Journal of comorbidity最新文献

{"title":"The Patient Centered Assessment Method (PCAM): integrating the social dimensions of health into primary care.","authors":"Rebekah Pratt,&nbsp;Carina Hibberd,&nbsp;Isobel M Cameron,&nbsp;Margaret Maxwell","doi":"10.15256/joc.2015.5.35","DOIUrl":"https://doi.org/10.15256/joc.2015.5.35","url":null,"abstract":"<p><strong>Background: </strong>Social dimensions of health are known to contribute to what is often termed \"patient complexity,\" which is particularly common among patients with multimorbidity. Health-care professionals require tools to help them identify and manage these aspects of patient needs.</p><p><strong>Objectives: </strong>To examine: (i) the Patient Centered Assessment Method (PCAM), a tool for assessing patient complexity in ways that are sensitive to the biopsychosocial dimensions of health, in primary care settings in Scotland; (ii) the impact of the PCAM on referral patterns and its perceived value; and (iii) the PCAM's perceived applicability for use in a complex patient population.</p><p><strong>Design: </strong>Two studies are described: (i) a mixed-methods prospective cohort study of the implementation of the PCAM in primary care clinics; and (ii) a qualitative exploratory study that evaluated the value of the PCAM in a complex patient population.</p><p><strong>Results: </strong>Use of the PCAM did not impact patient satisfaction or perception of practitioners' empathy, but it did increase both the number of onward referrals per referred patient (9-12%) and the proportion of referrals to non-medical services addressing psychological, social, and lifestyle needs. Nurses valued the PCAM, particularly its ability to help them address psychological and social domains of patients' lives, and found it to be highly relevant for use in populations with known high complexity.</p><p><strong>Conclusions: </strong>The PCAM represents a feasible approach for assessing patient needs with consideration to the social dimensions of health, and allows practitioners to refer patients to a broader range of services to address patient complexity.</p>","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":"5 ","pages":"110-119"},"PeriodicalIF":0.0,"publicationDate":"2015-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15256/joc.2015.5.35","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35561290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"11th International Conference on Developmental Coordination Disorder (DCD11)","authors":"Dcd Congress Abstracts","doi":"10.15256/joc.2015.5.52","DOIUrl":"https://doi.org/10.15256/joc.2015.5.52","url":null,"abstract":"DCD11 – Developmental coordination disorder and other neurodevelopmental disorders: a focus on comorbidity; Toulouse, France, July 2-4, 2015 Comorbidity refers to the presence of two or more disorders in the same person (especially DCD, dyslexia and attention deficit hyperactivity disorder in terms of developmental disorders). There has been growing interest in the presence of comorbidity in persons with neurodevelopmental disorders. Many recent studies suggest that up to half of all individuals diagnosed with a psychiatric or neurodevelopmental disorder have more than one condition. Comorbidity not only impacts patient outcomes but can also create a significant strain on both family and school life. It can also complicate diagnosis and healthcare organization. The 11 th congress on DCD aimed to address some of the important issues surrounding comorbidity in neurodevelopmental disorders. Three main topics were covered during oral and poster presentations: (1) assessment and diagnostic criteria, (2) underlying processes, causal factors, and prognostic markers, and (3) intervention and management of DCD and associated disorders. Journal of Comorbidity 2015;5(2):32–109","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":"5 1","pages":"32 - 109"},"PeriodicalIF":0.0,"publicationDate":"2015-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15256/joc.2015.5.52","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67070791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimorbidity or polypharmacy: two sides of the same coin?","authors":"Carol Sinnott,&nbsp;Colin P Bradley","doi":"10.15256/joc.2015.5.51","DOIUrl":"https://doi.org/10.15256/joc.2015.5.51","url":null,"abstract":"Polypharmacy, broadly defined as the chronic co-prescription of several drugs [1], has long been recognized as problematic. The greater the number of medicines a patient takes, the greater the risk of adverse effects of any one medicine, and the greater the risk of drug–drug interactions. Thus, polypharmacy is an accepted risk for poor health outcomes, including hospitalizations and mortality [2]. The number of drugs per patient (or polypharmacy) has come to be used as a measure of potentially hazardous professional behaviour, and is sometimes used in conjunction with the term ‘inappropriate prescribing’. Nonetheless, the prevalence of polypharmacy is rising inexorably [3]. This rise is driven, principally, by the rising prevalence of multimorbidity, i.e. the co-occurrence of two or more chronic long-term diseases or conditions in one patient [4]. The issue is compounded by clinical guidelines that advocate the use of several medicines in the management of individual diseases and their associated risk factors [5]. The result is a dilemma for prescribers: on the one hand there is the need to keep the number of medicines to a minimum, while on the other ensuring that the patient receives what evidence-based guidelines advocate as being in their best interest [6].  