Increase In Multimorbidity Research Articles

Research on the frailty status and adverse outcomes of elderly patients with multimorbidity

BackgroundAs patients age, the frailty of those with multimorbidity increases, often resulting in adverse health outcomes. The current study investigated the frailty status and the factors which influence it in elderly patients with multimorbidity in Chinese hospitals. The relationship between the frailty of patients with multimorbidity and adverse outcomes was explored.MethodsThe current prospective cohort study investigated inpatients in the internal medicine department of 5 tertiary hospitals in Sichuan Province, China. A total of 3836 elderly patients with multimorbidity were enrolled. Frailty was assessed using the FRAIL scale and adverse outcome events occurring during hospitalization were tracked. Descriptive statistics and logistic regressions were used for data analysis.ResultsThe prevalence of frailty was 27.2% and of pre-frailty, 58.9%. Logistic regression analysis showed that increasing age, low BMI, low education level, lack of exercise, multiple types of medications and multiple numbers of chronic diseases were the main risk factors for frailty in elderly patients with multimorbidity (OR values: 1.020, 1.469, 2.350, 2.836, 1.156 and 1.308, respectively). The incidence of adverse outcomes was 13.9% among the cohort with the most common being deep vein thrombosis (42.4%), followed by pressure injury (38.8%). Regression analysis showed a significant correlation of frailty with adverse outcome (OR: 1.496; p < 0.01).ConclusionsThe prevalence of frailty and pre-frailty in hospitalized elderly patients with multimorbidity was high. Increasing age, low BMI, low education level, lack of exercise, multiple types of medications and multiple numbers of chronic diseases were factors which influenced frailty and frailty was an important factor in the occurrence of adverse outcomes. The most common adverse outcome of elderly multimorbidity patients during hospitalization was deep vein thrombosis.

The contribution of advanced practice nurses in Swiss family practices: Multiple case study design

The contribution of advanced practice nurses in Swiss family practices: Multiple case study design Abstract. Background: The increase in chronic diseases, multimorbidity and shortage of health professionals make it essential to adapt primary health care. New models of care are needed which are oriented towards patient needs and thus ensure comprehensive care for chronically ill people. In this context, there is great potential for the use of advanced practice nurses in Swiss family practices. Aims: In this study we investigated the contribution of advanced practice nurses in the interprofessional context in two family practices. Methods: We conducted a multiple case study design. We investigated two advanced practice nurses, located in family practices in rural and in mountainous regions. We used qualitative and quantitative methods. As an intermediate step, within-case analyses were performed and we summarized data inductively to create case vignettes. Results: The cases showed that advanced practice nurses contribute to self-management, prevention and health promotion in complex, stable and unstable patients. These areas have not been covered adequately by other health professionals in family practices. They strengthened interface management through hybrid employment and flexible, addressee-appropriate communication. Conclusions: Similarities and differences between family practices with and without new professional roles should be elicited to specifically identify gaps in care for the chronically ill.

Effectiveness of the MULTIPAP Plus intervention in youngest-old patients with multimorbidity and polypharmacy aimed at improving prescribing practices in primary care: study protocol of a cluster randomized trial

BackgroundThe progressive ageing of the population is leading to an increase in multimorbidity and polypharmacy, which in turn may increase the risk of hospitalization and mortality. The enhancement of care with information and communications technology (ICT) can facilitate the use of prescription evaluation tools and support system for decision-making (DSS) with the potential of optimizing the healthcare delivery process.ObjectiveTo assess the effectiveness and cost-effectiveness of the complex intervention MULTIPAP Plus, compared to usual care, in improving prescriptions for young-old patients (65-74 years old) with multimorbidity and polypharmacy in primary care.Methods/designThis is a pragmatic cluster-randomized clinical trial with a follow-up of 18 months in health centres of the Spanish National Health System. Unit of randomization: family physician. Unit of analysis: patient.PopulationPatients aged 65–74 years with multimorbidity (≥ 3 chronic diseases) and polypharmacy (≥ 5 drugs) during the previous 3 months were included.Sample sizen = 1148 patients (574 per study arm).InterventionComplex intervention based on the ARIADNE principles with three components: (1) family physician (FP) training, (2) FP-patient interview, and (3) decision-making support system.OutcomesThe primary outcome is a composite endpoint of hospital admission or death during the observation period measured as a binary outcome, and the secondary outcomes are number of hospital admission, all-cause mortality, use of health services, quality of life (EQ-5D-5L), functionality (WHODAS), falls, hip fractures, prescriptions and adherence to treatment. Clinical and sociodemographic factors will be explanatory variables.Statistical analysisThe main result is the difference in percentages in the final composite endpoint variable at 18 months, with its corresponding 95% CI. Adjustments by the main confounding and prognostic factors will be performed through a multilevel analysis. All analyses will be carried out in accordance to the intention-to-treat principle.DiscussionIt is important to prevent the cascade of negative health and health care impacts attributable to the multimorbidity-polypharmacy binomial. ICT-enhanced routine clinical practice could improve the prescription process in patient care.Trial registrationClinicalTrials.gov NCT04147130. Registered on 22 October 2019

