A complex intervention for multimorbidity in primary care: A feasibility study

Abstract

Aim: To assess the feasibility of a patient-centered complex intervention for multimorbidity (CIM) based on general practice in collaboration with community health-care centers and outpatient clinics. Methods: Inclusion criteria were age ≥18 years, diagnoses of two or more of three chronic conditions (diabetes, chronic obstructive pulmonary disease (COPD), and chronic heart conditions), and a hospital contact during the previous year. The CIM included extended consultations and nurse care manager support in general practice and intensified cross-sectorial collaboration. Elements included a structured care plan based on patients’ care goals, coordination of services, and, if appropriate, shifting outpatient clinic visits to general practice, medication review, referral to rehabilitation, and home care. The acceptability dimension of feasibility was assessed with validated questionnaires, observations, and focus groups. Results: Forty-eight patients were included (mean age 72.2 (standard deviation (SD) 9.5, range 52–89); 23 (48%) were men. Thirty-seven patients had two diseases; most commonly COPD and cardiovascular disease (46%), followed by diabetes and cardiovascular disease (23%), and COPD and diabetes (15%). Eleven (23%) patients had all three conditions. Focus group interviews with patients with multimorbidity identified three main themes: (1) lack of care coordination existed across health-care sectors before the CIM, (2) extended consultations provided better care coordination, and (3) patients want to be involved in planning their treatment and care. In focus groups, health-care professionals discussed two main themes: (1) patient-centered care and (2) culture and organizational change. Completion rates for questionnaires were 98% (47/48). Conclusions: Patients and health-care professionals found the CIM acceptable.

The Prevalence of Polypharmacy and Potentially Inappropriate Medications and Its Relationship with Cognitive Status in Portuguese Institutionalized Older Adults: A Cross-Sectional Study

“…The number of consumed drugs per day is different among nursing home residents across countries. Different physicians’ attitudes when prescribing treatments for complex patients may explain such differences [ 37 , 38 ]. On average, the number of daily medications described in this study accorded with the SHELTER project data obtained across 57 institutions from eight different European countries (7.0 ± 3.6, average (SD)) [ 33 ].…”

Intersectoral communication amongst healthcare providers regarding care plans: a scoping review

“…The importance of relationships across sectors Sources reviewed featured a variety of intersectoral communication relationships and pathways. Twelve sources examined communication from health to community sectors 25 , 31 – 33 , 36 , 37 , 39 , 41 , 43 , 49 , 51 , 52 and four investigated the opposite direction of communication; community programs communicating to the health sector. 26 , 27 , 46 , 48 Five sources included communication between health and social sectors, 26 , 28 , 30 , 38 , 47 and another four explored interactions between health sectors (primary, secondary, tertiary), 38 , 40 , 47 , 50 other pathways included primary care to pharmacy 45 , 47 and informal care providers.…”

Agenda navigation in consultations covering multiple topics. A qualitative case study from general practice

“…Interventions targeted at patients with multimorbidity often offer more time and explicitly encourage the inclusion of all the patient’s health problems, but a consultation strategy is usually not specified (e.g. [ 35 , 36 ]). Our study adds the skills of opening and closing individual topics by speech acts to a consultation process suitable for the handling of several health problems.…”