Journal of Comorbidity 2015;5(1):29–31","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":"5 ","pages":"29-31"},"PeriodicalIF":0.0,"publicationDate":"2015-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15256/joc.2015.5.51","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35561289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Care coordination of multimorbidity: a scoping study.","authors":"Anne Doessing,&nbsp;Viola Burau","doi":"10.15256/joc.2015.5.39","DOIUrl":"https://doi.org/10.15256/joc.2015.5.39","url":null,"abstract":"<p><strong>Background: </strong>A key challenge in healthcare systems worldwide is the large number of patients who suffer from multimorbidity; despite this, most systems are organized within a single-disease framework.</p><p><strong>Objective: </strong>The present study addresses two issues: the characteristics and preconditions of care coordination for patients with multimorbidity; and the factors that promote or inhibit care coordination at the levels of provider organizations and healthcare professionals.</p><p><strong>Design: </strong>The analysis is based on a scoping study, which combines a systematic literature search with a qualitative thematic analysis. The search was conducted in November 2013 and included the PubMed, CINAHL, and Web of Science databases, as well as the Cochrane Library, websites of relevant organizations and a hand-search of reference lists. The analysis included studies with a wide range of designs, from industrialized countries, in English, German and the Scandinavian languages, which focused on both multimorbidity/comorbidity and coordination of integrated care.</p><p><strong>Results: </strong>The analysis included 47 of the 226 identified studies. The central theme emerging was complexity. This related to both specific medical conditions of patients with multimorbidity (case complexity) and the organization of care delivery at the levels of provider organizations and healthcare professionals (care complexity).</p><p><strong>Conclusions: </strong>In terms of how to approach care coordination, one approach is to reduce complexity and the other is to embrace complexity. Either way, future research must take a more explicit stance on complexity and also gain a better understanding of the role of professionals as a prerequisite for the development of new care coordination interventions.</p>","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":"5 ","pages":"15-28"},"PeriodicalIF":0.0,"publicationDate":"2015-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15256/joc.2015.5.39","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35561288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coping with complexity: working beyond the guidelines for patients with multimorbidities.","authors":"Julian Treadwell","doi":"10.15256/joc.2015.5.49","DOIUrl":"https://doi.org/10.15256/joc.2015.5.49","url":null,"abstract":"Primary care physicians believe they are delivering evidence-based care, understanding that adherence to evidence-based clinical guidelines results in tangible benefits in the populations for which they were developed. Unfortunately, most clinical guidelines are based on trial populations which are very different to primary care populations [1], and do not reflect the reality of multimorbidity in general practice [2–6]. Since patients with multimorbidity account for around eight in every 10 primary care consultations [7], it is unsurprising that many primary care physicians find managing these patients challenging. Additionally, current clinical guidelines do not provide guidance on how best to prioritize recommendations for individuals with multimorbidity, and may therefore result in over-treatment and polypharmacy, and a risk of overlooking patient preferences [2,8].  Journal of Comorbidity 2015;5(1):11–14","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":"5 ","pages":"11-14"},"PeriodicalIF":0.0,"publicationDate":"2015-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15256/joc.2015.5.49","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35561287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke rehabilitation and patients with multimorbidity: a scoping review protocol.","authors":"Michelle L A Nelson, Linda Kelloway, Deirdre Dawson, J Andrew McClure, Kaileah A McKellar, Anita Menon, Sarah Munce, Kara Ronald, Robert Teasell, Michael Wasdell, Renee F Lyons","doi":"10.15256/joc.2015.5.47","DOIUrl":"10.15256/joc.2015.5.47","url":null,"abstract":"<p><p>Stroke care presents unique challenges for clinicians, as most strokes occur in the context of other medical diagnoses. An assessment of capacity for implementing \"best practice\" stroke care found clinicians reporting a strong need for training specific to patient/system complexity and multimorbidity. With mounting patient complexity, there is pressure to implement new models of healthcare delivery for both quality and financial sustainability. Policy makers and administrators are turning to clinical practice guidelines