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Allgemein-​ und Fa­mi­li­en­me­di­zin

Allgemein- und Familienmedizin Logo
Campus der Universität Bielefeld
© Uni­ver­si­tät Bie­le­feld

Kath­rin Gödde

Com­pa­ri­son of co­mor­bi­di­ty sta­tus and eli­gi­bi­li­ty to par­ti­ci­pa­te in na­vi­ga­ti­on in­ter­ven­ti­on pro­jects in an el­d­er­ly pa­ti­ent po­pu­la­ti­on in Bran­den­burg

Dr. Kath­rin Gödde1; Su­san­ne Schul­ze1; San­dra Wend­landt2; Oli­ver Schä­fer3; Prof. Dr. Chris­ti­ne Holm­berg1

1Bran­den­burg Me­di­cal School Theo­dor Fon­ta­ne; 2Cha­rité – Uni­ver­si­täts­me­di­zin Ber­lin, cor­po­ra­te mem­ber of Freie Uni­ver­si­tät Ber­lin and Humboldt-​Universität zu Ber­lin; 3Uni­ver­si­ty Hos­pi­tal of Bran­den­burg an der Havel

Back­ground: Co­or­di­na­ti­on of care can be chal­len­ging for pa­ti­ents in the frag­men­ted Ger­man health­ca­re sys­tem, es­pe­cial­ly for el­d­er­ly pa­ti­ents and pa­ti­ents with co­mor­bi­di­ties. The­re­fo­re, a va­rie­ty of care co­or­di­na­ti­on in­ter­ven­ti­ons have been de­ve­lo­ped and eva­lua­ted in Ger­ma­ny that often focus on sin­gle di­sea­ses. Here, we want to in­ves­ti­ga­te to which de­gree eli­gi­bi­li­ty to par­ti­ci­pa­te in these care in­ter­ven­ti­ons over­laps in pa­ti­ents with mul­ti­mor­bi­di­ty.

Me­thods: We per­for­med an in­ter­net and li­te­ra­tu­re se­arch to iden­ti­fy care co­or­di­na­ti­on in­ter­ven­ti­ons in Ger­ma­ny. Ad­di­tio­nal­ly, we per­for­med a se­con­da­ry ana­ly­sis of rou­ti­ne data from 2022 of an el­d­er­ly pa­ti­ent po­pu­la­ti­on (>65 years) from a hos­pi­tal in Bran­den­burg to in­ves­ti­ga­te the co­mor­bi­di­ty sta­tus. Fi­nal­ly, we will com­pa­re diagnosis-​related in­clu­si­on cri­te­ria of the iden­ti­fied stu­dies with pa­ti­ent co­mor­bi­di­ty data to iden­ti­fy the num­ber of pro­jects these pa­ti­ents would be eli­gi­ble for.

Re­sults: The in­ter­net and li­te­ra­tu­re se­arch iden­ti­fied 32 care in­ter­ven­ti­ons that main­ly fo­cu­sed on sin­gle di­sea­ses (e.g. stro­ke, dia­be­tes) or di­sea­se groups (e.g. car­dio­va­s­cu­lar di­sea­ses). The sam­ple pa­ti­ents (N=8059) were on aver­age 77.8 years old (SD = 7.88 years), had 1.4 hos­pi­tal stays in 2022 (SD = 0.99) and 49.6 % were fe­ma­le. Fur­ther ana­ly­ses of eli­gi­bi­li­ty over­lap will be pre­sen­ted for this po­pu­la­ti­on.

Con­clu­si­on: Ex­pec­ted re­sults will give in­sights about the eli­gi­bi­li­ty over­lap to par­ti­ci­pa­te in co­or­di­na­ti­on of care in­ter­ven­ti­ons for pa­ti­ents with mul­ti­mor­bi­di­ty and could the­re­fo­re sup­port a re­source­ful im­ple­men­ta­ti­on of such in­ter­ven­ti­ons.

Stine Jor­stad Bugge

Net­work of Doc­tors for Mul­ti­mor­bi­di­ty and Dia­be­tes – The NOMAD In­ter­ven­ti­on: Pro­to­col for fe­a­si­bi­li­ty trial of mul­ti­di­sci­pli­na­ry team con­fe­ren­ces for peop­le with dia­be­tes and mul­ti­mor­bi­di­ty

Stine Jor­stad Bugge1,2,3, Da­ni­el Pils­gaard Hen­rik­sen1,2,3, Per Dam­kier2,3 , Mar­tin Torp Rah­bek2,4, Ka­ro­li­ne Schous­boe1,3, Mette Juel Roth­mann1,3, Ma­ri­an­ne Kjær Poul­sen1,3, Ca­mil­la Han­sen1, Sub­a­gi­ni Na­ga­ra­jah3,5, Per Bruno Jen­sen3,5, Sofie Lock Jo­han­son3,6, Va­si­li­ki Panou3,6, Ida Rans­by Schnei­der3,7, Char­lot­te Gjørup Pe­der­sen8,9, Jonas Dahl An­der­sen10,11, Jørgen Han­gaard1,3, Ann-​Dorthe Olsen Zwis­ler3,7,12

1Steno Dia­be­tes Cent­re Oden­se, Oden­se Uni­ver­si­ty Hos­pi­tal, Oden­se, Den­mark; 2De­part­ment of Phar­ma­co­lo­gy, Oden­se Uni­ver­si­ty Hos­pi­tal, Oden­se, Den­mark; 3De­part­ment of Cli­ni­cal Re­se­arch, Uni­ver­si­ty of Sou­thern Den­mark, Oden­se, Den­mark; 4De­part­ment of Pu­blic Health, Uni­ver­si­ty of Sou­thern Den­mark, Oden­se, Den­mark; 5De­part­ment of Ne­phro­lo­gy, Oden­se Uni­ver­si­ty Hos­pi­tal, Oden­se, Den­mark; 6De­part­ment of Re­spi­ra­to­ry Me­di­ci­ne, Oden­se Uni­ver­si­ty Hos­pi­tal, Oden­se, Den­mark; 7De­part­ment of Car­dio­lo­gy, Oden­se Uni­ver­si­ty Hos­pi­tal, Oden­se, Den­mark; 8Steno Dia­be­tes Cent­re Aar­hus, Aar­hus uni­ver­si­ty Hos­pi­tal, Aar­hus, Den­mark;9De­part­ment of Pu­blic Health, Aar­hus Uni­ver­si­ty, Aar­hus, Den­mark; 10Steno Dia­be­tes Cent­re Nor­t­hern Jut­land, Aal­borg Uni­ver­si­ty Hos­pi­tal, Aal­borg, Den­mark; 11De­part­ment of Health Sci­ence and Tech­no­lo­gy, Aal­borg Uni­ver­si­ty, Aal­borg, Den­mark; 12REHPA, The Da­nish Know­ledge Cent­re for Re­ha­bi­li­ta­ti­on and Pal­lia­ti­ve Care, Oden­se Uni­ver­si­ty Hos­pi­tal, Ny­borg, Den­mark

