What research agenda could be generated from the European General Practice Research Network concept of Multimorbidity in Family Practice?

J Y Le Reste, P Nabbe, H Lingner, D Kasuba Lazic, R Assenova, M Munoz, A Sowinska, C Lygidakis, C Doerr, S Czachowski, S Argyriadou, J Valderas, B Le Floch, J Deriennic, T Jan, E Melot, P Barraine, M Odorico, C Lietard, P Van Royen, H Van Marwijk, J Y Le Reste, P Nabbe, H Lingner, D Kasuba Lazic, R Assenova, M Munoz, A Sowinska, C Lygidakis, C Doerr, S Czachowski, S Argyriadou, J Valderas, B Le Floch, J Deriennic, T Jan, E Melot, P Barraine, M Odorico, C Lietard, P Van Royen, H Van Marwijk

Abstract

Background: Multimorbidity is an intuitively appealing, yet challenging, concept for Family Medicine (FM). An EGPRN working group has published a comprehensive definition of the concept based on a systematic review of the literature which is closely linked to patient complexity and to the biopsychosocial model. This concept was identified by European Family Physicians (FPs) throughout Europe using 13 qualitative surveys. To further our understanding of the issues around multimorbidity, we needed to do innovative research to clarify this concept. The research question for this survey was: what research agenda could be generated for Family Medicine from the EGPRN concept of Multimorbidity?

Methods: Nominal group design with a purposive panel of experts in the field of multimorbidity. The nominal group worked through four phases: ideas generation phase, ideas recording phase, evaluation and analysis phase and a prioritization phase.

Results: Fifteen international experts participated. A research agenda was established, featuring 6 topics and 11 themes with their corresponding study designs. The highest priorities were given to the following topics: measuring multimorbidity and the impact of multimorbidity. In addition the experts stressed that the concept should be simplified. This would be best achieved by working in reverse: starting with the outcomes and working back to find the useful variables within the concept.

Conclusion: The highest priority for future research on multimorbidity should be given to measuring multimorbidity and to simplifying the EGPRN model, using a pragmatic approach to determine the useful variables within the concept from its outcomes.