Relationships between Glycemic and Lipid Control and TSH in Euthyroid Latinx Adults- a Community-Based Study

ObjectivesThyroid hormone abnormalities are among the most common endocrine disorders comorbidly suffered alongside metabolic syndrome and type 2 diabetes mellitus (T2DM). Thyroid hormones and their regulating hormone, thyroid-stimulating hormone (TSH), play a role in metabolism, obesity, insulin resistance and other disorders that share similar mechanisms. The aim of this study was to examine the associations between TSH and clinical measures of chronic disease markers in a Latinx population receiving free health care services at a community clinic. MethodsA needs assessment was conducted on euthyroid Latinx adult patients from a community clinic in south Florida. The medical records of 93 randomly selected patients were cross-sectionally reviewed to collect data on demographics, diagnoses of health conditions, and biomedical laboratory information. The cut-off point for high TSH was ≥2 mU/L and low TSH as <2 mU/L. Statistical analyses included descriptive statistics, independent t-test, chi-squared test, logistic regressions. ResultsThe mean age was 51.9 ± 11.8 years and 82.8% were female. There were no differences between low and high TSH groups on age, gender, BMI, hypertension, T2DM, CVD, or CVD risk factors. The low TSH group had significantly higher fasting glucose (194.0 mg/dL ± 86.2 vs 140 mg/dL ± 52.8, P = 0.046), hemoglobin A1c (9.6% ±2.8 vs 7.5% ±1.5, P = 0.018), and total cholesterol (200.5 mg/dL ± 32.8 vs 171.5 mg/dL ± 39.7, P = 0.034) compared with the high TSH group. Subgroup analysis of those with T2DM revealed that the low TSH group also had a greater proportion of patients with high fasting glucose (≥170 mg/dL) and high hemoglobin A1c (≥8.5%) compared with the high TSH group. Similarly, those with a low TSH had 6 times greater odds of having high fasting glucose (OR 6.66, 95% CI 1.31–33.69, P = 0.022) and high hemoglobin A1c (OR 6.11, 95% CI 1.19–31.16, P = 0.029). ConclusionsIn Latinx euthyroid patients receiving medical services at a community clinic, a relationship between low-normal TSH levels, fasting glucose and hemoglobin A1c was demonstrated. As the population ages and the risk of both obesity and multimorbidity increases, understanding how thyroid hormone dysfunction can influence chronic disease status may help address health disparities suffered in disadvantaged and vulnerable populations. Funding SourcesFIU RCMI/NIMHD

Multimorbidity Treatment Burden Questionnaire (MTBQ): Translation, Cultural Adaptation, and Validation in French-Canadian.

Reliable treatment burden measures are needed given the aging population and the associated increase in multimorbidity and polypharmacy. Treatment burden is defined as the effort to care for one's health and the resulting impact on one's daily life. This study aimed to translate the Multimorbidity Treatment Burden Questionnaire (MTBQ) for French-Canadians and assess its reliability and validity. The MTBQ was translated and tested with cognitive debriefing interviews, and the French version (MTBQ-F) was then administered 2 times among 105 participants. Reliability and validity were examined using the intra-class correlation coefficient (ICC), Cronbach's alpha, and Spearman's correlations. The median global MTBQ-F scores were 32.69 (interquartile range [IQR]: 21.15-48.08) and 30.77 (IQR: 21.15-46.15) for the first and second administrations, respectively. Test-retest (ICC: 0.73; 95% CI: 0.63-0.81) and internal consistency reliability (Cronbach's alpha: 0.80) were good. There was a moderate positive correlation between the MTBQ-F score and the number of self-reported conditions (rho: 0.28). This valid instrument could identify patients experiencing a high treatment burden and assess the impact of interventions among them.