Back­ground: Pre­va­lence of dia­be­tes and co­e­xis­ting mul­ti­mor­bi­di­ty rises world­wi­de. Pro­vi­ding evidence-​based, co­he­rent and patient-​centred care for mul­ti­mor­bid pa­ti­ents pose chal­len­ges in health­ca­re sys­tems, which ty­pi­cal­ly de­li­ver disease-​specific care. We pro­po­se an in­ter­ven­ti­on com­pri­sing mul­ti­di­sci­pli­na­ry team con­fe­ren­ces (MDTs). The MDT con­sists of me­di­cal spe­cia­lists in five spe­cia­li­ties mee­ting bi­weekly to dis­cuss mul­ti­mor­bid pa­ti­ents. This pro­to­col de­scri­bes a study ai­ming to fe­a­si­bi­li­ty test MDTs de­si­gned to co­or­di­na­te care and im­pro­ve qua­li­ty of life for peop­le with dia­be­tes and mul­ti­mor­bi­di­ty.

Me­thods: A mixed-​methods one-​arm fe­a­si­bi­li­ty test of the MDT. Fe­a­si­bi­li­ty will be as­ses­sed th­rough pro­spec­tive­ly collec­ted data. We will ex­plo­re pa­ti­ent per­spec­ti­ves th­rough patient-​reported out­co­mes (PROs) and as­sess fe­a­si­bi­li­ty of elec­tro­nic ques­ti­onn­aires. Fe­a­si­bi­li­ty out­co­mes are re­cruit­ment, PRO com­ple­ti­on, tech­ni­cal dif­fi­cul­ties, MDT im­pact and cli­ni­ci­an pre­pa­ra­ti­on time. Du­ring 17 months we re­cruit up to 112 par­ti­ci­pants. Re­sults are re­por­ted nar­ra­tive­ly and with de­scrip­ti­ve sta­tis­tics. The study will pre­ce­de a fu­ture large-​scale ran­do­mi­sed trial.

Dis­cus­sion: Mul­ti­di­sci­pli­na­ry ap­proa­ches fo­cu­sing on bet­ter ma­nage­ment of mul­ti­mor­bid dia­be­tic pa­ti­ents may im­pro­ve func­tio­nal sta­tus, qua­li­ty of life and health out­co­mes. Mul­ti­mor­bi­di­ty and dia­be­tes are high­ly pre­va­lent in our health­ca­re sys­tem, but we lack solid evidence-​based ap­proa­ches to patient-​centred care for these pa­ti­ents. This study re­p­res­ents in­iti­al steps to­wards buil­ding such evi­den­ce. The con­cept can be ef­fi­ci­en­cy tested in a ran­do­mi­sed set­ting, if found fe­a­si­ble to in­ter­ven­ti­on pro­vi­ders and re­cei­vers. If not, we will have gai­ned ex­pe­ri­ence on how to ma­na­ge dia­be­tes and mul­ti­mor­bi­di­ty and or­ga­ni­sa­tio­nal aspects, which toge­ther may ge­ne­ra­te hy­po­the­ses for fur­ther re­se­arch on mul­ti­mor­bi­di­ty care.

Sanne Lykke Lund­strøm

Care model for pa­ti­ents with com­pli­ca­ted mul­ti­mor­bi­di­ty (CIM2) – preli­mi­na­ry re­sults of a pilot RCT study

Sanne Lykke Lund­strøm1; Bar­ba­ra Ann Bar­rett2; Iben Char­lot­te Aa­mann1; Anne Frølich2 1

1NSR Hos­pi­tal & Bispebjerg-​ and Fre­de­riks­berg Hos­pi­tal; 2NSR Hos­pi­tal

Back­ground: Ma­na­ging care for pa­ti­ents with com­plex mul­ti­mor­bi­di­ty de­mands an in­te­gra­ted, patient-​focused ap­proach, yet or­ga­ni­zing health­ca­re ser­vices for such cases con­ti­nues to pose si­gni­fi­cant chal­len­ges. In re­spon­se, our team de­ve­lo­ped the ""com­plex in­ter­ven­ti­on for mul­ti­mor­bi­di­ty"" (CIM), which we have since ad­van­ced to CIM2 fol­lo­wing a fe­a­si­bi­li­ty study. The ef­fec­ti­ve­n­ess of CIM in de­li­vering com­pre­hen­si­ve care has been re­co­gni­zed, cul­mi­na­ting in its in­cor­po­ra­ti­on into the 2022-​2024 agree­ment bet­ween Da­nish Re­gi­ons and the Da­nish Or­ga­niza­ti­on of Ge­ne­ral Prac­ti­tio­ners.

Aim: Our study aims to eva­lua­te CIM2 th­rough a pilot Ran­do­mi­zed Con­trol­led Trial (RCT), de­tailing our ex­pe­ri­en­ces in re­crui­ting prac­ti­ces and pa­ti­ents, and sharing early fin­dings.

