Training Doctors to Manage Patients with Multimorbidity: A Systematic Review

Lewis, Cliona; Wallace, Emma; Kyne, Lorraine; Cullen, William R.; Smith, Susan M.

doi:10.15256/joc.2016.6.87

Cited by 41 publications

(40 citation statements)

References 41 publications

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“…Reliable and up-to-date analyses are necessary to guide health policy, physicians and medical guideline development. Furthermore, the authors of care models focusing on patients with multimorbidity give indications of how to use disease models or principles in daily practice, but the training of doctors in the management of patients with multimorbidity seems to be hardly evaluated [34]. The current evidence of interventions developed for the care of people with multimorbidity and polypharmacy is ambiguous [35–37].…”

Section: Discussionmentioning

confidence: 99%

Trends in multimorbidity and polypharmacy in the Flemish-Belgian population between 2000 and 2015

et al. 2019

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Objectives The aim of this paper was to describe the time trends in the prevalence of multimorbidity and polypharmacy in Flanders (Belgium) between 2000 and 2015, while controlling for age and sex. Methods Data were available from Intego, a Flemish-Belgian general practice-based morbidity registration network. The practice population between 2000 and 2015 was used as the denominator, representing a mean of 159,946 people per year. Age and gender-standardised prevalence rates were used for the trends of multimorbidity and polypharmacy in the total population and for subgroups. Joinpoint regression analyses were used to analyse the time trends and breaks in trends, for the entire population as well as for specific age and sex groups. Results Overall, in 2015, 22.7% of the population had multimorbidity, while the overall prevalence of polypharmacy was 20%. Throughout the study period the standardised prevalence rate of multimorbidity rose for both sexes and in all age groups. The largest relative increase in multimorbidity was observed in the younger age groups (up to the age of 50 years). The prevalence of polypharmacy showed a significant increase between 2000 and 2015 for all age groups except the youngest (0–25 years). Conclusion For all adult age groups multimorbidity and polypharmacy are frequent, dynamic over time and increasing. This asks for both epidemiological and interventional studies to improve the management of the resulting complex care.

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Section: Discussionmentioning

confidence: 99%

Trends in multimorbidity and polypharmacy in the Flemish-Belgian population between 2000 and 2015

et al. 2019

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“…The educational emphasis of health-care professionals should incorporate longitudinal clerkship that helps students to acquire a broad understanding of the emerging challenges of long-term multimorbidity conditions presented by aging adults 53 . For example, skills for handling multiple diseases should be developed through the gradual integration of general clinical reasoning within the patients’ undivided physical-mental needs 54,55 .…”

Section: Discussionmentioning

confidence: 99%

Multilevel Analysis of the Patterns of Physical-Mental Multimorbidity in General Population of São Paulo Metropolitan Area, Brazil

Wang

Nunes

Coêlho

et al. 2019

Sci Rep

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Chronic diseases are often comorbid and present a weighty burden for communities in the 21st century. The present investigation depicted patterns of multimorbidity in the general population and examined its association with the individual- and area-level factors in an urban sample of non-elderly adults of Brazil. Data were from the cross-sectional São Paulo Megacity Mental Health Survey, a stratified multistage area probability sampling investigation. Trained interviewers assessed mental morbidities and asked about physical conditions for 1,571 community-dwelling women and 1,142 men, aged between 18 and 64 years. Principal component analysis depicted patterns of physical-mental multimorbidity, by sex. Following, the patterns of multimorbidity were subjected to multilevel regression analysis, taking into account individual- and area-level variables. Three patterns of clustering were found for women: ‘irritable mood and headache’, ‘chronic diseases and pain’, and ‘substance use disorders’. Among men, the patterns were: ‘chronic pain and respiratory disease’, ‘psychiatric disorders’, and ‘chronic diseases’. Multilevel analyses showed associations between multimorbidity patterns and both individual- and area-level determinants. Our findings call for a reformulation of health-care systems worldwide, especially in low-resource countries. Replacing the single-disease framework by multi-disease patterns in health-care settings can improve the ability of general practitioners in the health-care of person-centred needs.

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“…More commonly, however, GPs expressed a need for more training and education in how to manage multimorbidity. Although this may be one of the easier multimorbidity challenges to address, the question of how to adequately provide such training to general practitioners remains unresolved [143].…”

Section: Solutions From Gpsmentioning

confidence: 99%

General practitioner strategies for managing patients with multimorbidity: a systematic review and thematic synthesis of qualitative research

2020

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Background: General practitioners (GPs) increasingly manage patients with multimorbidity but report challenges in doing so. Patients describe poor experiences with health care systems that treat each of their health conditions separately, resulting in fragmented, uncoordinated care. For GPs to provide the patient-centred, coordinated care patients need and want, research agendas and health system structures and policies will need to adapt to address this epidemiologic transition. This systematic review seeks to understand if and how multimorbidity impacts on the work of GPs, the strategies they employ to manage challenges, and what they believe still needs addressing to ensure quality patient care. Methods: Systematic review and thematic synthesis of qualitative studies reporting GP experiences of managing patients with multimorbidity. The search included nine major databases, grey literature sources, Google and Google Scholar, a hand search of Journal of Comorbidity, and the reference lists of included studies. Results: Thirty-three studies from fourteen countries were included. Three major challenges were identified: practising without supportive evidence; working within a fragmented health care system whose policies and structures remain organised around single condition care and specialisation; and the clinical uncertainty associated with multimorbidity complexity and general practitioner perceptions of decisional risk. GPs revealed three approaches to mitigating these challenges: prioritising patient-centredness and relational continuity; relying on knowledge of patient preferences and unique circumstances to individualise care; and structuring the consultation to create a sense of time and minimise patient risk.

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Training Doctors to Manage Patients with Multimorbidity: A Systematic Review

Cited by 41 publications

References 41 publications

Trends in multimorbidity and polypharmacy in the Flemish-Belgian population between 2000 and 2015

Trends in multimorbidity and polypharmacy in the Flemish-Belgian population between 2000 and 2015

Multilevel Analysis of the Patterns of Physical-Mental Multimorbidity in General Population of São Paulo Metropolitan Area, Brazil

General practitioner strategies for managing patients with multimorbidity: a systematic review and thematic synthesis of qualitative research

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