Psychosocial complexity in multimorbidity: the legacy of adverse childhood experiences

Sinnott, Carol; Hugh, Sheena Mc; Fitzgerald, Anthony P.; Bradley, Colin; Kearney, Patricia M.

doi:10.1093/fampra/cmv016

Cited by 41 publications

(38 citation statements)

References 24 publications

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“…9 In primary care screening these higher scores can be expected with the inclusion of visits for chronic condition manage- ment, since it has been shown that the level of ACE scores are an independent predictor of multimorbidity. 17 The Kaiser population also included women who were 50% more likely to have high-risk ACEs, whereas our population showed no sex differences.…”

Section: Discussionmentioning

confidence: 71%

Screening for Adverse Childhood Experiences in a Family Medicine Setting: A Feasibility Study

Glowa

Olson

Johnson

2016

The Journal of the American Board of Family Medicine

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Introduction:The role of adverse childhood experiences (ACEs) in predicting later adverse adult health outcomes is being widely recognized by makers of public policy. ACE questionnaires have the potential to identify in clinical practice unaddressed key social issues that can influence current health risks, morbidity, and early mortality. This study seeks to explore the feasibility of implementing the ACE screening of adults during routine family medicine office visits.Methods: At 3 rural clinical practices, the 10-question ACE screen was used before visits with 111 consecutive patients of 7 clinicians. Clinician surveys about the use of the results and the effect on the visits were completed immediately after the visits. The presence of any ACE risk and "high-risk" ACE scores (>4) were compared with clinician survey responses.Results: A risk of ACEs was present in 62% of patients; 22% had scores >4. Clinicians were more likely to have discussed ACE issues for high-risk patients (score 0 -3, 36.8%; score >4, 83.3%; P ‫.؍‬ 00). Clinicians also perceived that they gained new information (score 0 -3, 35.6%; score >4, 83.3%; P ‫؍‬ .00). Clinical care changed for a small proportion of high-risk patients, with no change in immediate referrals or plan for follow-up. In 91% of visits where a risk of ACEs was present, visit length increased by <5 minutes.

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Section: Discussionmentioning

confidence: 71%

Screening for Adverse Childhood Experiences in a Family Medicine Setting: A Feasibility Study

Glowa

Olson

Johnson

2016

The Journal of the American Board of Family Medicine

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“…To calculate the sample size for a prevalence study, the expected prevalence is required. Based on previous research,6 7 14 19 the expected prevalence of MM in a population of people with CP is approximately between 22% and 54%. Nicholl20 notes that if there is a doubt about the prevalence total in a given population, researchers should err towards assuming a 50% prevalence rate as it will yield a larger sample size.…”

Section: Methodsmentioning

confidence: 99%

“…19 26 27 To ensure that the list of conditions met international best practice recommendations,21 23 in terms of which conditions to include in an MM disease count list, we then combined our study with one international study that examined MM in people living with CP 5. We also examined two of the most recent systematic reviews, which outline the most common conditions included in MM studies and contain recommendations for the type of conditions to be included in MM checklists 10…”

Section: Methodsmentioning

confidence: 99%

Prevalence, impact and cost of multimorbidity in a cohort of people with chronic pain in Ireland: a study protocol

et al. 2017

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IntroductionMultimorbidity (MM) refers to the coexistence of two or more chronic conditions within one person, where no one condition is considered primary. As populations age and healthcare provision improves, MM is becoming increasingly common and poses a challenge to the single morbidity approach to illness management, usually adopted by healthcare systems. Indeed, recent research has shown that 66.2% of the people in primary care in Ireland are living with MM. Healthcare usage and cost is significantly associated with MM, and additional chronic conditions lead to exponential increases in service usage and financial costs, and decreases in physical and mental well-being. Certain conditions, for example, chronic pain, are highly correlated with MM. This study aims to assess the extent, profile, impact and cost of MM among Irish adults with chronic pain.Methods and analysisUsing cluster sampling, participants aged 18 years and over will be recruited from Irish pain clinics and provided an information package and questionnaire asking them to participate in our study at three time points, 1 year apart. The questionnaire will include our specially developed checklist to assess the prevalence and impact of MM, along with validated measures of quality of life, pain, depression and anxiety, and illness perception. Economic data will also be collected, including direct and indirect costs.Ethics and disseminationEthical approval has been granted by the Research Ethics Committee of the National University of Ireland, Galway. Dissemination of results will be via journal articles and conference presentations.

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“…In an effort to improve healthcare quality and decrease costs, “super-utilizers” –patients with multiple chronic conditions and frequent hospital visits—have been identified as a population whose care is particularly costly and fragmented (Gawande 2011; Hasselmann 2013). The Centers for Medicare and Medicaid funded complex care management (CCM) demonstration projects, interdisciplinary teams of health care providers integrated into primary care who work to improve outcomes and reduce expenditures for “super utilizers.” CCM programs draw on the growing body of research that shows trauma and chronic stress are strongly associated with poor physical and mental health, as well as with social and structural barriers to accessing care (Felitti MD et al 1998; Lee, Tsenkova, and Carr 2014; Sinnott et al 2015). More recent research shows extremely high rates of trauma among CCM patients (Haas 2014; Hong, Siegel, and Ferris 2014).…”

Section: Introductionmentioning

confidence: 99%

“…Diagnosis with multiple chronic illnesses (multimorbidity) in adulthood is associated with a history of Adverse Childhood Experiences (ACEs) such as abuse and parental incarceration (Sinnott et al 2015), and multimorbidity is universal among CCM patients. ACEs are now a widely-used approach to measuring individual experiences of stress and trauma in childhood.…”

Section: Introductionmentioning

confidence: 99%

Defining trauma in complex care management: Safety-net providers' perspectives on structural vulnerability and time

Thompson-Lastad

Yen

Fleming

et al. 2017

Social Science & Medicine

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In this paper, we delineate how staff of two complex care management (CCM) programs in urban safety net hospitals in the United States understand trauma. We seek to (1) describe how staff in CCM programs talk about trauma in their patients’ lives; (2) discuss how trauma concepts allow staff to understand patients’ symptoms, health-related behaviors, and responses to care as results of structural conditions; and (3) delineate the mismatch between long-term needs of patients with histories of trauma and the short-term interventions that CCM programs provide. Observation and interview data gathered between February 2015 and August 2016 indicate that CCM providers define trauma expansively to include individual experiences of violence such as childhood abuse and neglect or recent assault, traumatization in the course of accessing health care and structural violence. Though CCM staff implement elements of trauma-informed care, the short-term design of CCM programs puts pressure on the staff to titrate their efforts, moving patients towards graduation or discharge. Trauma concepts enable clinicians to name structural violence in clinically legitimate language. As such, trauma-informed care and structural competency approaches can complement each other.

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Psychosocial complexity in multimorbidity: the legacy of adverse childhood experiences

Abstract: Multimorbidity is independently associated with a history of ACEs. These findings demonstrate the psychosocial complexity associated with multimorbidity and should be used to inform health care provision in this patient cohort.

Cited by 41 publications

References 24 publications

Screening for Adverse Childhood Experiences in a Family Medicine Setting: A Feasibility Study

Screening for Adverse Childhood Experiences in a Family Medicine Setting: A Feasibility Study

Prevalence, impact and cost of multimorbidity in a cohort of people with chronic pain in Ireland: a study protocol

Defining trauma in complex care management: Safety-net providers' perspectives on structural vulnerability and time

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