Me­thods: We re­crui­ted four­teen ge­ne­ral prac­ti­ces from two Da­nish re­gi­ons, ran­dom­ly as­signing them to eit­her the CIM2 in­ter­ven­ti­on or a con­trol group. The in­ter­ven­ti­on group re­cei­ved spe­cial trai­ning to offer patient-​centered care th­rough ex­ten­ded con­sul­ta­ti­ons for pa­ti­ents with com­plex health con­di­ti­ons. Data were collec­ted at ba­se­li­ne, 6, and 12 months, in­clu­ding in­ter­views with both pa­ti­ents and health­ca­re pro­fes­sio­nals.

Re­sults: Early fin­dings, based on pa­ti­ent as­sess­ments and ques­ti­onn­aires, along­si­de de­scrip­ti­ons of the re­cruit­ment pro­cess, in­di­ca­te CIM2's po­ten­ti­al to im­pro­ve care qua­li­ty for pa­ti­ents with com­pli­ca­ted mul­ti­mor­bi­di­ty.

Con­clu­si­on: This pilot RCT of CIM2 re­p­res­ents a si­gni­fi­cant step to­wards en­han­cing patient-​centered, in­te­gra­ted care, con­tri­bu­ting to bet­ter health­ca­re out­co­mes for in­di­vi­du­als with com­plex needs. Our fin­dings offer in­sights into the in­iti­al ef­fec­ti­ve­n­ess of the CIM2 model and its con­tri­bu­ti­on to on­go­ing ef­forts to im­pro­ve care for this chal­len­ging pa­ti­ent group.

Glo­ria Metz­ner

Ad­dres­sing mul­ti­mor­bi­di­ty with a local, per­so­na­li­zed care ma­nage­ment ap­proach - In­sights from the ran­do­mi­zed con­trol­led LoChro-​trial

Glo­ria Metz­ner; Lukas Ma­xi­mi­li­an Horst­mei­er; Se­bas­ti­an Voigt-​Radloff; Erik Farin-​Glattacker

Sec­tion of Health Care Re­se­arch and Re­ha­bi­li­ta­ti­on Re­se­arch, In­sti­tu­te of Me­di­cal Bio­me­try and Sta­tis­tics, Fa­cul­ty of Me­di­ci­ne and Me­di­cal Cen­ter, Uni­ver­si­ty of Frei­burg

Back­ground: Mul­ti­mor­bi­di­ty pres­ents a chal­len­ge for mo­dern health­ca­re. Sever­al care ap­proa­ches have been de­ve­lo­ped, but often fo­cu­sed on sin­gle di­sea­ses.

Ob­jec­ti­ve: This study as­ses­sed the ef­fec­ti­ve­n­ess of a new local, per­so­na­li­zed care-​approach (LoChro-​Care) for pa­ti­ents with mul­ti­ple chro­nic di­sea­ses in com­pa­ri­son to usual care (con­trol group, CG).

Me­thod: The ran­do­mi­zed con­trol­led trial in­clu­ded 524 par­ti­ci­pants (aged 65+). LoChro-​Care con­sists of a struc­tu­red as­si­s­tance to en­han­ce pa­ti­ents’ self-​management in co­or­di­na­ti­on their sup­por­ti­ve net­work, pro­vi­ded by trai­ned chro­nic care ma­na­gers for 12 months (in­ter­ven­ti­on group, IG). Pa­ti­ents’ func­tio­nal health was as­ses­sed using the WHO­DAS, de­pres­si­ve sym­ptoms by the PHQ-9, and pa­ti­ents’ de­gree of mul­ti­mor­bi­di­ty with the weigh­ted index by Tooth et al. (2008). Data ana­ly­ses was con­duc­ted with linear-​mixed-models.

Re­sults: The re­sults in­di­ca­te no si­gni­fi­cant dif­fe­rence bet­ween IG and CG (WHO­DAS: p=.52; PHQ-9: p=.65). In both groups, the func­tio­nal (WHO­DAS: b=11.04, p < .001) and men­tal health sta­tus (PHQ-9: b=4.82, p=.02) si­gni­fi­cant­ly worsened over time. Pa­ti­ents’ de­gree of mul­ti­mor­bi­di­ty was a si­gni­fi­cant pre­dic­tor for this de­cli­ne in func­tio­nal (WHO­DAS: b=1.59, p < .001) and men­tal health (PHQ-9: b=.91, p < .001) in both groups.

Dis­cus­sion: Re­sults did not re­ve­al any si­gni­fi­cant im­pro­vements of LoChro-​Care over usual care. One po­ten­ti­al ex­pl­a­na­ti­on might be that our sam­ple was al­rea­dy high­ly bur­den­ed so that self-​management sup­port alone could not suc­ceed in im­pro­ving health sta­tus. Fu­ture sup­por­ti­ve care ap­proa­ches should reach pa­ti­ents ear­lier and proac­tive­ly pro­vi­de case ma­nage­ment stra­te­gies.

Ve­ro­ni­ka Ben­che­va

Un­der­stan­ding the scope of de­pre­scribing in a shared de­cis­i­on set­ting: A sub­ana­ly­sis of the CO­FRAIL Study

Ve­ro­ni­ka Ben­che­va1; Mat­thi­as Go­go­lin1; Prof. Sven Schmiedl1; Prof. Achim Mor­t­sie­fer1; Prof. Ste­fan Wilm2; Anja Woll­ny3; Eva Dre­we­low3; Ma­nue­la Ritz­ke3; Prof. At­ti­la Alti­ner4; Prof. An­drea Icks2; Jens Abra­ham5; Bir­gitt Wiese6; Prof. Petra Thür­mann1

1Uni­ver­si­ty of Wit­ten/Her­de­cke; 2Heinrich-​Heine-University Düs­sel­dorf ; 3Uni­ver­si­ty Me­di­cal Cent­re Ros­tock; 4Hei­del­berg Uni­ver­si­ty; 5Mar­tin Lu­ther Uni­ver­si­ty Halle-​Wittenberg; 6Han­no­ver Me­di­cal School

In­tro­duc­tion: Mul­ti­mor­bi­di­ty and po­ly­phar­ma­cy fre­quent­ly cor­re­la­te with ne­ga­ti­ve out­co­mes such as ad­ver­se drug ef­fects, falls and hos­pi­ta­liza­ti­ons. Im­ple­men­ting de­pre­scribing into the tre­at­ment re­gi­men may lead to mi­ni­mi­zing these out­co­mes.

