Journal of multimorbidity and comorbidity最新文献

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.

Background: The dynamics of working within multidisciplinary teams (MDTs) to manage diabetes and comorbidities remain underexplored. Investigating physicians' experiences provide insights into the benefits and challenges of MDTs in this complex context, paving the way for improving current practices and shaping future interventions to better address the needs of this patient population.

Aim: To explore perceived benefits and barriers of MDTs in the management of people with diabetes and comorbidities among physicians.

Methods: Eleven semi-structured interviews (duration 26-38 min) were conducted online among physicians. Criterion sampling of physicians from relevant medical specialties and with experience from MDTs were included. Interviews were analyzed using thematic analysis.

Results: Four major themes emerged from the thematic analysis: (1) benefits of MDT, (2) challenges related to MDT, (3) the need for MDTs and cross-sectorial work, and (4) prerequisites for successful MDTs. Improved professional learning and relationships, enhanced capacity leverage, and optimized treatment were some of the major benefits. Siloed healthcare systems and cultures and resource demanding MDTs were considered barriers. Composition and outline of the MDTs, including the role of general practitioners (GPs), were considered important aspects of MDTs. The increase in multimorbidity, polypharmacy, and complexity in patient pathways necessitates MDTs and cross-sectorial work.

Conclusion: Our findings indicate several benefits and barriers of MDTs. MDTs and cross-sectorial work are needed prospectively in healthcare and hold the potential to embrace some of the challenges encountered by people with diabetes and comorbidities. Understanding and incorporating experiences of physicians could inform future improvements in care management.

Background: Individual diseases are important risk factors for early exit from the labour force among older adults, but the contribution of multimorbidity to working life expectancy (WLE) is unclear.

Methods: We used data from two prospective cohort studies: Finnish Public Sector study (FPS) and Health and Social Support Study (HeSSup). Multimorbidity at baseline was ascertained from a combination of self-reported, physician-diagnosed chronic diseases, and nationwide cancer and medication reimbursement registers. WLE from age 50 up to 68 years was ascertained utilising linked data from a nationwide register of pensionable earnings. WLE was estimated utilising a multi-state models in R.

Results: Our findings were based on data from 56,079 women and 17,078 men aged ≥50 years. In FPS, women and men with two chronic diseases could expect to work about 9 months less and those with three or more chronic diseases could expect to work about a year less than those with no chronic disease. In HeSSup, women and men with three or more diseases had about 2-3 years shorter WLEs than those with no disease. In both studies participants with physical-mental multimorbidity had 3-12 months shorter WLEs and individuals with multimorbidity comprising two physical diseases had 8-10 months shorter WLEs than those with no chronic disease. The patterns were similar across the socioeconomic positions.

Conclusion: Women and men with multiple chronic diseases could expect to work ∼1 year less than those with no chronic disease. The differences in WLE can have important economic implications to individuals, health services and society.

Background: The number of patients with multimorbidity challenges healthcare systems worldwide. Objective: To explore the development of multimorbidity prevalence in the Danish population over the course of 18 years. Design: National registers were used to form eighteen cohorts including all persons aged ≥18 years; one cohort for each separate calendar year from 2000 to 2018. Multimorbidity was defined based on ten diagnosis groups (ICD-codes): lung, musculoskeletal, endocrine, mental, cancer, neurological, gastrointestinal, cardiovascular, genitourinary, and sensory organs. At least two diagnoses from different diagnosis groups had to be present to be considered multimorbidity. The diagnoses were from hospital contacts in the Danish health registers. We report both ≥2 and ≥4 multimorbidity. Results: From 2000-2018, the prevalence of multimorbidity increased from 7.1 % to 16.1 % with a relative increase of 126% and 314% for ≥2 and ≥ 4 diagnosis groups, respectively. The oldest age groups had the highest prevalence. In 2018, half of the population aged ≥80 years had multimorbidity. Young women showed the relatively largest prevalence increase of ≥ 4 multimorbidity. In absolute terms, the number of musculoskeletal diagnoses increased the most, whereas genitourinary, endocrinological, and musculoskeletal diagnoses showed the highest relative increase. Conclusions: In Denmark, the prevalence of patients with multimorbidity is increasing, and it has more than doubled from 2000-2018. The observed development in occurrence of multimorbidity over time may serve as relevant input for governments when rethinking the health care.

