Journal of multimorbidity and comorbidity最新文献

Background: People living with MLTCs attending primary care often have unmet social care needs (SCNs), which can be challenging to identify and address. Artificial intelligence (AI) derived clusters could help to identify patients at risk of SCNs. Evidence is needed on views about the use of AI-derived clusters, to inform acceptable and meaningful implementation within interventions.

Method: Qualitative semi-structured interviews (online and telephone), including a description of AI-derived clusters and a tailored vignette, with 24 people living with MLTCs and 20 people involved in the care of MLTCs (carers and health care professionals). Interviews were analysed using Reflexive and Codebook Thematic Analysis.

Results: Primary care was viewed as an appropriate place to have conversations about SCNs. However, participants felt health care professionals lack capacity to have these conversations and to identify support. AI was perceived as a tool that could potentially increase capacity but only when supplemented with effective, clinical conversations. Interventions harnessing AI should be brief, be easy to use and remain relevant over time, to ensure no additional burden on clinical capacity. Interventions must allow flexibility to be used by multidisciplinary teams within primary care, frame messages positively and facilitate conversations that remain patient centered.

Conclusion: Our findings suggest that implementing AI-derived clusters to identify and support SCNs in primary care is perceived as valuable and can be used as a tool to inform and prioritse effective clinical conversations. But concerns must be addressed, including how AI-derived clusters can be used in a way that considers personal context.

Objective: The Patient Experience with Treatment and Self-management (PETS) is a valid self-report measure of treatment burden. The objective of this analysis is to determine severity cut points for its scores.

Methods: Data from two survey studies of adults with multimorbidity were used to determine estimates of low, moderate, and high burden for twelve PETS scores. Anchor-based analyses were used to map mean PETS scores onto scores of other self-report measures, including physical and mental health, self-efficacy, and activity limitations. Low, medium, and high scores on the anchors were based on published thresholds or tertile splits of score distributions. Mean PETS scores were compared across levels of the anchor variable using analysis of variance (ANOVA) then summarized to produce burden severity cut points.

Results: Study 1 featured survey data from 332 adults with multimorbidity (mean age = 66 years, 56% female); study 2 featured survey data from 439 adults with multimorbidity (mean age = 60 years, 62% female). Anchor measures were correlated with PETS scores at rho≥ 0.30. ANOVAs comparing PETS scores across the levels of each anchor variable were all significant (ps< .001). Estimates were placed into data tables. Cut scores for discriminating treatment burden severity levels were identified as the midpoint between the mean PETS scores associated with adjacent anchor categories (e.g., low vs. medium and medium vs. high burden), rounded to the nearest whole number.

Conclusions: Severity thresholds can improve the interpretability of PETS scores. The preliminary estimates derived require verification in future studies.

Background: Chronic obstructive pulmonary disease (COPD) and hypertension are prevalent public health burdens, with hypertension often co-existing in up to 65% of COPD patients and complicating patient management. While numerous clinical guidelines address these conditions individually, there is a scarcity of evidence-based interventions for managing both simultaneously. Purpose: This systematic review aimed to identify interventional studies targeting people with concomitant COPD and hypertension Research Design: The review followed PRISMA guidelines and was registered on PROSPERO (CRD42024533767). A comprehensive search was conducted across multiple databases, including PubMed, EMBASE, Scopus, CINAHL, the Cochrane Library and Cochrane Controlled Register of Trials. Results: The search yielded 3,348 records, of which three studies met the inclusion criteria. These studies examined interventions including oral nitrate supplementation, medication adherence management and a collaborative care model. One study reported a significant reduction in systolic blood pressure (SBP) and improvement in COPD-related outcomes, while the other two reported mixed effects. The collaborative care model notably reduced hospitalizations and healthcare costs. Conclusions: The findings highlight the limited and inconsistent evidence available for managing concomitant COPD and hypertension, reinforcing the need for further research on this topic. Despite frequent clinical encounters with patients having both conditions, practitioners lack a unified treatment strategy. Future studies should focus on developing comprehensive management approaches that address the complex interplay between COPD and hypertension, aiming to improve patients' health outcomes and deliver efficient healthcare.

Background: Multimorbidity, the coexistence of two or more chronic diseases, affects 37% of adults globally, especially in rural areas with limited healthcare access. This burden leads to poorer health outcomes. Telehealth offers a solution by improving access to care. This scoping review explored the use of telehealth for managing multimorbidity in rural and remote areas.

Methods: A protocol was registered on Open Science Framework. Four databases were searched for peer-reviewed articles published in English from 2010 to 2024, focusing on telehealth interventions for multimorbidity in rural and remote areas.

Results: Out of 9,090 screened records, 15 articles were included in the review. Eight articles reported health outcomes (including five randomised controlled trials), while seven identified facilitators and barriers. Telehealth interventions were categorised as synchronous (5/15) and asynchronous (10/15), and they predominantly targeted physical health conditions (73%). Mixed effects on physiological outcomes were noted, with some studies reporting reductions in blood pressure and glycated haemoglobin. Mental health outcomes generally showed significant reductions in depression and anxiety. Facilitators included telehealth infrastructure, stakeholder engagement, and digital literacy, while barriers reflected the opposite.