Me­thod: In the CO­FRAIL study (a clus­terRCT) 114 ge­ne­ral prac­ti­tio­ners (GPs) and 623 frail (Rock­wood scale 5-7), el­d­er­ly ( ≥ 70 years) out­pa­ti­ents with po­ly­phar­ma­cy ( ≥ 5 drugs/d) were en­rol­led. The in­ter­ven­ti­on con­sisted of 3 fa­mi­ly con­fe­ren­ces (FK), where de­pre­scribing was con­duc­ted uti­li­zing a ma­nu­al de­ve­lo­ped for this study. In this sub­ana­ly­sis, we ob­tai­ned the me­di­ca­ti­on plans of a ran­dom­ly selec­ted group of pa­ti­ents wit­hin the in­ter­ven­ti­on group (IG) be­fo­re and after the 1st and 2nd FK and ana­ly­sed them fo­cu­sing on do­cu­men­ted me­di­ca­ti­on ad­just­ments in the me­di­ca­ti­on re­gimes.

Re­sults: The ana­ly­sis in­vol­ved n = 177 IG pa­ti­ents of whom me­di­ca­ti­on plans were avail­able with a mean age of 83.4 ± 5.9 years (68% fe­ma­les) who re­cei­ved 10.4 ± 3.9 drugs. In the IG 2.4 ± 2.1 me­di­ca­ti­ons per pa­ti­ent were de­pre­scri­bed, re­sul­ting in a si­gni­fi­cant (p < 0.001) re­duc­tion of 1.4 ± 2.0 drugs per pa­ti­ent. Fur­ther­mo­re, in 0.8 ± 1.0 drugs per pa­ti­ent do­sa­ges were re­du­ced. The most fre­quent­ly de­pre­scri­bed drugs were those for the tre­at­ment of gout, sta­tins and proton-​pump in­hi­bi­tors with with­dra­wal rates of 55%, 45%, and 31%, re­spec­tive­ly.

Con­clu­si­on: This sub­ana­ly­sis en­han­ced our un­der­stan­ding of tre­at­ment pat­terns and cli­ni­cal decision-​making pro­ces­ses in the tar­get group by sho­wing dif­fe­rent de­pre­scribing po­ten­ti­als for the ob­ser­ved me­di­ca­ti­on groups. It may be used in de­ve­lo­ping fu­ture tre­at­ment stra­te­gies.

Fran­cis­ca Leiva Fernández

An edu­ca­tio­nal in­ter­ven­ti­on on mul­ti­mor­bi­di­ty and po­ly­phar­ma­cy: As­sess­ment of 5 edi­ti­ons of the eMUL­TI­PAP cour­se

Fran­cis­ca Leiva-​Fernández1; Mar­cos Castillo-​Jiménez2; Aída Moreno-​Juste3; Jo­se­fa Bujalance-​Zafra4; An­to­nio Gimeno-​Miguel5; Isa­bel Del Cura-​González6; Juan An­to­nio López-​Rodríguez7; Paula Ara-​Bardají8; MUL­TI­PAP Group

1Mul­ti­pro­fes­sio­nal Tea­ching Unit of Com­mu­ni­ty and Fa­mi­ly Care. Málaga-​Guadalhorce Health District. Málaga, Spain.Group C-08 Bio­me­di­cal Re­se­arch In­sti­tu­te of Málaga(IBIMA).RI­CAPPS, ISCIII.; 2Dept of Phar­ma­co­lo­gy and Pa­ediatrics,School of Me­di­ci­ne,Uni­ver­si­ty of Ma­la­ga.Group C-08 Bio­me­di­cal Re­se­arch In­sti­tu­te of Málaga(IBIMA).Pri­ma­ry Care Health Cent­re Cam­pil­los, Nor­t­hern Málaga In­te­gra­ted Health­ca­re Area, An­da­lu­si­an Health Ser­vice. Spain ; 3Epi­Chron Re­se­arch Group, IACS, IIS Aragón, Mi­guel Ser­vet Uni­ver­si­ty Hos­pi­tal. San Pablo Pri­ma­ry Care Health Cent­re, Ara­gon Health Ser­vice (SALUD), Za­ra­go­za, Spain. RI­CAPPS, ISCIII; 4Group C-08 Bio­me­di­cal Re­se­arch In­sti­tu­te of Málaga (IBIMA), Málaga, Spain. Pri­ma­ry Care Health Cent­re Vic­to­ria, Health District Málaga-​Guadalhorce, An­da­lu­si­an Health Ser­vice, Málaga, Spain; 5Epi­Chron Re­se­arch Group, IACS, IIS Aragón, Mi­guel Ser­vet Uni­ver­si­ty Hos­pi­tal, 50009 Za­ra­go­za, Spain. RI­CAPPS, ISCIII.; 6Re­se­arch Unit, Pri­ma­ry Care As­si­s­tance Ma­nage­ment, Ma­drid Health Ser­vice. Dept of Me­di­cal Spe­cial­ties and Pu­blic Health, School of Health Sci­en­ces, Rey Juan Car­los Uni­ver­si­ty. IIS Gre­go­rio Marañon(IiSGM). RI­CAPPS, ISCIII. Ma­drid, Spain; 7Re­se­arch Unit,Pri­ma­ry Care As­si­s­tance Ma­nage­ment,Ma­drid Health Ser­vice.Dept of Me­di­cal Spe­cial­ties and Pu­blic Health, School of Health Sci­en­ces, Rey Juan Car­los Uni­ver­si­ty. IiSGM .RI­CAPPS,ISCIII. Ri­car­dos Ge­ne­ral Health Cen­ter,Ma­drid Health Ser­vice. Spain; 8Epi­Chron Re­se­arch Group, IACS, IIS Aragón, Mi­guel Ser­vet Uni­ve­si­ty Hos­pi­tal. Za­ra­go­za, Spain. RI­CAPPS, ISCIII.fran­cis­ca.leiva.sspa@jun­ta­de­an­da­lu­cia.es Ma­la­ga ES Dis­tri­to Sa­ni­ta­rio Malaga-​Guadalhorce