Background: Over the years, non-communicable diseases (NCDs), as well as the number of people with multiple chronic NCDs or multi-morbidity, are on a sharp rise globally, especially in low and middle-income countries (LMICs). This review attempts to deepen the knowledge (policy landscape) of how managing multiple NCDs and associated challenges are addressed across the health systems policies from India, South Africa and Thailand.

Methods: We conducted a search of two search engines (PubMed and Google) and the websites of national departments from February 2022 to December 2022. An analytical framework was produced for the qualitative document analysis, focusing on definitions of multi-morbidity, potential policy actions at patient, provider, health system, and macro-level domains, including social determinants of health. We utilised framework analysis of the national-level policies and related documents to explore the co-existent nature of multiple NCDs in India, South Africa, and Thailand.

Results: Of the 54 analysed documents, 11 (20.4%) were national policies/ programmes, 15 (27.8%) were operational or implementation or management guidelines, 12 (22.2%) were training manuals, 16 (29.6%) were action plans/ strategic plans/ frameworks. None of the countries had specific policies dealing with NCD multi-morbidity. Findings from the thematic analysis showed that health promotion activities at patient-level targeted multiple risk factors; however self-management support is for specific NCDs such as diabetes.

Conclusions: Our study highlights the need for dedicated policies that adopt a patient-centred and integrated approach with appropriate consideration of social determinants of health and health inequalities within these policies to manage NCD multi-morbidity holistically and effectively.

Objectives: There is no consensus definition for multimorbidity. We explored how different frameworks affect multimorbidity patterns and their associations with patient-reported outcomes using the prospective, observational Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) Study. Methods: Sixty-four conditions were classified into three frameworks: Framework-D (diseases), Framework-DCI (diseases and clinical indicators) and Framework-DCIS (diseases, clinical indicators and symptoms). Principal component analysis (PCA) identified five comparable patterns: Cardiovascular disease (CVD), Sexually transmitted diseases, Metabolic/AIDS-related, Mental health/Other, and Cancer. A sixth pattern was identified using Framework-D (Infections/Skin) and Framework-DCI/DCIS (Cardiometabolic). Using PCA loadings, burden z-scores were calculated for each individual/pattern, and their associations with functional impairment (Lawton Instrumental Activities of Daily Living <8), hospitalisation and SF-36 physical and mental health scores were assessed using logistic or linear regression. Results: The analyses included 1073 people with HIV (median [interquartile range; IQR] age 52 [47 - 59] years; 85% male; 97% on ART). Clinical indicators and symptoms were correlated with the CVD, Cardiometabolic and Mental health/Other patterns. While differences were marginal, Framework-DCI showed slightly stronger relationships between CVD and functional impairment, hospitalisation and physical health compared to Framework-D. Similarly, Framework-DCIS demonstrated somewhat stronger associations between Metabolic/AIDS-related and Mental health/Other patterns with certain outcomes. Conclusions: The inclusion of clinical indicators and symptoms were associated with some changes in the strength of associations between certain multimorbidity patterns and outcomes. Our findings suggest that their inclusion in multimorbidity frameworks should be guided by the specific research context and question, rather than solely by effect size on patient-important outcomes.

Background: Living with multiple long-term conditions (MLTCs) involves 'work'. A recent qualitative synthesis identified eight patient-centred work themes: 'learning and adapting', 'accumulation and complexity', 'investigation and monitoring', 'health service and administration' and 'symptom', 'emotional', 'medication' and 'financial' work. These themes may be underrepresented in electronic health records (EHRs). This study aimed to evaluate the representation of these themes and their constituent concepts in EHR data in a general population and among individuals with history of a mental health condition.

Methods: Using the OpenCodelists builder from OpenSAFELY, clinical code lists corresponding to work concepts were developed using Systematised Nomenclature of Medicine Clinical Terms (SNOMED CT) and validated by two clinicians. Additional concepts were engineered within the Clinical Practice Research Datalink (CPRD) and the Secure Anonymised Information Linkage (SAIL) Databank. We analysed trends in recording rates over 20 years across a SAIL general population cohort (n=5,180,602) and a CPRD cohort comprising individuals with a mental health diagnosis (n=3,616,776) and matched controls (n=4,457,225).

Results: 55 code lists and seven engineered concepts were developed across the themes. The proportion of patients with codes related to 'investigation and monitoring' exceeded 40%, while 'accumulation and complexity' and 'financial work' were poorly represented (<2% and <1% of the study population respectively). Recording was generally higher among individuals with a mental health diagnosis history.

