Multimorbidity
Conditions
Keywords
Multimorbidity, Primary Health Care, Trajectories, Mixed-methods, Patterns, Qualitative study, Discussion group, Semi-structured interviews, Photovoice, Shared decision-making, Cluster
Brief summary
The overall objective of the study is to analyze the evolution of multimorbidity, its most relevant patterns and trajectories in the Spanish National Health System population, from 2012 to 2022, and to analyze the factors that determine it, as well as the experience of professionals and patients in navigating the health system and in shared decision making. Multimorbidity trajectories can help identify homogeneous groups of individuals with similar needs and prognoses, and help practitioners and health systems to personalize clinical interventions and preventive strategies. Capturing this dynamism is the only way to better understand the natural history of multimorbidity and shed light on hitherto unexplained findings.
Detailed description
* Design: Mixed-method study. * Quantitative study: retrospective and prospective observational study. It integrates demographic and clinical information from electronic medical records and clinical-administrative databases. It involves the harmonisation of the cohorts of users of the public health system of the 7 participating regions. * Qualitative study with a phenomenological and ethnographic approach using focus group techniques, semi-structured interviews and Photovoice to find out the perspective of patients and professionals in shared decision-making. * Systematic literature review on the effectiveness of interventions on training, multimorbidity and polypharmacy in health professionals. * Analysis: * Quantitative study: Cluster, network and trajectory analysis * Qualitative study: Thematic content analysis that will be triangulated among the members of the research team. Meanings will be interpreted and an explanatory framework will be created with the contributions of each type of informant.
Interventions
OTHERRetrospective and prospective cohort
* Retrospective study: Population-based retrospective cohort study with RWD. Patients ≥60 years old with 2 or more chronic diseases diagnosed before 01/01/2012, users of the public health system of the participating Autonomous Communities, will be included. Those who have had no contact with primary care defined as contact in a medical or nursing consultation in the previous two years (2010-2012) will be excluded. * Prospective longitudinal observational open cohort study developed in the context of the MULTIPAP and LOXO studies.Patients over 65 years of age with multimorbidity (3 or more chronic pathologies) and polypharmacy (5 or more drugs taken during at least the last 3 months before inclusion in the study) under follow-up from primary care in Madrid, Aragon and Andalusia.
OTHERFocus group, semi-structured interviews and Photovoice
The participants will be people with multimorbidity over 60 years of age recruited from Primary Care centers in Spain. A theoretical sampling will be carried out. Data will be collected through video and audio recordings from a total of 16 focus groups and 20 interviews in 7 regions, and will finally be transcribed for a triangulated thematic analysis. Two groups will be carried out with participation-action research methodology - Photovoice.
OTHERSystematic review
No patient recruitment required
Sponsors
PI. Bernardino Oliva. Instituto Investigación Sanitaria Illes Balears
Fundacio d'Investigacio en Atencio Primaria Jordi Gol i Gurina
PI Antonio Gimeno. Instituto de Investigación Sanitaria Aragón.
PI. Rafael Rotaeche. Instituto Investigación Bioguipuzcoa. Osakidetza
PI. Francisca Leiva. Instituto de Investigacion Biomedica de Malaga.
CI. Julian Librero. Navarra Biomed. Servicio Navarro de Salud
Fundación Investigacion en Innovacion Biomédica en Atención Primaria FIIBAP
Instituto de Investigación Sanitaria Gregorio Marañón
Gerencia de Atención Primaria, Madrid
Study design
Observational model
OTHER
Time perspective
OTHER
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 60 years or older * 2 or more chronic diseases
Exclusion criteria
\- Not having used the national health system in the last year
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Use of service | 1 year | Primary Care medical/nursing visits, emergencies, referrals, admissions |
| Drugs | 1 year | 300 ATC Swedish National Study of Ageing and Care (SNAC-K20) 8It is a classification, not a scale) |
| Multimorbidity | Baseline | Presence of two or more diagnoses of any of the 60 diseases categorised by the Swedish National Study of Ageing and Care (SNAC-K20) (It is a classification, not a scale) |
| Death | Start date 31/12/2012, 1 year | Death and abandonment: the occurrence of this event will be measured, regardless of the cause |
| Frailty | Baseline/ 1 year | EFRAIL (It consists of 5 dichotomous questions. Scoring from 0 to 5. Interpretation: * Probable frailty: 3 to 5 points. * Probable pre-fragility: 1 to 2 points. * No fragility or robustness: 0 points) |
| Morbidity | Baseline/ 1 year | Defined with ICD-10, laboratory defined in the Swedish National Study of Ageing and Care (SNAC-K20). It is a classification, not a scale |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Health releated quality of life | Baseline | Euroqol 5D-5L (It consists of 2 parts - The EQ-5D descriptive system and the Visual Analog Scale (VAS). Scale (VAS). In the VAS the individual scores his or her health between two extremes, 0 and 100, the worst and the best state of health imaginable. imaginable) |
| Adherence | Baseline | Morisky-Green (Patients who answer NO to all four questions are considered compliant with treatment and those who answer YES to one or more are considered non-compliant) |
| Social support | Baseline | Dukes-Unk-11(This questionnaire consists of 11 items and a Likert-type response scale. The score range is between 11 and 55 points. A score equal to or greater than 32 indicates normal support, while a score of less than 32 indicates low perceived social support) |
| Functioning and disability | Baseline/ 1 year | WHODAS (It is composed of 36 items that evaluate the following 6 dimensions. The overall score runs a scale from 0 to 100, with higher values indicating greater disability) |
Other
| Measure | Time frame | Description |
|---|---|---|
| Age | Baseline | Years |
| Deprivation Index | Baseline | MEDEA (Values from 1 to 5. Higher values indicate a more unfavorable socioeconomic situation) |
| Country | Baseline | Country of origin |
| Sex | Baseline | Male/Female |
Countries
Spain
Outcome results
None listed