Mul­ti­mor­bi­di­ty (MM) is a wi­des­pread pro­blem and it poses un­sol­ved is­su­es like the health­ca­re pro­fes­sio­nals’ trai­ning. A trai­ning cur­ri­cu­lum has been pro­po­sed, but it has not been suf­fi­ci­ent­ly ex­plo­red in a cli­ni­cal con­text. The eMUL­TI­PAP cour­se was first de­ve­lo­ped as part of the MUL­TI­PAP com­plex in­ter­ven­ti­on, ap­p­lied th­rough a prag­ma­tic con­trol­led, clus­ter ran­do­mi­zed cli­ni­cal trial to ge­ne­ral prac­ti­tio­ners (GP) and his/her pa­ti­ents with MM with 12 months follow-​up. It has also been ap­p­lied in other re­se­arch con­text and usual prac­ti­ce con­di­ti­ons. The eMUL­TI­PAP cour­se is based on problem-​based lear­ning, con­st­ruc­ti­vism and Ari­ad­ne princi­ples, which its main ob­jec­ti­ve is to re­view the in­ter­na­tio­nal re­com­men­da­ti­ons for de­a­ling with MM and po­ly­me­di­ca­ti­on in pri­ma­ry care, mi­ni­mi­zing as far as pos­si­ble the safe­ty pro­blems for the pa­ti­ent. It has been as­ses­sed ac­cording to the Kirk­pa­trick model, con­side­ring 4 le­vels of eva­lua­ti­on: Re­ac­tion, Lear­ning, Be­ha­viour and Re­sults. The re­sults have shown high stu­dent sa­tis­fac­tion, know­ledge im­pro­vement and high ap­p­li­ca­bi­li­ty of lear­ning with more mo­ti­va­ti­on to con­sider MM in the cli­ni­cal prac­ti­ce all over the five edi­ti­ons. It has also been re­la­ted with an im­pro­vement in the Me­di­ca­ti­on Ap­pro­pria­ten­ess Index at 6 months and at 12 months. The con­t­ents have been ad­ap­ted ac­cording to the stu­dents' sug­ges­ti­ons, which has been re­flec­ted in lear­ning gains. We con­clu­de that the eMUL­TI­PAP cour­se ge­ne­ra­tes si­gni­fi­cant chan­ges in GP’s lear­ning, en­han­cing cli­ni­cal prac­ti­ce in mul­ti­mor­bi­di­ty sce­na­ri­os. These re­sults have been pu­blished in a re­port in Spa­nish: ISBN 978-​84-09-53990-1

Mar­cus Heu­mann

Pri­ma­ry health­ca­re nur­ses as fa­ci­li­ta­tors for the par­ti­ci­pa­ti­on and self-​care of pa­ti­ents with com­plex chro­nic con­di­ti­ons. Bar­ri­ers and en­ablers

Mar­cus Heu­mann1; Dr. Gun­du­la Röhnsch2; Dr. Edur­ne Zabaleta-​del-Olmo3; Prof. Dr. Bea­triz Ro­sa­na Gonçalves de Oli­vei­ra Toso4; Prof. Dr. Ligia Gio­va­nel­la5; Prof. Dr. Kers­tin Hämel1

1Bie­le­feld Uni­ver­si­ty; 2Freie Uni­ver­si­tät Ber­lin; 3Fund­a­ció In­sti­tut Uni­ver­si­ta­ri per a la Re­cer­ca a l'Aten­ció Primària de Salut Jordi Gol I Gu­ri­na (IDIAP­JGol); 4Wes­tern Paraná State Uni­ver­si­ty—UNIO­ES­TE; 5Na­tio­nal School of Pu­blic Health, Fundação Os­wal­do Cruz

Back­ground: Of­fe­ring person-​centred care for pa­ti­ents with com­plex chro­nic con­di­ti­ons chal­len­ges health­ca­re sys­tems world­wi­de. Strong mul­ti­pro­fes­sio­nal pri­ma­ry health­ca­re (PHC) can con­tri­bu­te by ad­dres­sing the mul­ti­ple so­cial and health needs of pa­ti­ents with chro­nic con­di­ti­ons and mul­ti­mor­bi­di­ty. PHC nur­ses are in­crea­sin­gly re­spon­si­ble for chro­nic care and par­ti­ci­pa­ti­on sup­port in mo­dels of team-​based care. It is the­re­fo­re im­portant to streng­t­hen their abi­li­ties to sup­port pa­ti­ent par­ti­ci­pa­ti­on and self-​care.

Aim: To iden­ti­fy bar­ri­ers and en­ablers PHC nur­ses face when sup­por­ting the par­ti­ci­pa­ti­on of pa­ti­ents with com­plex chro­nic con­di­ti­ons.

Me­thod: We con­duc­ted in­ter­views with 34 prac­ti­cing PHC nur­ses and 23 key in­for­mants in Bra­zil, Ger­ma­ny, and Spain. The data were ana­ly­sed from a cross-​country per­spec­ti­ve using the­ma­tic co­ding.

Re­sults: Four ca­te­go­ries for bar­ri­ers and en­ablers emer­ged. They refer to (1) nur­ses’ abi­li­ty to build “bonds” with pa­ti­ents and fos­ter trus­ting re­la­ti­ons­hips; (2) their ap­proach to streng­t­he­ning the re­sour­ces for self-​care in pa­ti­ents’ fa­mi­lies; (3) in how far nur­ses’ en­ga­ge­ment to­wards pa­ti­ent par­ti­ci­pa­ti­on is sup­por­ted by other pro­fes­si­ons in the PHC team; and (4) to what ex­tent nur­ses are fa­ci­li­ta­ted to en­ga­ge in par­ti­ci­pa­ti­on sup­port by their work en­vi­ron­ment, e.g., tech­ni­cal in­fra­st­ruc­tu­re and time to have con­ver­sa­ti­ons with pa­ti­ents.

