Managing multimorbidity needs time and thought

Sutherland, Imogen; Samadian, Samad

doi:10.1136/bmj.m711

Cited by 1 publication

(2 citation statements)

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“…With these results we are witnessing the progressive increase in the prevalence and weight of PCC in hospital, medical areas, and specifi cally in Internal Medicine. This epidemiological evolution should make us think about the importance of incorporating and strengthening the necessary competencies in the management of these populations [26][27][28]. Hospital doctors must be prepared for an optimal approach to preventing and treating geriatric syndromes, polypharmacy, family and social aspects, and prognostic stratifi cation that will allow them to off er the best care while avoiding deviations towards futility or nihilism [26][27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

“…This epidemiological evolution should make us think about the importance of incorporating and strengthening the necessary competencies in the management of these populations [26][27][28]. Hospital doctors must be prepared for an optimal approach to preventing and treating geriatric syndromes, polypharmacy, family and social aspects, and prognostic stratifi cation that will allow them to off er the best care while avoiding deviations towards futility or nihilism [26][27][28][29][30]. Most of today's doctors are trained in a 'hi-tech' culture of care, but we probably need to recover our atavistic roots and off er 'hi-touch' medicine as well.…”

Section: Discussionmentioning

confidence: 99%

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Characterization of Patients with Chronic Diseases and Complex Care Needs: A New High-Risk Emergent Population

M¹,

L²,

J³

et al. 2022

J Biomed Res Environ Sci

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Background: To analyze the prevalence and main epidemiological, clinical and outcome features of in-Patients with Complex Chronic conditions (PCC) in internal medicine areas, using a pragmatic working definition. Methods: Prospective study in 17 centers from Spain, with 97 in-hospital, monthly prevalence cuts. A PCC was considered when criteria of polypathological patient (two or more major chronic diseases) were met, or when a patient suffered one major chronic disease plus one or more of nine predefined complexity criteria like socio-familial risk, alcoholism or malnutrition among others (PCC without polypathology). A complete set of baseline features as well as 12-months survival were collected. Then, we compared clinical, outcome variables, and PROFUND index accuracy between polypathological patients and PCC without polypathology. Results: The global prevalence of PCC was 61% (40% of them were polypathological patients, and 21% PCC withouth polypathology) out of the 2178 evaluated patients. Their median age was 82 (59.5% men), suffered 2.3 ± 1.1 major diseases (heart diseases (70.5%), neurologic (41.5%), renal (36%), and lung diseases (26%)), 5.5 ± 2.5 other chronic conditions, met 2.5 ± 1.5 complexity criteria, and presented functional decline (Barthel index 55 (25-90)). Compared to polypathological patients, the subgroup of PCC without polypathology were younger, with a different pattern of major diseases and comorbidities, a better functional status, and lower 12-months mortality rates ((36.2% vs 46.8%; p = .003; OR 0.7(0.48-0.86). The PROFUND index obtained adequate calibration and discrimination power (AUC-ROC 0.67 (0.63-0.69)) in predicting 12-month mortality of PCC. Conclusion: Patients with complex chronic conditions are highly prevalent in internal medicine areas; their clinical pattern has changed in parallel to socio-epidemiological modifications, but their death-risk is still adequately predicted by PROFUND index.

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