Conclusion: This review highlights that telehealth interventions can be cost-effective and improve access and health outcomes in rural and remote areas. However, the variability in findings emphasises the need for standardised implementation and further research to ascertain reliability. Future studies should explore strategies to address barriers and optimise telehealth interventions for managing multimorbidity in these settings.

Background: Core outcome sets for people with multiple long-term conditions (multimorbidity) intervention studies offer an opportunity to compare data across studies and countries. However, a key research gap remains: the development of the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) Core Set for multimorbidity rehabilitation. ICF Core Sets are a selection of essential categories from the full ICF classification that are considered most relevant for describing the functioning of a person with a specific health condition or in a specific healthcare context. This study aims to develop and validate an ICF Core Set for exercise-based multimorbidity rehabilitation. Unlike system- or disease-specific rehabilitation, multimorbidity rehabilitation entails using a modified structure that accommodates all conditions that an individual with multimorbidity has.

Methods: The three-phase, multi-method process created by the WHO and ICF Research Branch will be followed. The process will involve conducting four preparatory studies (phase 1), including (i) a systematic literature review (to examine researcher perspectives), (ii) a qualitative study (to examine patient perspectives), (iii) an expert survey (to examine health professional perspectives), and (iv) an empirical study (to examine clinical perspectives). This will be followed by an international consensus conference (phase 2) where lists of ICF categories resulting from phase 1 studies will be consolidated into a first version of an ICF Core Set for multimorbidity rehabilitation, which will be validated using an international comparative data analysis (phase 3).

Conclusion: An ICF Core Set created for multimorbidity rehabilitation will (1) benefit patients with multimorbidity who are often excluded from clinical trials of single-disease rehabilitation programs, (2) ensure precise and comprehensive assessment and documentation of functioning and disability relevant to this patient population, (3) help rehabilitation providers and their patients and/or caregivers when setting rehabilitation goals and planning rehabilitative interventions to achieve those goals, (4) help researchers in the synthesis of evidence for multimorbidity rehabilitation and facilitate the comparability of data across studies and countries, and (5) provide the scientific basis from which assessment tools can be derived for use in clinical and research settings and health care administration.

Trial registration: COMET database (https://www.comet-initiative.org/Studies/Details/3266).

Background: The relationship between dietary patterns (DP) and health outcomes (elevated blood pressure, dyslipidaemia, hyperglycaemia, and body mass index) among adolescents and young adults (AYA) with HIV is not well understood. We aimed to identify dietary patterns and determinants associated with metabolic syndrome components among adolescents and young adults living with HIV in Lagos, Nigeria.

Methods: We conducted a cross-sectional study among 180 participants at an ART clinic in Lagos. Information on sociodemographic and clinical characteristics, as well as 72-hour dietary recall were collected. Anthropometric measurements (BMI (kg/m²)) and blood pressure readings were collected. Blood samples were assayed for fasting blood sugar and lipid profiles. Statistical analysis was done using SPSS version 27, WHO Anthro Plus software.

Results: The male-to-female ratio was 1:1. Four major DPs identified were DP 1 (higher consumption of beverages, vitamins, and vegetables); DP 2 (high intake of minerals, and fruits); DP3 (higher intake of carbohydrates, fat and oil); and DP4 (higher intake alcohol and vegetables). DP1 was associated with dyslipidaemia, underweight BMI and hyperglycaemia were associated with DP4, while DP2 had lower odds of overweight and elevated blood pressure.

Conclusion: This outcome provides valuable insights into DPs and their association with metabolic co-morbidity among AYA with HIV. This will inform nutritional counselling and interventions to promote quality of life and health.

Background: Treatment burden describes the workload undertaken by people with chronic illness and multimorbidity to manage their healthcare demands and the impact on their wellbeing. Burden of Treatment Theory (BOTT) describes the work that people with multimorbidity do to self-manage chronic illness/multimorbidity and the factors that affect capacity (personal and healthcare resources, support network) to meet treatment demands. Here we aim to identify and characterise the different applications of Burden of Treatment Theory in research; to explore the contribution of Burden of Treatment Theory to advancing knowledge and understanding of treatment burden and capacity issues and to identify critiques or limitations of Burden of Treatment Theory in research.

Methods: Systematic review of BOTT research published in the English language. Databases searched were Web of Science, Scopus, Medline, CINAHL and medRxiv.org. We also consulted with experts in the field. Two reviewers screened titles, abstracts and papers and undertook data extraction. Quality appraisal was undertaken using adapted CASP checklists for qualitative studies and systematic reviews and a Mixed Studies Review checklist.

