Multimorbidity: A complex reality in primary health care

The focus of primary health care (PHC) in developed countries is now largely centred on the treatment and management of long-term or chronic diseases. Due to shared risk factors and interaction among diseases, chronic conditions are increasingly occurring in clusters.1 In Canada, more than 50% of adults aged 65 years and older report having at least two chronic diseases.2 The co-occurrence of multiple chronic diseases in an individual, or multimorbidity, is also understood to be the norm rather than the exception in PHC.3 Multimorbidity is associated with reduced quality of life, limited functional status, polypharmacy, increased mortality, and high health care costs.3 Deemed an “endless struggle” by PHC providers, multimorbidity is becoming more prevalent in younger patients and is no longer confined to elderly populations. 1,4 This phenomenon is pushing PHC providers and researchers alike to understand its multifaceted nature. A better understanding of the etiology behind multimorbidity can lead to a transformed clinical approach that will, in turn, be cost-saving in the long-run. To achieve this, three main components are necessary

Canadian guidelines for clinical practice: an analysis of their quality and relevance to the care of adults with comorbidity

<p>Abstract</p> <p>Background</p> <p>Clinical guidelines have been the subject of much criticism in primary care literature partly due to potential conflicts in their implementation among patients with multiple chronic conditions. We assessed the relevance of selected Canadian clinical guidelines on chronic diseases for patients with comorbidity and examined their quality.</p> <p>Methods</p> <p>We selected 16 chronic medical conditions according to their frequency of occurrence, complexity of treatment, and pertinence to primary care. Recent Canadian clinical guidelines (2004 - 2009) on these conditions, published in English or French, were retrieved. We assessed guideline relevance to the care of patients with comorbidity with a tool developed by Boyd and colleagues. Quality was assessed using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument.</p> <p>Results</p> <p>Regarding relevance, 56.2% of guidelines addressed treatment for patients with multiple chronic conditions and 18.8% addressed the issue for older patients. Fifteen guidelines (93.8%) included specific recommendations for patients with one concurrent condition; only three guidelines (18.8%) addressed specific recommendations for patients with two comorbid conditions and one for more than two concurrent comorbid conditions. Quality of the evaluated guidelines was good to very good in four out of the six domains measured using the AGREE instrument. The domains with lower mean scores were Stakeholder Involvement and Applicability.</p> <p>Conclusions</p> <p>The quality of the Canadian guidelines examined is generally good, yet their relevance for patients with two or more chronic conditions is very limited and there is room for improvement in this respect.</p

Fabriques du cinéma expérimental

International audienc

Princípios de acaso e diversão : uma conversa com Martin Arnold

International audienc