Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus

Muth, Christiane; Blom, Jeanet W.; Smith, Susan M; Johnell, Kristina; González‐González, Ana Isabel; Nguyen, Truc Sophia; Brueckle, Maria-Sophie; Cesari, Matteo; Tinetti, Mary E.; Valderas, José M

doi:10.1111/joim.12842

Cited by 209 publications

(187 citation statements)

References 57 publications

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“…These results are consistent with the literature, which emphasizes that patients with multiple chronic diseases face a heavier burden than the general population . Clinicians also believe that the complexity associated with this burden makes it difficult to manage the patients' condition because it requires higher levels of care and services (ie, higher intensity of care in terms of financial and professional resources) compared to the general population …”

Section: Discussionsupporting

confidence: 90%

“…20 Clinicians also believe that the complexity associated with this burden makes it difficult to manage the patients' condition because it requires higher levels of care and services (ie, higher intensity of care in terms of financial and professional resources) compared to the general population. 21,22 Another factor that has an impact on the burden of disease is the number of decisions to be made, several times per week or month.…”

Section: Discussionmentioning

confidence: 99%

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Decisional needs assessment of patients with complex care needs in primary care

Poitras

Hudon

Godbout

et al. 2019

Evaluation Clinical Practice

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Rationale Patients with complex care needs who frequently use health services often face challenges in managing their health and with integrated care, leading to frequent decision making. These complex care needs require a good understanding of health issues and their impact on daily life. As the decisional needs of this particular clientele have yet to be described in scientific literature, they warrant further study. Objectives To assess the decision‐making needs of patients with complex care needs (PCCN) who frequently use health care services. Methods We performed a multicenter cross‐sectional qualitative descriptive study in four institutions of the health and social services network of Quebec (Canada). We enrolled a convenience sample of PCCNs who frequently use health care services, health care providers, case managers, and decision‐makers. We conducted interviews and focus groups and investigated decisional needs according to the Ottawa decision support framework: roles played and desired in the decision‐making process, facilitators, and barriers. We conducted qualitative data collection and qualitative deductive/inductive thematic analysis within and across participating groups. Results In total, 16 patients, 38 clinicians, six case managers, and 14 decision‐makers participated in the study. The decisional needs of this clientele are numerous, varied and different from those of the general population. We identified 26 decisional needs grouped under five themes. The most frequent decisions related to visiting the emergency department, moving to a nursing home, and adhering to a plan or treatment. In addition, we identified new themes such as patients' fear and mistrust of health professionals, differences of opinion between health professionals and health professionals' preconceived opinions of patients. Conclusion We observed a wide range of types of decisions that patients face and differences in decision‐making needs across participating groups. Our results should inform future research on the development of a patient decision aid tool.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Decisional needs assessment of patients with complex care needs in primary care

Poitras

Hudon

Godbout

et al. 2019

Evaluation Clinical Practice

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“…It is therefore essential to continue developing evidence-based guidelines (e.g. Muth et al [24,25]) to design care pathways that are sensitive to the needs of multimorbid patients. These guidelines should also be developed in a simplified format to help patients and lay persons comprehend them, particularly the elements that require specific action from the patients themselves, for example lifestyle changes (nutrition, physical activity, etc.).…”

Section: Disease-specific Models and Guidelines In Populations With Amentioning

confidence: 99%

Integrated care for the management of ageing-related non-communicable diseases: current gaps and future directions

Monaco

Palmer²,

Marengoni

et al. 2020

Aging Clin Exp Res

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Due to the increase in the older population in Europe and associated rise in the absolute number of persons with Non-Communicable Diseases (NCDs), it is becoming increasingly important to find ways to promote healthy ageing, which is defined as the process of developing and maintaining the functional ability that enables well-being in older age. Older persons with NCDs can have complex care needs due to the increased risk of frailty, multimorbidity, and polypharmacy. However, current health systems in Europe often provide fragmented care for older people with NCDs; many receive disjointed care from numerous specialists or via different levels of care. In the current article, we discuss barriers and challenges in implementing integrated care models in European settings for older NCD patients. Specifically, we discuss the need for greater use of case managers in the care and treatment persons with complex care needs as well as the lack of training and education in healthcare professionals on topics related to multimorbidity, frailty, and polypharmacy. We discuss the limitations that arise from the current focus on disease-specific guidelines and care models that do not take comorbid conditions into account, and the lack of good quality evidence that evaluates the effectiveness of integrated care interventions, especially in European health settings. We highlight the importance of evaluating and monitoring mental health in conjunction with somatic symptoms in NCD patients and discuss the integral role of information and communication technology in healthcare to streamline integrated care processes and help to achieve better outcomes for patients.

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“…Response to chronic conditions is frequently complicated by multimorbidity, the simultaneous presence of multiple health conditions in an individual [2][3][4][5]. Multimorbidity challenges usual care delivery, which is frequently structured around pathways of care for single diseases [6][7][8][9][10]. Key principles have been proposed for the design of high-performing health systems that meet the complex needs of people with multimorbidity, ranging from patient and caregiver engagement, to information systems, alignment of funding and incentives [11,12].…”

Section: Introductionmentioning

confidence: 99%

Quality of care assessment for people with multimorbidity

et al. 2019

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Multimorbidity, the simultaneous presence of multiple health conditions in an individual, is an increasingly common phenomenon globally. The systematic assessment of the quality of care delivered to people with multimorbidity will be key to informing the organization of services for meeting their complex needs. Yet, current assessments tend to focus on single conditions and do not capture the complex processes that are required for providing care for people with multimorbidity. We conducted a scoping review on quality of care and multimorbidity in selected databases in June 2018 and identified 87 documents as eligible for review, predominantly original research and reviews from North America, Europe and Australasia and mostly frequently related to primary care settings. We synthesized data qualitatively in terms of perceived challenges, evidence and proposed metrics. Findings reveal that the association between quality of care and multimorbidity is complex and depends on the conditions involved (quality appears to be higher for those with concordant conditions, and lower in the presence of discordant conditions) and the approach used for measuring quality (quality appears to be higher in people with multimorbidity when measured using condition/drug‐specific process or intermediate outcome indicators, and worse when using patient‐centred reports of experiences of care). People with discordant multimorbidity may be disadvantaged by current approaches to quality assessment, particularly when they are linked to financial incentives. A better understanding of models of care that best meet the needs of this group is needed for developing appropriate quality assessment frameworks. Capturing patient preferences and values and incorporate patients’ voices in the form of patient‐reported experiences and outcomes of care will be critical towards the achievement of high‐performing health systems that are responsive to the needs of people with multimorbidity.

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Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus

Cited by 209 publications

References 57 publications

Decisional needs assessment of patients with complex care needs in primary care

Decisional needs assessment of patients with complex care needs in primary care

Integrated care for the management of ageing-related non-communicable diseases: current gaps and future directions

Quality of care assessment for people with multimorbidity

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