to support decision-making and resource allocation. Stroke rehabilitation programs across Canada are being transformed to better align with the Canadian Stroke Strategy's Stroke Best Practice Recommendations. The recommendations provide a framework to facilitate the adoption of evidence-based best practices in stroke across the continuum of care. However, given the increasing and emerging complexity of patients with stroke in terms of multimorbidity, the evidence supporting clinical practice guidelines may not align with the current patient population. To evaluate this, electronic databases and gray literature will be searched, including published or unpublished studies of quantitative, qualitative or mixed-methods research designs. Team members will screen the literature and abstract the data. Results will present a numerical account of the amount, type, and distribution of the studies included and a thematic analysis and concept map of the results. This review represents the first attempt to map the available literature on stroke rehabilitation and multimorbidity, and identify gaps in the existing research. The results will be relevant for knowledge users concerned with stroke rehabilitation by expanding the understanding of the current evidence.</p>","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":"5 ","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2015-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5636031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35561286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing research quality and reporting: why the <i>Journal of Comorbidity</i> is now publishing study protocols.","authors":"Susan M Smith,&nbsp;Stewart W Mercer,&nbsp;Jane Gunn,&nbsp;Marjan van den Akker,&nbsp;Martin Fortin","doi":"10.15256/joc.2014.4.46","DOIUrl":"https://doi.org/10.15256/joc.2014.4.46","url":null,"abstract":"The Journal of Comorbidity was launched in 2011 and has since become established as a high-quality journal that publishes open-access, peer-reviewed articles, with a focus on advancing the clinical management of patients with comorbidity/multimorbidity. To further enhance research quality and reporting of studies in this field, the journal is now offering authors the opportunity to publish a summary of their study protocols – a move designed to generate interest and raise awareness in ongoing clinical research and to enable researchers to detail their methodologies in order that replication by scientific peers is possible. Journal of Comorbidity 2014;4(1):55−57","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":"4 ","pages":"55-57"},"PeriodicalIF":0.0,"publicationDate":"2014-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15256/joc.2014.4.46","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35561285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimorbidity in patients enrolled in a community-based methadone maintenance treatment programme delivered through primary care.","authors":"Diane E Arnold-Reed,&nbsp;Tom Brett,&nbsp;Lakkhina Troeung,&nbsp;Jasmine O'Neill,&nbsp;Rupert Backhouse,&nbsp;Max K Bulsara","doi":"10.15256/joc.2014.4.42","DOIUrl":"https://doi.org/10.15256/joc.2014.4.42","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity, the co-existence of two or more (2+) long-term conditions in an individual, is common among problem drug abusers.</p><p><strong>Objective: </strong>To delineate the patterns, multimorbidity prevalence, and disease severity in patients enrolled in a community-based primary care methadone maintenance treatment (MMT) programme.</p><p><strong>Design: </strong>This was a retrospective cohort study (<i>n</i>=274). The comparator group consisted of mainstream primary care patients. Electronic medical record assessment was performed using the Cumulative Illness Rating Scale.</p><p><strong>Results: </strong>Prevalence of multimorbidity across 2+ domains was significantly higher within the MMT sample at 88.7% (243/274) than the comparator sample at 51.8% (142/274), <i>p</i><0.001. MMT patients were seven times more likely to have multimorbidity across 2+ domains compared with mainstream patients (OR 7.29, 95% confidence interval 4.68-11.34; <i>p</i><0.001). Prevalence of multimorbidity was consistently high across all age groups in the MMT cohort (range 87.8-100%), while there was a positive correlation with age in the comparator cohort (<i>r</i>=0.29, <i>p</i><0.001). Respiratory, psychiatric, and hepatic-pancreatic domains were the three most common domains with multimorbidity. Overall, MMT patients (mean±SD, 1.97±0.43) demonstrated significantly higher disease severity than mainstream patients (mean±SD, 1.18±0.78), <i>p<</i>0.001. Prevalence of moderate disease severity observed in the <45-year MMT age group was 50% higher than the ≥45-year comparator age group.</p><p><strong>Conclusions: </strong>Prevalence of multimorbidity and disease severity in MMT patients was greater than in the age- and sex-matched comparators. Patients with a history of drug abuse require co-ordinated care for treatment of their addiction, and to manage and prevent chronic illnesses. Community-based programmes delivered through primary care help fulfil this need.