Multimorbidity: What Do We Know? What Should We Do?

Navickas, Rokas; Petric, Vesna-Kerstin; Feigl, Andrea B; Seychell, Martin

doi:10.15256/joc.2016.6.72

Cited by 221 publications

(239 citation statements)

References 24 publications

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“…Using Q-methodology, we identified three viewpoints held by patients with multi-morbidity on the important aspects of PCC delivery in the primary care setting, representing [1] the prepared proactive patient, [2] the everyday patient, and [3] the vulnerable patient. The results of this study are important for improving care delivery for patients with multi-morbidity in primary care.…”

Section: Resultsmentioning

confidence: 99%

“…We define multi-morbidity as the co-existence of two or more chronic conditions in one patient. Patients with multi-morbidity are often considered to constitute a vulnerable and complex population with a high risk of mortality and high utilization of care, and they often are less satisfied with their care [3,4]. Moreover, a systematic review showed that quality of life decreases with an increasing number of diseases [5].…”

Section: Introductionmentioning

confidence: 99%

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Views of patients with multi-morbidity on what is important for patient-centered care in the primary care setting

2020

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Background: Patient-centered care (PCC) has been proposed as the way forward in improving primary care for patients with multi-morbidity. However, it is not clear what PCC exactly looks like in practice for patients with multimorbidity. A better understanding of multi-morbid patients' views on what PCC should look like and which elements are most important may help to improve care delivery for this vulnerable population. The present study thus aimed to identify views of patients with multi-morbidity on the relative importance of PCC aspects in a Dutch primary care setting. Methods: Interviews were conducted with 16 patients with multi-morbidity using Q-methodology, which combines quantitative and qualitative analyses. The participants ranked 28 statements about the eight dimensions of PCC (patients' preferences, information and education, access to care, emotional support, family and friends, continuity and transition, physical comfort, and coordination of care) by relative importance. By-person factor analysis using centroid factor extraction and varimax rotation were used to reveal factors that represent viewpoints. Qualitative interview data were used to interpret the viewpoints. Results: The analyses revealed three factors representing three distinct viewpoints of patients with multi-morbidity on what is important for patient-centered care in the primary care setting. Patients with viewpoint 1 are prepared proactive patients who seem to be well-off and want to be in charge of their own care. To do so, they seek medical information and prefer to be supported by a strongly coordinated multidisciplinary team of healthcare professionals. Patients with viewpoint 2 are everyday patients who visit GPs and require well-coordinated, respectful, and supportive care. Patients with viewpoint 3 are vulnerable patients who are less resourceful in terms of communication skills and finances, and thus require accessible care and professionals taking the lead while treating them with dignity and respect. Conclusion: The findings of this study suggest that not all patients with multi-morbidity require the same type of care delivery, and that not all aspects of PCC delivery are equally important to all patients.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Views of patients with multi-morbidity on what is important for patient-centered care in the primary care setting

2020

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“…Multimorbidity, the presence of multiple chronic conditions or diseases in the same individual [4,5,6], is becoming progressively more common [7]. Currently, an estimated 50 million people in the European Union suffer from multimorbidity [8], making it the most common chronic condition [5]. Also, in America, the number of people with chronic conditions is projected to increase steadily for the next 30 years [9].…”

Section: Introductionmentioning

confidence: 99%

The Knowledge, Awareness, and Practices of Portuguese General Practitioners Regarding Multimorbidity and its Management: Qualitative Perspectives from Open-Ended Questions

Prazeres

Santiago

2016

IJERPH

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Multimorbidity’s high prevalence and negative impact has made it a subject of worldwide interest. The main aim of this study was to access the Portuguese knowledge, awareness, and practices of general practitioners (GPs) regarding multimorbidity and its management, in order to aid in the development of interventions for improving outcomes in multimorbid patients in primary care. A web-based qualitative descriptive study was carried out in the first trimester of 2016 with primary care physicians working in two districts of the Centre region of Portugal. Open-ended questions were analysed via inductive thematic content analysis. GPs pointed out several difficulties and challenges while managing multimorbidity. Extrinsic factors were associated with the healthcare system logistics’ management (consultation time, organization of care teams, clinical information) and society (media pressure, social/family support). Intrinsic factors related to the GP, patient, and physician-patient relationship were also stated. The most significant conclusion to emerge from this study is that although GPs perceived difficulties and challenges towards multimorbidity, they also have the tools to deal with them: the fundamental characteristics of family medicine. Also, the complex care required by multimorbid patients needs adequate consultation time, multidisciplinary teamwork, and more education/training.

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“…Loneliness has been associated with frailty (Herrera‐Badilla, Navarrete‐Reyes, Amieva, & Avila‐Funes, ) and a fall in the previous year (Hajek & Konig, ). Hence, the co‐occurrence of these and other health problems is common (Navickas, Petric, Feigl, & Seychell, ; Onder et al, ).…”

Section: Introductonmentioning

confidence: 99%

A coordinated preventive care approach for healthy ageing in five European cities: A mixed methods study of process evaluation components

Franse

Zhang

Grieken

et al. 2019

Journal of Advanced Nursing

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Aims To evaluate specific process components of the Urban Health Centres Europe (UHCE) approach; a coordinated preventive care approach aimed at healthy ageing by decreasing falls, polypharmacy, loneliness and frailty among older persons in community settings of five cities in the United Kingdom, Greece, Croatia, the Netherlands and Spain. Design Mixed methods evaluation of specific process components of the UHCE approach: reach of the target population, dose of the intervention actually delivered and received by participants and satisfaction and experience of main stakeholders involved in the approach. Methods The UHCE approach intervention consisted of a preventive assessment, shared decision‐making on a care plan and enrolment in one or more of four coordinated care‐pathways that targeted falls, polypharmacy, loneliness and frailty. Quantitative data from a questionnaire and quantitative/qualitative data from logbooks were collected among older persons involved in the approach. Qualitative data from focus groups were collected among older persons, informal caregivers and professionals involved in the approach. Quantitative data were analysed by means of descriptive statistics and multilevel logistic regression models. Qualitative data were analysed through thematic analysis. Results Having limited function was associated with non‐enrolment in falls and loneliness care‐pathways (both p < .01). The mean rating of the approach was 8.3/10 (SD 1.9). Feeling supported by a care professional and meeting people were main benefits for older persons. Mistrust towards unfamiliar care providers, lack of confidence to engage in care activities and health constraints were main barriers towards engagement in care. Conclusions Although the UHCE approach was received generally positively, health constraints and psychosocial barriers prevented older person's engagement in care. Impact Coordinated preventive care approaches for older community‐dwelling persons should address health constraints and psychosocial barriers that hinder older person's engagement in care. Trial registration: ISRCTN registry number is ISRCTN52788952. Date of registration is 13/03/2017.

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Multimorbidity: What Do We Know? What Should We Do?

Cited by 221 publications

References 24 publications

Views of patients with multi-morbidity on what is important for patient-centered care in the primary care setting

Views of patients with multi-morbidity on what is important for patient-centered care in the primary care setting

The Knowledge, Awareness, and Practices of Portuguese General Practitioners Regarding Multimorbidity and its Management: Qualitative Perspectives from Open-Ended Questions

A coordinated preventive care approach for healthy ageing in five European cities: A mixed methods study of process evaluation components

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