Elderly Patients’ Perspectives on the Acceptability of Deprescribing Medicines: A Qualitative Study Protocol

The ageing population has resulted in an increase in multimorbidity and polypharmacy, and subsequently the complexity of optimising elderly patients’ medicines. The need for deprescribing can arise from factors such as increased susceptibility to adverse effects of medicines in older age, due to functional and cognitive changes, which increases elderly people’s risk of harm. Previous questionnaire-survey-based research suggests that patients tend not to disagree with deprescribing, but qualitative research on patients’ perspectives on deprescribing appears sparse and focused on specific conditions, circumstances (e.g., terminal illness) or medicines. Further exploration of this area is therefore important for health professionals, and greater understanding in particular is needed about elderly patients’ perspectives on the acceptability of deprescribing and how best to conduct deprescribing consultations. This study aims to explore these issues, with an approach informed by the Theoretical Framework of Acceptability (TFA). Semi-structured, audio-recorded interviews will therefore be undertaken with a purposive sample of approximately 20 hospital in-patients who are ≥65years of age, prescribed at least one regular medicine and have multimorbidities and/or frailty. Two acute Trusts were identified through existing networks where patients will be identified by the ward pharmacist and recruited to the study by the researcher. Due to the nature of the discussion and the potential vulnerable nature of participants, a distress protocol has been created to support management of any distress or fatigue that may occur. The TFA has been used so far to develop the study objectives and interview guide topics. The interview guide has been structured into five broad topics, which will cover the constructs of the TFA. Interview recordings will be transcribed verbatim and analysed using the Framework Analysis technique, informed by the TFA.

Pharmacogenomics: Relevance and opportunities for clinical pharmacology

Pharmacogenomics: Relevance and opportunities for clinical pharmacology

Goal-oriented care for patients with chronic conditions or multimorbidity in primary care: A scoping review and concept analysis.

The healthcare system is faced by an ageing population, increase in chronic conditions and multimorbidity. Multimorbid patients are faced with multiple parallel care processes leading to a risk of fragmented care. These problems relate to the disease-oriented paradigm. In this paradigm the treatment goals can be in contrast with what patients value. The concept of goal-oriented care is proposed as an alternative way of providing care as meeting patients' goals could have potential benefits. Though, there is a need to translate this concept into tangible knowledge so providers can better understand and use the concept in clinical practice. The aim of this study is to address this need by means of a concept analysis. This concept analysis using the method of Walker and Avant is based on a literature search in PubMed, Embase, Cochrane Library, PsychInfo, CINAHL, OTSeeker and Web of Science. The method provides eight iterative steps: select a concept, determine purpose, determine defining attributes, identify model case, identify additional case, identify antecedents and consequences and define empirical referents. The analysis of 37 articles revealed that goal-oriented care is a dynamic and iterative process of three stages: goal-elicitation, goal-setting, and goal-evaluation. The process is underpinned by the patient's context and values. Provider and patient preparedness are required to provide goal-oriented care. Goal-oriented care has the potential to improve patients' experiences and providers' well-being, to reduce costs, and improve the overall population health. The challenge is to identify empirical referents to evaluate the process of goal-oriented care. A common understanding of goal-oriented care is presented. Further research should focus on how and what goals are set by the patient, how this knowledge could be translated into a tangible workflow and should support the development of a strategy to evaluate the goal-oriented process of care.

Adverse childhood experiences in depression and the mediating role of multimorbidity in mid-late life: A nationwide longitudinal study