</p>","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":"4 ","pages":"46-54"},"PeriodicalIF":0.0,"publicationDate":"2014-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15256/joc.2014.4.42","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35561284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-management interventions in patients with long-term conditions: a structured review of approaches to reporting inclusion, assessment, and outcomes in multimorbidity.","authors":"Cassandra Kenning,&nbsp;Peter A Coventry,&nbsp;Peter Bower","doi":"10.15256/joc.2014.4.33","DOIUrl":"https://doi.org/10.15256/joc.2014.4.33","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity has many potential implications for healthcare delivery, but a particularly important impact concerns the validity of trial evidence underpinning clinical guidelines for individual conditions.</p><p><strong>Objective: </strong>To review how authors of published trials of self-management interventions reported inclusion criteria, sample descriptions, and consideration of the impact of multimorbidity on trial outcomes.</p><p><strong>Methods: </strong>We restricted our analysis to a small number of exemplar long-term conditions: type 2 diabetes mellitus, coronary heart disease, and chronic obstructive pulmonary disease. We focussed our search on published Cochrane reviews. Data were extracted from the trials on <i>inclusion/exclusion</i>, <i>sample description</i>, and <i>impact on outcomes</i>.</p><p><strong>Results: </strong>Eleven reviews consisting of 164 unique trials were identified. Sixty percent of trials reported excluding patients with forms of multimorbidity. Reasons for exclusion were poorly described or defined. Reporting of multimorbidity within the trials was poor, with only 35% of trials reporting on multimorbidity in their patient samples. Secondary analyses, exploring the impact of multimorbidity, were very rare.</p><p><strong>Conclusions: </strong>The importance of multimorbidity in trials is only going to become more important over time, but trials often exclude patients with multimorbidity, and reporting of multimorbidity in trials including such patients is generally poor. This limits judgements about the external validity of the results for clinical populations. A consistent approach to the conduct and reporting of secondary analyses of the effects of multimorbidity on outcomes, using current best-practice guidance, could lead to a rapid development of the evidence base.</p>","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":"4 ","pages":"37-45"},"PeriodicalIF":0.0,"publicationDate":"2014-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15256/joc.2014.4.33","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35561283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Competing risks of cancer mortality and cardiovascular events in individuals with multimorbidity.","authors":"Elizabeth A Bayliss,&nbsp;Liza M Reifler,&nbsp;Chan Zeng,&nbsp;Deanna B McQuillan,&nbsp;Jennifer L Ellis,&nbsp;John F Steiner","doi":"10.15256/joc.2014.4.41","DOIUrl":"https://doi.org/10.15256/joc.2014.4.41","url":null,"abstract":"<p><strong>Background: </strong>Cancer patients with cardiovascular and other comorbidities are at concurrent risk of multiple adverse outcomes. However, most treatment decisions are guided by evidence from single-outcome models, which may be misleading for multimorbid patients.</p><p><strong>Objective: </strong>We assessed the interacting effects of cancer, cardiovascular, and other morbidity burdens on the competing outcomes of cancer mortality, serious cardiovascular events, and other-cause mortality.</p><p><strong>Design: </strong>We analyzed a cohort of 6,500 adults with initial cancer diagnosis between 2001 and 2008, SEER 5-year survival ≥26%, and a range of cardiovascular risk factors. We estimated the cumulative incidence of cancer mortality, a serious cardiovascular event (myocardial infarction, coronary revascularization, or cardiovascular mortality), and other-cause mortality over 5 years, and identified factors associated with the competing risks of each outcome using cause-specific Cox proportional hazard models.</p><p><strong>Results: </strong>Following cancer diagnosis, there were 996 (15.3%) cancer deaths, 328 (5.1%) serious cardiovascular events, and 542 (8.3%) deaths from other causes. In all, 4,634 (71.3%) cohort members had none of these outcomes. Although cancer prognosis had the greatest effect, cardiovascular and other morbidity also independently increased the hazard of each outcome. The effect of cancer prognosis on outcome was greatest in year 1, and the effect of other morbidity was greater in individuals with better cancer prognoses.</p><p><strong>Conclusion: </strong>In multimorbid oncology populations, comorbidities interact to affect the competing risk of different outcomes. Quantifying these risks may provide persons with cancer plus cardiovascular and other comorbidities more accurate information for shared decision-making than risks calculated from single-outcome models. Journal of Comorbidity 2014;4:29-36.</p>","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":"4 ","pages":"29-36"},"PeriodicalIF":0.0,"publicationDate":"2014-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15256/joc.2014.4.41","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35561282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}