Con­clu­si­on: PHC nur­ses are chal­len­ged to ad­dress the sup­port needs of pa­ti­ents with com­plex chro­nic con­di­ti­ons and en­ga­ge in pa­ti­ent par­ti­ci­pa­ti­on and self-​care, as these pa­ti­ents and their fa­mi­lies are often over­whel­med by the com­ple­xi­ty of chro­nic care. PHC nur­ses also see chan­ces for tailo­red health­ca­re pro­vi­si­on th­rough the par­ti­ci­pa­ti­on of pa­ti­ents with com­plex chro­nic con­di­ti­ons.

Ju­dith Fuchs

Pre­va­lence of mul­ti­mor­bi­di­ty and needs for in­ter­ven­ti­on in peop­le aged 65 and older in the na­ti­onwi­de study 'Ge­sund­heit 65+'

Dr. Ju­dith Fuchs; Dr. Beate Ga­ert­ner

Ro­bert Koch In­sti­tu­te

In­tro­duc­tion: Mul­ti­mor­bi­di­ty (MM) is one of the most im­portant and chal­len­ging aspects in pu­blic health and is as­so­cia­ted with phy­si­cal and men­tal health dis­or­ders, frail­ty, hos­pi­tal ad­mis­si­ons and po­ly­phar­ma­cy.

Me­thods: 'Ge­sund­heit 65+' is a population-​based lon­gi­tu­di­nal epi­de­mio­lo­gi­cal study on the health si­tua­ti­on of peop­le aged 65 years and older in Ger­ma­ny. Based on two-​stage stra­ti­fied ran­dom sam­pling from 128 local po­pu­la­ti­on re­gis­tries 3,694 in­di­vi­du­als par­ti­ci­pa­ted in the ba­se­li­ne sur­vey (re­spon­se 30.9%) bet­ween June 2021 and April 2022 (47.9% women, mean age 78.8 years). MM was de­fi­ned as the pre­sence of 2 or more di­sea­ses and health pro­blems (yes vs. no) from a list of 11 chro­nic di­sea­ses and health pro­blems (self-​reported 12-​month pre­va­lence of hy­per­ten­si­on, co­ro­na­ry heart di­sea­se, stro­ke, hy­per­cho­le­s­te­ro­le­mia, dia­be­tes, chro­nic bron­chi­tis, os­teo­ar­thri­tis, os­teo­po­ro­sis, lower back com­plaints or other chro­nic back com­plaints, de­pres­si­on and life-​time can­cer).

Re­sults: Over­all, 48.9% of the par­ti­ci­pants were mul­ti­mor­bid, women more often (53.6%, CI 50.4-56.8) than men (43.0%, CI 39.7-46.4) and the pre­va­lence was si­gni­fi­cant­ly hig­her in older in­di­vi­du­als. Women and men with MM re­por­ted si­gni­fi­cant­ly more often poo­rer self-​rated health, hos­pi­tal ad­mis­si­on in the last 12 month and the use of 5 and more pre­scri­bed me­di­ca­ti­ons (po­ly­phar­ma­cy) than par­ti­ci­pants wit­hout MM. Fur­ther­mo­re, women with MM re­por­ted lo­ne­li­ness more often.

Con­clu­si­on: MM is high­ly pre­va­lent in older peop­le and is as­so­cia­ted with ag­e­ing. In ad­di­ti­on to the ge­ne­ral re­com­men­da­ti­ons to pro­mo­te a healt­hy life­style (e.g., suf­fi­ci­ent ex­er­ci­se, ba­lan­ced diet), in­ter­ven­ti­ons in mul­ti­mor­bid in­di­vi­du­als should also ad­dress lo­ne­li­ness and po­ly­phar­ma­cy.

Dha­nee­sha Sen­arat­ne

The im­pact of ad­ver­se child­hood ex­pe­ri­en­ces on mul­ti­mor­bi­di­ty: a sys­te­ma­tic re­view and meta-​analysis

Dr. Dha­nee­sha Sen­arat­ne; Dr. Bhus­han Thak­kar; Prof. Blair Smith; Prof. Tim Hales; Dr. Loui­se Mar­ryat; Prof. Les­ley Col­vin

Uni­ver­si­ty of Dun­dee

Back­ground: Ad­ver­se child­hood ex­pe­ri­en­ces (ACEs) are po­ten­ti­al­ly stress­ful events or en­vi­ron­ments that occur be­fo­re the age of 18. They are im­pli­ca­ted in the ae­tio­lo­gy of long-​term health out­co­mes, in­clu­ding mul­ti­mor­bi­di­ty. In this sys­te­ma­tic re­view and meta-​analysis we aimed to ag­gre­ga­te the cur­rent evi­den­ce lin­king ACEs and mul­ti­mor­bi­di­ty.

Me­thods: We se­ar­ched seven da­ta­ba­ses from in­cep­ti­on to 20 July 2023 (PRO­SPE­RO: CRD42023389528). We selec­ted stu­dies with ad­ver­se events ha­ving oc­cur­red du­ring child­hood (< 18 years) and an as­sess­ment of mul­ti­mor­bi­di­ty in adult­hood (≥ 18 years). Stu­dies that only as­ses­sed ad­ver­se events in adult­hood or health out­co­mes in child­hood were ex­clu­ded. Risk of bias was as­ses­sed using the ROBINS-​E tool. We per­for­med meta-​analysis of pre­va­lence and dose-​response meta-​analysis for quan­ti­ta­ti­ve data syn­the­sis.

Re­sults: From 15,586 re­cords, 25 stu­dies were eli­gi­ble for in­clu­si­on (372,162 par­ti­ci­pants). The pre­va­lence of ex­po­sure to ≥ 1 ACE was 48.1% (95% CI 33.4-63.1%). The pre­va­lence of mul­ti­mor­bi­di­ty was 34.5% (95% CI 23.4-47.5%). Eight stu­dies pro­vi­ded suf­fi­ci­ent data for dose-​response meta-​analysis (197,981 par­ti­ci­pants). There was a si­gni­fi­cant dose-​dependent re­la­ti­ons­hip bet­ween ACE ex­po­sure and mul­ti­mor­bi­di­ty (p < 0.001), with every ad­di­tio­nal ACE con­tri­bu­ting a 12.9% (95% CI 7.9-17.9%) in­crea­se in the odds for mul­ti­mor­bi­di­ty. How­e­ver, there was he­te­ro­gen­ei­ty among the in­clu­ded stu­dies (I2 = 76.9%, Co­ch­ran Q = 102, p < 0.001).