BackgroundsAdverse childhood experiences are co-occurring factors of multimorbidity and depression in mid-late life, but the combined effect of ACEs and multimorbidity on depression over life has not been fully studied. MethodsWe used data from the China Health and Retirement Longitudinal Study which includes 4,440 middle-aged and older adults. Different types of ACEs experienced up to the age of 17 were assessed based on self-reports. We used parallel process Latent Growth Curve modelling to evaluate the longitudinal mediation role of ACEs, multimorbidity and depression. ResultsPeople who had more ACEs were found to have a higher level of multimorbidity (intercept: 0.057, 95% CI: 0.031 to 0.079) and depression (intercept: 0.047, 95% CI: 0.013 to 0.076) at the baseline and a faster increase in multimorbidity (slope: 0.107, 95%CI: 0.078 to 0.136) and depression (slope: 0.074, 95%CI: 0.035 to 0.153). The mediation analysis indicated that there was a positive indirect association of ACEs via the multimorbidity intercept with the intercept of depression (0.028, 95%CI: 0.012 to 0.043), and a small negative association with the slope of depression (-0.002, 95%CI: -0.003 to -0.001). We also found a positive indirect association of ACEs via the multimorbidity slope with the intercept (0.035, 95%CI: 0.021 to 0.049) and slope (0.008, 95%CI: 0.004 to 0.011) of depression. ConclusionsACEs were related to higher depression partly via elevated multimorbidity. Public health services and behavioural interventions to prevent and reduce the occurrence of ACEs might help to lower the risk of multimorbidity and depression in later life.

Different definitions of multimorbidity and their effect on prevalence rates: a retrospective study in German general practices.

Multimorbidity is common among general practice patients and increases a general practitioner's (GP's) workload. But the extent of multimorbidity may depend on its definition and whether a time delimiter is included in the definition or not. The aims of the study were (1) to compare practice prevalence rates yielded by different models of multimorbidity, (2) to determine how a time delimiter influences the prevalence rates and (3) to assess the effects of multimorbidity on the number of direct and indirect patient contacts as an indicator of doctors' workload. This retrospective observational study used electronic medical records from 142 German general practices, covering 13 years from 1994 to 2007. The four models of multimorbidity ranged from a simple definition, requiring only two diseases, to an advanced definition requiring at least three chronic conditions. We also included a time delimiter for the definition of multimorbidity. Descriptive statistics, such as means and correlation coefficients, were applied. The annual percentage of multimorbid primary care patients ranged between 84% (simple model) and 16% (advanced model) and between 74% and 13% if a time delimiter was included. Multimorbid patients had about twice as many contacts annually than the remainder. The number of contacts were different for each model, but the ratio remained similar. The number of contacts correlated moderately with patient age (r = 0.35). The correlation between age and multimorbidity increased from model to model up to 0.28 while the correlations between contacts and multimorbidity varied around 0.2 in all four models. Multimorbidity seems to be less prevalent in primary care practices than usually estimated if advanced definitions of multimorbidity and a temporal delimiter are applied. Although multimorbidity increases in any model a doctor's workload, it is especially the older person with multiple chronic diseases who is a challenge for the GP.

Changes in clinical indices of multimorbidity and frailty predict subsequent cognitive decline: Findings from the Look AHEAD and Look AHEAD MIND studies

AbstractBackgroundTwo common features of aging are increases in the number of chronic diseases and in the number of deficits in functional, behavioral, and clinical characteristics. Accordingly, indices of multimorbidity and deficit accumulation (i.e. frailty indices) have been promoted as clinical markers of biological aging. As such, it is to be expected that changes over time in these indices should be predictive of downstream changes in important functions, such as cognition.MethodWe examined associations that 8‐year changes in 1) a multimorbidity index comprised of 9 chronic diseases (e.g. CHD, cancer, depression) and 2) a frailty index (FI) based on deficit accumulation in 38 functional, behavioral, and clinical characteristics had with subsequent standardized measures of cognitive function over 10 years. We drew data from the Look AHEAD clinical trial of a multidomain intensive lifestyle intervention (ILI) in 3841 adults, aged 45‐76 years at baseline, who were at risk for accelerated biological aging due to overweight/obesity and type 2 diabetes mellitus, and who underwent cognitive assessment. The domains of memory, attention, and executive function were assessed with validated instruments and combined to form a composite cognitive measure.Result1501 (39%) of the cohort had increases of one and 867 (23%) had increases of &gt;2 chronic diseases. Older individuals, males, and non‐Hispanic Whites tended to be over‐represented among those with the greatest increase in multimorbidities. The 33%ile of the distribution of FI changes was ‐0.005 and the 67%ile was 0.048. Greater FI increases tended to occur among individuals who were older, non‐Hispanic White, heavier, and who had greater baseline multimorbidity. Changes in multimorbidity and FI were moderately correlated (r=0.25; p&lt;0.001). As seen in the attached table, greater increases in both multimorbidity and FI were associated with subsequently worse levels of executive function, attention, and composite cognitive function (p&lt;0.001). While assignment to ILI was associated with smaller increases in both indices of aging, this did not translate overall to better cognitive functioning.ConclusionAccelerated aging, as captured by these geroscience‐informed indices, predicts subsequent poorer cognitive function. However, whether interventions generally targeting multimorbidity and FI reduce risks for cognitive impairment remains to be seen.