Results: Thirty papers included: 16 qualitative studies; 5 systematic reviews; 3 protocols; 3 discussion papers, a theory conceptual paper, a realist review and a feasibility trial. Most (n=17) originated in UK, with 3 from Australia and Argentina, 2 from Norway and one each from United States and Malawi. Nine papers mentioned use of BOTT constructs but 21 additionally provided rationale for BOTT use and demonstrated engagement with the theory. Two papers adapted/refined BOTT to the context of their research focus. Twenty-seven studies prospectively outlined use of BOTT, with only 3 applying BOTT retrospectively to report study outputs and 'inform analysis' of findings.

Conclusion: BOTT provides a useful conceptual, analytical and sensitising lens in studies focusing on both the characterisation and alleviation of treatment burden through healthcare interventions, and the constructs discussed are stable and applicable across multiple settings. Future research could include use by empirical researchers in contexts needing more adaptation and critical assessment.

Introduction: Preventing or delaying multimorbidity (people living with two or more chronic conditions) is a public health priority. It is currently uncertain if multimorbidity is associated with features of the built environment, a term describing human-made or modified features of the surroundings in which humans live.

Aims: To undertake a systematic review of the literature to determine if built environment features and interventions are associated with multimorbidity and to review the analytical methods used and their implications for causal inference.

Methods: Four databases will be searched (Medline, Embase, Science Citation Index Expanded, and Social Sciences Citation Index) using a prespecified search strategy that incorporates terms for both multimorbidity and the built environment, which includes aspects of neighbourhood design, transport interventions, natural environment, food environments, and housing. Inclusion criteria will include: 1) involves community-based adult populations not selected based on an index condition; and 2) a built environment exposure or intervention was assessed; and 3) outcomes include multimorbidity prevalence, incidence, or trajectory. Reference lists of included studies and previous reviews will also be searched. Two reviewers will independently screen, data extract, and quality appraise (using the ROBINS-E or RoB 2 tool). Results will be synthesised by meta-analysis or, if heterogeneity is too great, according to Synthesis without meta-analysis (SWiM) guidelines. Results will be grouped by type of exposure or intervention and by study quality.

Conclusions: This systematic review will improve understanding of built environment associations with multimorbidity. It could identify aetiological pathways that support the development of multimorbidity-preventative strategies.

Background: Patients with multiple chronic conditions often face fragmented care and inconsistent information, increasing their risk of serious health issues. Their perceived collaboration across clinics may be shaped by difficulties in accessing and using information for informed decision-making. This study explored the association between patient-perceived collaboration across clinics and health literacy among outpatients with diabetes and at least one comorbidity at the hospital level. Methods: This cross-sectional study at the outpatient clinic at Steno Diabetes Center Aarhus included all patients with diabetes and at least one comorbidity who were simultaneously receiving treatment at another outpatient clinic within the hospital. The association between patient-perceived extensive collaboration across clinics (exposure) and patient health literacy (outcome) was assessed using four selected scales and regression models. Results were presented as both unadjusted and adjusted, accounting for potential confounders. Results: A total of 3,435 outpatients received a survey, with 1,655 responses. Of these, 686 reported receiving cross-clinic treatment. Among the 552 respondents who answered the exposure-related question, 44.7% perceived extensive collaboration across clinics, while 55.3% perceived limited collaboration. Statistically significant differences were found in three out of four health literacy scales, with those who perceived limited collaboration scoring lower in areas related to managing their health and engaging with healthcare providers. Conclusion: The findings suggest that outpatients with comorbidities and perceived poor clinic collaboration may have low health literacy, highlighting the need to address this in their treatment and communication with healthcare providers. Future research is needed to determine whether limited perception arises from personal challenges, elements of the treatment process, or relational and organizational issues across clinics, in order to improve the perception of collaboration and clinical outcomes.

Background: Multiple chronic conditions (MCCs) are of increasing public health concern. There remain significant gaps in understanding the relationship between racial discrimination as a determinant of MCC burden. This study examines the association between race-based differential treatment and MCC prevalence by race.

Methods: We analyzed data from Black and White adults who completed the South Carolina Behavioral Risk Factor Surveillance System (2016-2017) survey Reactions to Race optional module (n=18,047). MCCs were summed and categorized (0; 1; 2-3; 4+ conditions). Racial discrimination was operationalized across multiple domains: experiences of race-based differential treatment in work settings and in healthcare settings, and emotional and physical reactions to race-based differential treatment. Multinomial logistic regression models were stratified by race and adjusted for confounders.

Results: Overall, 63.7% of Black and 60.4% of White adults had ≥2 MCC. Experiences of race-based differential treatment in work and health care settings and emotional reactions to race-based differential treatment were associated with a higher risk of MCCs among Black and White adults.

Conclusions: Our findings suggest that experiences and reactions to race-based differential treatment were associated with greater MCC burden among Black and White adults. This adds to a growing literature highlighting the importance of examining racial discrimination as a key factor contributing to the MCC burden within populations. Future research should interrogate potential social mechanisms identifying high MCC risk within racial groups.