Dis­cus­sion: This sys­te­ma­tic re­view and meta-​analysis de­mons­tra­tes a dose-​dependent re­la­ti­ons­hip bet­ween ACEs and mul­ti­mor­bi­di­ty across a large num­ber of par­ti­ci­pants. It builds on an ex­ten­si­ve body of li­te­ra­tu­re that shows an as­so­cia­ti­on bet­ween ACEs and poor long-​term health out­co­mes.

Ni­ko­laj Nor­mann Holm

Clus­te­ring mul­ti­mor­bid di­sea­se tra­jec­to­ries in disease-​space and time

Ni­ko­laj Nor­mann Holm; Dr. Thao Minh Le; Prof. Anne Frølich; Prof. Ove An­der­sen; Helle Gybel Juul-​Larsen; An­ders Stockmarr; Prof. Sve­tha Ven­ka­tesh

Tech­ni­cal Uni­ver­si­ty of Den­mark

Na­ti­onwi­de clus­te­ring ana­ly­ses have pre­vious­ly been em­ploy­ed to high­light mul­ti­mor­bi­di­ty pat­terns, which can be used as a basis for fo­cu­sed in­ter­ven­ti­ons. His­to­ri­cal­ly, such ana­ly­ses have uti­li­zed cross-​sectional data, ne­glec­ting the tem­po­ral dy­na­mics in­flu­en­cing mul­ti­mor­bi­di­ty pro­gres­si­on.

We in­tro­du­ce a novel, deep lear­ning ap­proach for tem­po­ral disease-​based clus­te­ring, where clus­ters are for­med from di­sea­se port­fo­li­os ari­sing around the same sta­ges in life. The ap­proach re­li­es on a lon­gi­tu­di­nal da­ta­set of chro­nic di­sea­ses, pos­si­bly de­ri­ved from elec­tro­nic health re­cords.

We eva­lua­ted our ap­proach on a da­ta­set con­tai­ning the en­ti­re adult Da­nish po­pu­la­ti­on of chro­nic heart di­sea­se (HD) pa­ti­ents in 1995-​2015, com­pri­sing 766,596 in­di­vi­du­als. We uti­li­zed al­go­rith­mic dia­gno­ses for 15 chro­nic di­sea­ses, tar­ge­ting dia­gno­ses from pri­ma­ry and se­con­da­ry health­ca­re sec­tors.

We de­mons­tra­te how the spa­tio­tem­po­ral clus­ters ob­tai­ned from our model can pro­vi­de a novel un­der­stan­ding of the de­ve­lo­p­ment of mul­ti­mor­bi­di­ty over time. The pre­sence of high cho­le­s­te­rol, os­teo­po­ro­sis and de­men­tia were pi­vo­tal in cha­rac­te­ri­zing the se­pa­ra­te clus­ters ari­sing at dif­fe­rent sta­ges in life in the HD po­pu­la­ti­on. Our ana­ly­sis of pa­ti­ent tran­si­ti­ons among clus­ters un­vei­led three main tra­jec­to­ry pa­thways. One path fea­tured re­spi­ra­to­ry mul­ti­mor­bi­di­ty, which was ty­pi­cal for heart failu­re pa­ti­ents. Ano­ther was com­pli­ca­ted by hy­per­ten­si­on and dia­be­tes, while a third pa­thway was cha­rac­te­ri­zed by early mul­ti­mor­bi­di­ty and high cho­le­s­te­rol, ty­pi­cal for is­chemic heart di­sea­se pa­ti­ents. Our fin­dings il­lus­tra­te the ad­van­ta­ges of con­duc­ting tem­po­ral clus­ter ana­ly­ses on mul­ti­mor­bi­di­ty, which can fa­ci­li­ta­te tar­ge­ted early-​stage in­ter­ven­ti­ons.

The pro­po­sed ap­proach is ver­sa­ti­le and does not re­qui­re con­di­tio­ning on a spe­ci­fic di­sea­se, such as HD.

An­ders Stockmarr

Clus­ters of Chro­nic Di­sea­ses in the Da­nish Po­pu­la­ti­on

Dr. An­ders Stockmarr PhD1; Prof. Anne Frølich PhD2

1Tech­ni­cal Uni­ver­si­ty of Den­mark; 2Uni­ver­si­ty of Co­pen­ha­gen

With the aging of Eu­ropean po­pu­la­ti­ons, clus­ters of in­di­vi­du­als with chro­nic con­di­ti­ons are a way of map­ping the struc­tu­re of the po­pu­la­ti­on that in the fu­ture will chal­len­ge our heaths sec­tors, and who will ex­pe­ri­ence a life­time with more pres­su­re from chro­nic con­di­ti­ons, chal­len­ging their Qua­li­ty of Life. From al­go­rith­mic dia­gno­ses of the en­ti­re Da­nish po­pu­la­ti­on, we dis­cuss pro­per­ties of clus­ters of in­di­vi­du­als, and tech­ni­ques to crea­te these. This in­clu­des de­tailed stu­dies of co-​occurrences of di­sea­ses, so­ci­ode­mo­gra­phy, ge­ne­ral health, and chal­len­ges with com­mon clus­te­ring me­cha­nisms.

Danny An­thoni­mut­hu

Usage of ma­chi­ne lear­ning in mul­ti­mor­bi­di­ty re­se­arch: pro­to­col for a scoping re­view

Danny An­thoni­mut­hu1; Ole He­j­le­sen; Ann-​Dorthe Olsen Zwis­ler; Flem­ming Witt Udsen

1Aal­borg uni­ver­si­ty

Back­ground: Mul­ti­mor­bi­di­ty, the pre­sence of mul­ti­ple chro­nic con­di­ti­ons, poses glo­bal health­ca­re chal­len­ges, lea­ding to in­crea­sed mor­ta­li­ty, re­du­ced qua­li­ty of life, and hig­her costs. The bur­den of mul­ti­mor­bi­di­ty is ex­pec­ted to wor­sen if no ef­fec­ti­ve in­ter­ven­ti­on is taken. Ma­chi­ne lear­ning has the po­ten­ti­al to as­sist in ad­dres­sing these chal­len­ges by pro­vi­ding ad­van­ced ana­ly­sis for di­sea­se pre­dic­tion, tre­at­ment de­ve­lo­p­ment, and cli­ni­cal stra­te­gies.