Integrated primary care and social services for older adults with multimorbidity in England: a scoping review

BackgroundAs the prevalence of older adults with multimorbidity increases, greater integration of services is necessary to manage the physical and psycho-social needs of this cohort. This study describes and summarises current evidence, clinical provision and progress towards integrated primary care and social services for older adults with multimorbidity in England.MethodsA scoping review was conducted involving systematic searches of a range of electronic academic and policy databases. Articles were screened and extracted in duplicate by two independent reviewers. Data were extracted onto a charting sheet and thematic synthesis was used to summarise findings. Articles were included if published in English and related to primary care, social care and multimorbidity in older adults in England. Conceptually, the review was framed using the Rainbow Model of Integrated Care.ResultsThe search yielded 7656 articles of which 84 were included. Three themes were identified: (1) a focus on individual level services rather than multi-level or multi-sector integration, with an increasing emphasis on the need to consider broader determinants of population health as critical to integrated care for older adults with multimorbidity; (2) the need for policymakers to allow time for integration to embed, to enable new structures and relationships to develop and mature; and (3) the inherent tension between top-down and bottom-up driven approaches to integrated care requires a whole-systems structure, while allowing for local flexibilities.ConclusionsThere is limited evidence of multi-level and multi-sector integration of services for older adults with multimorbidity in England. The literature increasingly acknowledges wider determinants of population health that are likely to require integration beyond primary care and social services. Improving clinical care in one or two sectors may not be as effective as simultaneously improving the organisation or design across services as one single system of provision. This may take time to establish and will require local input.

Physical Activity as a Mediator Between Race/Ethnicity and Changes in Multimorbidity.

Studies report racial/ethnic disparities in multimorbidity (≥2 chronic conditions) and their rate of accumulation over time as well as differences in physical activity. Our study aimed to investigate whether racial/ethnic differences in the accumulation of multimorbidity were mediated by physical activity among middle-aged and older adults. We assessed racial/ethnic differences in the accumulation of multimorbidity (of 9 conditions) over 12 years (2004-2016) in the Health and Retirement Study (N = 18,264, mean age = 64.4 years). Structural equation modeling was used to estimate latent growth curve models of changes in multimorbidity and investigate whether the relationship of race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White participants) to changes in the number of chronic conditions was mediated by physical activity after controlling for age, sex, education, marital status, household wealth, insurance coverage, smoking, alcohol, and body weight. There was a significant increase in multimorbidity over time. Initial levels and changes in multimorbidity over time varied significantly across individuals. Indirect effects of the relationship between race/ethnicity and changes in multimorbidity as mediated by physical activity were significant, consistent with the mediational hypothesis. Black respondents engaged in significantly lower levels of physical activity than White respondents after controlling for covariates, but there were no differences between Hispanic and White respondents once education was included. Discussion: These results provide important new information for understanding how modifiable lifestyle factors may help explain disparities in multimorbidity in mid-to-late life, suggesting greater need to intervene to reduce sedentary behavior and increase physical activity.

Sex differences in multimorbidity and polypharmacy trends: A repeated cross-sectional study of older adults in Ontario, Canada.

