations: a warning signal for GPs when following up a multimorbid patient

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