Ob­jec­ti­ve: This paper re­p­res­ents the pro­to­col of a scoping re­view, which aims to iden­ti­fy and ex­plo­re the cur­rent li­te­ra­tu­re con­cer­ning the uti­liza­ti­on of ma­chi­ne lear­ning for mul­ti­mor­bi­di­ty pa­ti­ents. Fur­ther­mo­re, the scoping re­view will also ex­plo­re the avail­able li­te­ra­tu­re in in­ves­ti­ga­ting the usa­bi­li­ty and in­ter­face aspects of ma­chi­ne lear­ning mo­dels de­si­gned for pa­ti­ents with mul­ti­mor­bi­di­ty.

Me­thods: The scoping re­view will be based on the gui­de­li­nes of the Pre­fer­red Re­por­ting Items for Sys­te­ma­tic Re­views and Meta-​analyses ex­ten­si­on for Scoping Re­views (PRISMA-​ScR). 5 da­ta­ba­ses (Pub­Med, EM­BA­SE, IEEE, Web of Sci­ence, and Scopus) are cho­sen to con­duct a li­te­ra­tu­re se­arch. Qua­li­fied stu­dies will un­der­go a scree­ning pro­cess of title, abs­tract, and full text.

Re­sults: The fin­dings of the scoping re­view will be con­vey­ed th­rough a nar­ra­ti­ve syn­the­sis. Ad­di­tio­nal­ly, data ex­trac­ted from the stu­dies will be for­mat­ted in a more com­pre­hen­si­ve man­ner, such as charts or ta­bles. The re­sults will be pre­sen­ted in a forth­co­ming scoping re­view, which will be pu­blished in a peer-​reviewed jour­nal.

Con­clu­si­on: This scoping re­view will offer in­sight into exis­ting li­te­ra­tu­re on ma­chi­ne lear­ning in mul­ti­mor­bi­di­ty pa­ti­ents, out­lining ap­proa­ches and iden­ti­fy­ing re­se­arch gaps.

Des­mond Luan Seng Ong

De­ve­lo­ping a value-​driven ap­proach to the ma­nage­ment of mul­ti­mor­bi­di­ty in pri­ma­ry care

Des­mond Luan Seng Ong1; Chun Yen Beh1; Cindy Shiqi Zhu1; Meena Sund­ram1; Yew Seng Kwan1; Ali­cia Hui­y­ing Ong1; Hwei Ming Tan1; Ming Hann Cheah1; Jose Maria Val­de­ras2

1Na­tio­nal Uni­ver­si­ty Po­ly­cli­nics; 2Na­tio­nal Uni­ver­si­ty of Sin­ga­po­re

Back­ground: Mul­ti­mor­bi­di­ty is as­so­cia­ted with poo­rer pri­ma­ry care pro­ces­ses and out­co­mes. Re­li­an­ce on exis­ting condition-​specific pro­cess and out­co­me in­di­ca­tors of qua­li­ty and safe­ty may be sub­op­ti­mal if not in­a­de­qua­te for eva­lua­ting the ma­nage­ment of mul­ti­mor­bi­di­ty. Ap­pro­pria­te in­di­ca­tor me­a­su­res are es­sen­ti­al to sup­port per­for­mance eva­lua­ti­on and qua­li­ty im­pro­vement in the ma­nage­ment of mul­ti­mor­bi­di­ty in pri­ma­ry care.

Aim: To com­pre­hen­si­ve­ly iden­ti­fy avail­able pro­cess and out­co­me in­di­ca­tors for the qua­li­ty and safe­ty of the ma­nage­ment of mul­ti­mor­bi­di­ty in pri­ma­ry care.

Me­thods: We per­for­med a sys­te­ma­tic re­view of sci­en­ti­fic pu­bli­ca­ti­ons that used, de­ve­lo­ped and/or eva­lua­ted pro­cess and out­co­mes in­di­ca­tors in the ma­nage­ment of mul­ti­mor­bi­di­ty in pri­ma­ry care fol­lo­wing a de­tailed pro­to­col (PRO­SPE­RO CRD42023388669). With the help of a li­bra­ri­an, we for­mu­la­ted a se­arch stra­te­gy or­ga­ni­zed in three main blocks (mul­ti­mor­bi­di­ty, qua­li­ty and safe­ty, and pri­ma­ry care), which was im­ple­men­ted in elec­tro­nic da­ta­ba­ses (MED­LI­NE, EM­BA­SE, CI­NAHL, Scopus, and Web of Sci­ence). Two re­view­ers in­de­pendent­ly scree­n­ed the tit­les, abs­tracts, and full-​texts. Data will be ex­trac­ted from the in­clu­ded full texts using a data ex­trac­tion form.

Re­sults: A total of 3714 ar­ti­cles were re­trie­ved. After scree­ning, 26 pu­bli­ca­ti­ons were dee­med eli­gi­ble. Pu­bli­ca­ti­ons in­clu­ded pa­pers on de­ve­lo­p­ment of in­di­ca­tors, eva­lua­ti­on of in­di­ca­tors, as well as in­ter­ven­tio­nal stu­dies with in­di­ca­tors as out­co­me me­a­su­res. Scree­ning of ci­ta­ti­ons and data ex­trac­tion are on­go­ing. Re­sults will in­clu­de pu­bli­ca­ti­on cha­rac­te­ris­tics and the iden­ti­fied in­di­ca­tors.

Con­clu­si­ons: Fin­dings from this re­view will help in­form and de­ve­lop a set of pro­cess and out­co­me in­di­ca­tors for the ma­nage­ment of mul­ti­mor­bi­di­ty in pri­ma­ry care in Sin­ga­po­re.

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