Multimorbidity is increasing among older adults, but the impact of these recent trends on the extent and complexity of polypharmacy and possible variation by sex remains unknown. We examined sex differences in multimorbidity, polypharmacy (5+ medications) and hyper-polypharmacy (10+ medications) in 2003 vs 2016, and the interactive associations between age, multimorbidity level, and time on polypharmacy measures. We employed a repeated cross-sectional study design with linked health administrative databases for all persons aged ≥66 years eligible for health insurance in Ontario, Canada at the two index dates. Descriptive analyses and multivariable logistic regression models were conducted; models included interaction terms between age, multimorbidity level, and time period to estimate polypharmacy and hyper-polypharmacy probabilities, risk differences and risk ratios for 2016 vs 2003. Multimorbidity, polypharmacy and hyper-polypharmacy increased significantly over the 13 years. At both index dates prevalence estimates for all three were higher in women, but a greater absolute increase in polypharmacy over time was observed in men (6.6% [from 55.7% to 62.3%] vs 0.9% [64.2%-65.1%] for women) though absolute increases in multimorbidity were similar for men and women (6.9% [72.5%-79.4%] vs 6.2% [75.9%-82.1%], respectively). Model findings showed that polypharmacy decreased over time among women aged < 90 years (especially for younger ages and those with fewer conditions), whereas it increased among men at all ages and multimorbidity levels (with larger absolute increases typically at older ages and among those with 4 or fewer conditions). There are sex and age differences in the impact of increasing chronic disease burden on changes in measures of multiple medication use among older adults. Though the drivers and health consequences of these trends warrant further investigation, the findings support the heterogeneity and complexity in the evolving association between multimorbidity and polypharmacy measures in older populations.

26 Introducing the Sherpa Model for Managing Multi-Morbidity to Trainee GPS: Outcomes and Relevance to Elderly CareÂ

Abstract Background Primary care trainees are traditionally taught to use a consultation model which focuses on eliciting the patients’ main reason for consulting “today”. As the number of patients with multi-morbidity increases, this approach is often inappropriate or unhelpful. Patients can be left without an understanding of their interacting health issues. The SHERPA model provides a biopsychosocial framework for consulting patients with multi-morbidity. We aimed to examine the responses to this model when integrated into a training programme for newly registered GPs. Methods Sixteen participants provide qualitative data on their experience and follow-up use of SHERPA. Four hours of teaching were observed. Twenty-four feedback templates on training (n = 18) and SHERPA application (n = 6) were collected. Individual semi-structured one-to-one interviews were conducted with trainees (n = 5) and trainers (n = 3). Data were transcribed and, using the Framework approach, systematically analysed focussing on the trainees’ reaction to the teaching sessions and their ability to use the SHERPA consultation model. Results Participants engaged well with the teaching sessions, enjoying the scenarios and bringing observations from their own experience. Five participants went on to apply SHERPA successfully with their patients. Barriers to using this approach were: not seeing appropriate patients with multi-morbidities (due to current placement or patient type); time; lack of confidence and familiarity; concern about missing important immediate clinical issues; and viewing the approach as “in addition” rather than key to shared decision-making. Conclusion The SHERPA model was viewed as a helpful addition by trainee GPs, although practical issues, fears and not seeing it as their priority for their case-mix, limited their application of it. Regular support from trainers, where trainees reflect on their experience of using SHERPA, could increase their confidence and familiarity with this method. These findings suggest that SHERPA may be relevant to other specialities such as geriatric medicine, where multi-morbidity is common.

Temporal dynamics, patterns and correlates of single and multimorbidity in India, 1994-2018.

ObjectiveAs a consequence of the epidemiological transition, multimorbidity has been identified as a critical public health challenge in India. The majority of the studies in the domain are grounded on hospital-based data or are based on small sample size, findings from which can only be generalized to a specific sub-group. These studies recommend exploring multimorbidity holistically at a national level to ensure adequate healthcare management in the country. Therefore, the present study examines the pattern and correlates of single and multimorbidity over the past two decades in India.MethodsThe study utilized data on 397901, 257519, and 399705 individuals from 52nd (1994–1995), 60th (2004–2005), and 75th (2018) rounds of cross-sectional data from the National Sample Survey (NSS). Univariate, bivariate, and multivariable statistical methods were applied to draw inferences from the data. The findings depict an increase in single and multimorbidity burden over individuals’ age and NSS rounds.ResultsHypertension and diabetes were the fastest-growing morbidities over time. Higher education, urban residence, and belonging to an affluent class were significantly associated with both single and multimorbidity occurrence over time.ConclusionThe burden of single and multimorbidity increases over time among India’s older adults. Therefore, there is an urgent need to recuperate chronic disease management strategies for older adults in the Indian healthcare infrastructure.

Increases in multimorbidity with weight class in the United States.