Conclusion: While EHR data captures some aspects of MLTC work, patient-centred concepts are under-represented. Future research should explore reasons behind variability in coding practices, and innovative methods for enriching structured records with patient-centred data.

Background: Understanding patients' expectations of health care is central to providing patient-centered care and improving patient satisfaction. However, the current literature is primarily focused on single disease-specific patient expectations.

Aim: To develop an in-depth understanding of the expectations patients with musculoskeletal conditions and comorbidities have towards physiotherapists working in private physiotherapy practice.

Methods: 35 observations with patients with musculoskeletal conditions and comorbidities receiving treatment in a Danish private physiotherapy setting were conducted. Of these, nine patients participated in interviews. A Grounded Theory analysis was undertaken, and categories were formed and agreed upon through an inductive approach grounded in the data.

Results: Three major themes emerged from the data 1) Professional expertise is needed but will not be enough if enthusiasm fades in a long treatment course 2) Being able to laugh about life when you have many health problems 3) The balance of involvement and the sharing of power and responsibility. Patients express a desire for a strong bond with their physiotherapists, fostering intimacy and mutual understanding. They seek light-hearted interactions and wish to share personal aspects like family dynamics and hobbies. The study also underscores their expectations for sharing power and care tailored to their specific needs.

Conclusion: Our findings reveal that patients with musculoskeletal conditions and comorbidities have clear expectations of treatment and collaboration with their physiotherapists in private physiotherapy practice. Underscoring personal relationships over physical results and demonstrating that this patient group has resources to support treatment and is clear about levels of involvement and collaboration.

Objective: The growing prevalence of chronic morbidity among Nepali older adults reflects the need for studies exploring the patterns and determinants for evidence-based public health strategies. This study evaluated chronic morbidity levels and the associated factors.

Methods: A cross-sectional study recruited 612 participants (≥ 60 years) from all three ecological regions in Gandaki province, Nepal. Chronic morbidity level was derived as the cumulated presence of eight chronic conditions: coronary heart disease, hypertension, stroke, diabetes, cancer, respiratory issues, musculoskeletal conditions, and depression, and then creating three groups: no morbidity, single morbidity and multimorbidity. Ordinal logistic regression analyzed factors associated with morbidity levels, and findings are presented in adjusted odds ratio (OR) and 95% confidence interval (CI). All ethical standards were properly followed.

Findings: About 40% of total participants reported having single morbidity, while 25% had multimorbidity. Participants above 70 years (OR: 1.68, CI: 1.18-2.38) and older women (OR: 2.34, CI: 1.53-3.58) reported odds of being in a higher morbidity category than their counterparts. Older adults without healthcare visits within a year had 90% lower odds (OR: 0.10, CI: 0.06-0.15) of being in a higher morbidity category.

Interpretation: This study underlines the importance of regular healthcare visits, recommending that older adults undergo timely screenings for early diagnosis and effective management. It also emphasizes the need for increased public awareness and health promotion initiatives focused on chronic disease prevention activities within the older population. Additionally, investigating gender-specific factors may provide deeper insight into effective public health interventions.

Introduction: Multimorbidity is associated with adverse clinical outcomes, including increased symptom burden and healthcare utilisation, particularly towards the end of life. Despite this, there is no accepted method to identify the point at which individuals with deteriorating health due to long-term conditions are nearing the end of life or might benefit from a palliative care approach - conceptualised as 'Advanced Multimorbidity'. This scoping review explored how Advanced Multimorbidity is described and operationalised within the literature.

Methods: Multiple electronic databases and Grey Literature sources were searched following scoping review frameworks. Two reviewers independently performed screening and data extraction. Content analysis was used to examine the different descriptions of Advanced Multimorbidity. Stakeholder consultations were undertaken with clinicians, academics and public participants. Patient and public involvement was separately integrated throughout this review from conceptualisation, design and reporting.

Results: Forty-four different descriptions of Advanced Multimorbidity were identified from 38 publications. These varied in terms of the clinical conditions and descriptors used. Eighteen descriptions relied on a single indicator to identify Advanced Multimorbidity; 24 used a multidimensional approach. Stakeholder consultations highlighted the need for descriptions that are user-friendly and actionable.

Conclusion: The lack of a standardised definition of Advanced Multimorbidity risks variance in clinical and research practice, potentially affecting patient care. A consensus on defining Advanced Multimorbidity would enable better identification of patients who could benefit from a palliative care approach, ensuring more consistent and person-centred care, as well as supporting research and policy development.