References

    1. Fortin M, Bravo G, Hudon C, Vanasse A, Lapointe L. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med. 2005;3:223–8. doi: 10.1370/afm.272.
    1. Brandlmeier P. Multimorbidity among elderly patients in an urban general practice. ZFA. 1976;52:1269–75.
    1. Starfield B. Global health, equity, and primary care. J Am Board Fam Med. 2007;20:511–3. doi: 10.3122/jabfm.2007.06.070176.
    1. Beasley JW, Starfield B, van Weel C, Rosser WW, Haq CL. Global health and primary care research. J Am Board Fam Med. 2007;20(6):518–26. doi: 10.3122/jabfm.2007.06.070172.
    1. Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med. 2008;23(5):536–42. doi: 10.1007/s11606-008-0529-9.
    1. Fortin M, Lapointe L, Hudon C, Vanasse A. Multimorbidity is common to family practice: is it commonly researched? Can Fam Physician. 2005;51:244–5.
    1. Fortin M, Soubhi H, Hudon C, Bayliss EA, van den Akker M. Multimorbidity’s many challenges. BMJ. 2007;334(7602):1016–7. doi: 10.1136/bmj.39201.463819.2C.
    1. World Health Organization . The World Health Report 2008. Primary Health Care - Now more than ever. Geneva: World Health Organization; 2008. p. 8.
    1. European Academy of Teachers in General Practice (Network within Wonca Europe). the european definition of general practice/family medicine. WONCA; 2002. Available from: . Accessed 1 may 2015.
    1. Huber M, Knottnerus JA, Green L, van der Horst H, Jadad AR, Kromhout D, et al. How should we define health? BMJ. 2011;343:d4163. doi: 10.1136/bmj.d4163.
    1. Reuben DB, Tinetti ME. Goal-oriented patient care--an alternative health outcomes paradigm. N Engl J Med. 2012;366(9):777–9. doi: 10.1056/NEJMp1113631.
    1. Hummers-Pradier E, Beyer M, Chevallier P, Eilat-Tsanani S, Lionis C, Peremans L, et al. Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 4. Results: specific problem solving skills. Eur J Gen Pr. 2010;16(3):174–81. doi: 10.3109/13814788.2010.504982.
    1. Rougé Bugat M-E, Cestac P, Oustric S, Vellas B, Nourhashemi F. Detecting Frailty in Primary Care: A Major Challenge for Primary Care Physicians. J Am Med Dir Assoc. 2012;13:669–72. doi: 10.1016/j.jamda.2012.07.015.
    1. Le Reste JY, Nabbe P, Lygidakis C, Doerr C, Lingner H, Czachowski S, et al. A Research Group from the European General Practice Research Network (EGPRN) Explores the Concept of Multimorbidity for Further Research into Long-Term Care. J Am Med Dir Assoc. 2012;14(2):132–3. doi: 10.1016/j.jamda.2012.07.017.
    1. Le Reste JY. The FPDM (family practice depression and Multimorbidity) Study: Project for systematic review of literature to find criteria for multimorbidity definition. Eur J Gen Pr. 2011;17(3):180.
    1. Le Reste J, Nabbe P, Manceau B, Lygidakis C, Doerr C, Lingner H, et al. The European General Practice Research Network presents a comprehensive definition of Multimorbidity in Family Medicine and Long-Term Care, following a systematic review of relevant literature. J Am Med Dir Assoc. 2013;14(5):319–25. doi: 10.1016/j.jamda.2013.01.001.
    1. Wittkampf KA, van Zwieten M, Smits FT, Schene AH, Huyser J, van Weert HC. Patients’ view on screening for depression in general practice. Fam Pract. 2008;25(6):438–44. doi: 10.1093/fampra/cmn057.
    1. Innes AD, Campion PD, Griffiths FE. Complex consultations and the “edge of chaos”. Br J Gen Pract. 2005;55(510):47–52.
    1. Britt HC, Harrison CM, Miller GC, Knox SA. Prevalence and patterns of multimorbidity in Australia. Med J Aust. 2008;189(2):72–7.
    1. Le Reste JY, Nabbe P, Rivet C, Lygidakis C, Doerr C, Czachowski S, et al. The European general practice research network presents the translations of its comprehensive definition of multimorbidity in family medicine in ten European languages. PLoS One. 2015;10(1):e0115796. doi: 10.1371/journal.pone.0115796.
    1. Hastie R, Kameda T. The robust beauty of majority rules in group decisions. Psychol Rev. 2005;112(2):494–508. doi: 10.1037/0033-295X.112.2.494.
    1. Jones J, Hunter D. Consensus methods for medical and health services research. BMJ. 1995;311(7001):376–80. doi: 10.1136/bmj.311.7001.376.
    1. Gallagher M, Hares T, Spencer J, Bradshaw C, Webb I. The nominal group technique: a research tool for general practice? Fam Pract. 1993;10(1):76–81. doi: 10.1093/fampra/10.1.76.
    1. Carney O, McIntosh J, Worth A. The use of the Nominal Group Technique in research with community nurses. J Adv Nurs. 1996;23(5):1024–9. doi: 10.1046/j.1365-2648.1996.09623.x.
    1. Letrilliart L, Vanmeerbeek M. À la recherche du consensus: quelle méthode utiliser? Exercer. 2011;99(99):170–7.
    1. Cadier S, Le Reste J-Y, Barraine P, Chiron B, Barais M, Nabbe P, et al. Création d’ une liste hiérarchisée d’ objectifs par la méthode du groupe nominal. Exercer. 2011;22(97):80–4.
    1. Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7(1):10. doi: 10.1186/1471-2288-7-10.
    1. Castanheira L, Fresco P, Macedo AF. Guidelines for the management of chronic medication in the perioperative period: systematic review and formal consensus. J Clin Pharm Ther. 2011;36(4):446–67. doi: 10.1111/j.1365-2710.2010.01202.x.
    1. Krüger AJ, Lockey D, Kurola J, Di Bartolomeo S, Castrén M, Mikkelsen S, et al. A consensus-based template for documenting and reporting in physician-staffed pre-hospital services. Scand J Trauma Resusc Emerg Med [Internet]. 2011 Jan [cited 2014 Aug 14];19:71. Available from: . Accessed 14 Sept 2015
    1. Fortin M, Hudon C, Dubois M-F, Almirall J, Lapointe L, Soubhi H. Comparative assessment of three different indices of multimorbidity for studies on health-related quality of life. Health Qual Life Outcomes. 2005;3:74. doi: 10.1186/1477-7525-3-74.
    1. Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009;7(4):357–63. doi: 10.1370/afm.983.
    1. Foguet-Boreu Q, Violan C, Roso-Llorach A, Rodriguez-Blanco T, Pons-Vigués M, Muñoz-Pérez MA, et al. Impact of multimorbidity: acute morbidity, area of residency and use of health services across the life span in a region of south Europe. BMC Fam Pract. 2014;15(1):55. doi: 10.1186/1471-2296-15-55.
    1. Smith SM, O’Kelly S, O’Dowd T. GPs’ and pharmacists' experiences of managing multimorbidity: a “Pandora”s box’. Br J Gen Pract. 2010;60(576):285–94. doi: 10.3399/bjgp10X514756.
    1. Noël PH, Parchman ML, Williams JW, Cornell JE, Shuko L, Zeber JE, et al. The challenges of multimorbidity from the patient perspective. J Gen Intern Med. 2007;22(Suppl 3):419–24. doi: 10.1007/s11606-007-0308-z.
    1. Stolper E, Leeuwen YVAN, Royen PVAN, Wiel MVANDE, Bokhoven MVAN, Houben P, et al. Establishing a European research agenda on “gut feelings” in general practice. A qualitative study using the nominal group technique. Eur J Gen Pract. 2010;16(2):75–9. doi: 10.3109/13814781003653416.
    1. Borrell-Carrió F, Suchman AL, Epstein RM. The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Ann Fam Med. 2004;2(6):576–82. doi: 10.1370/afm.245.
    1. Muth C, van den Akker M, Blom JW, Mallen CD, Rochon J, Schellevis FG, et al. The Ariadne principles: how to handle multimorbidity in primary care consultations. BMC Med. 2014;12(1):223. doi: 10.1186/s12916-014-0223-1.

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