Little is known regarding how multimorbidity combinations associated with obesity change with increase in body weight. This study employed data from the national Cerner HealthFacts Data Warehouse to identify changes in multimorbidity patterns by weight class using network analysis. Networks were generated for 154 528 middle-aged patients in the following categories: normal weight, overweight, and classes 1, 2, and 3 obesity. The results show significant differences (P-value<0.05) in prevalence by weight class for all but three of 82 diseases considered. The percentage of patients with multimorbidity (excluding obesity) increases from in 55.1% in patients with normal weight, to 57.88% with overweight, 70.39% with Class 1 obesity, 73.99% with Class 2 obesity, and 71.68% in Class 3 obesity, increasing most substantially with the progression from overweight to class 1 obesity. Most prevalent disease clusters expand from only hypertension and dorsalgia in normal weight, to add joint disorders in overweight, lipidemias in class 1 obesity, diabetes in class 2 obesity, and sleep disorders and chronic kidney disease in class 3 obesity. Recognition of multimorbidity patterns associated with weight increase is essential for true precision care of obesity-associated chronic conditions and can help clinicians identify and address preclinical disease before additional complications arise.

Childhood adversity and trajectories of multimorbidity in mid-late life: China health and longitudinal retirement study

BackgroundThe association between childhood adversity and an individual’s health in later life has been extensively studied in Western societies; however, little is known about this association for the development of...

The patient at the centre: evidence from 17 European integrated care programmes for persons with complex needs

BackgroundAs the prevalence of multi-morbidity increases in ageing societies, health and social care systems face the challenge of providing adequate care to persons with complex needs. Approaches that integrate care across sectors and disciplines have been increasingly developed and implemented in European countries in order to tackle this challenge. The aim of the article is to identify success factors and crucial elements in the process of integrated care delivery for persons with complex needs as seen from the practical perspective of the involved stakeholders (patients, professionals, informal caregivers, managers, initiators, payers).MethodsSeventeen integrated care programmes for persons with complex needs in 8 European countries were investigated using a qualitative approach, namely thick description, based on semi-structured interviews and document analysis. In total, 233 face-to-face interviews were conducted with stakeholders of the programmes between March and September 2016. Meta-analysis of the individual thick description reports was performed with a focus on the process of care delivery.ResultsFour categories that emerged from the overarching analysis are discussed in the article: (1) a holistic view of the patient, considering both mental health and the social situation in addition to physical health, (2) continuity of care in the form of single contact points, alignment of services and good relationships between patients and professionals, (3) relationships between professionals built on trust and facilitated by continuous communication, and (4) patient involvement in goal-setting and decision-making, allowing patients to adapt to reorganised service delivery.ConclusionsWe were able to identify several key aspects for a well-functioning integrated care process for complex patients and how these are put into actual practice. The article sets itself apart from the existing literature by specifically focussing on the growing share of the population with complex care needs and by providing an analysis of actual processes and interpersonal relationships that shape integrated care in practice, incorporating evidence from a variety of programmes in several countries.

Impact of multimorbidity on healthcare costs and utilisation: a systematic review of the UK literature.

BackgroundManaging multimorbidity is complex for both patients and healthcare systems. Patients with multimorbidity often use a variety of primary and secondary care services. Country-specific research exploring the healthcare utilisation and cost consequences of multimorbidity may inform future interventions and payment schemes in the UK.AimTo assess the relationship between multimorbidity, healthcare costs, and healthcare utilisation; and to determine how this relationship varies by disease combinations and healthcare components.Design and settingA systematic review.MethodThis systematic review followed the bidirectional citation searching to completion method. MEDLINE and grey literature were searched for UK studies since 2004. An iterative review of references and citations was completed. Authors from all articles selected were contacted and asked to check for completeness of UK evidence. The National Institutes of Health National Heart, Lung, and Blood Institute quality assessment tool was used to assess risk of bias. Data were extracted, findings synthesised, and study heterogeneity assessed; meta-analysis was conducted when possible.ResultsSeventeen studies were identified: seven predicting healthcare costs and 10 healthcare utilisation. Multimorbidity was found to be associated with increased total costs, hospital costs, care transition costs, primary care use, dental care use, emergency department use, and hospitalisations. Several studies demonstrated the high cost of depression and of hospitalisation associated with multimorbidity.ConclusionIn the UK, multimorbidity increases healthcare utilisation and costs of primary, secondary, and dental care. Future research is needed to examine whether integrated care schemes offer efficiencies in healthcare provision for multimorbidity.