Questionnaire survey of geriatricians and primary care physicians' approaches to treating older patients with multimorbidity.
family medicine
geriatrician
multimorbidity
older adults
primary care physician
Journal
Geriatrics & gerontology international
ISSN: 1447-0594
Titre abrégé: Geriatr Gerontol Int
Pays: Japan
ID NLM: 101135738
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
revised:
16
06
2023
received:
13
04
2023
accepted:
26
06
2023
medline:
3
8
2023
pubmed:
12
7
2023
entrez:
11
7
2023
Statut:
ppublish
Résumé
Geriatricians and primary care physicians in Japan are expected to provide care to older patients with multimorbidity. A questionnaire survey was carried out to understand the current approaches to older patients with multimorbidity. A total of 3300 participants, including 1650 geriatric specialists (G) and 1650 primary care specialists (PC) were enrolled. A 4-point Likert scale was used to score the following items: diseases that cause difficulty in treatment (diseases), patient backgrounds that cause difficulty in treatment (backgrounds), important clinical factors and important clinical strategies. Statistical comparisons were made between the groups. In the Likert scale, higher scores show a greater degree of difficulty. We obtained responses from 439 and 397 specialists in the G and PC, respectively (response rates 26.6 and 24.1%). The overall scores for "diseases" and "backgrounds" were significantly higher in the G than those in the PC (P < 0.001 and P = 0.018). The top 10 items in the "backgrounds" and in the "important clinical strategies" were all matched between the groups. The overall score of the "important clinical factors" was not statistically different between the groups; however, "low nutrition," "bedridden activities of daily living," "living alone" and "frailty" were found only in the top 10 items of the G, and "financial problems" was found in those of the PC. Geriatricians and primary care physicians have many similarities and differences in their approaches to multimorbidity management. Therefore, there is an urgent need to establish a system in which they can share a common understanding to manage older patients with multimorbidity. Geriatr Gerontol Int 2023; 23: 628-638.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
628-638Subventions
Organisme : Pfizer Health Research Foundation
ID : 21-8
Informations de copyright
© 2023 Japan Geriatrics Society.
Références
Kojima T, Mizokami F, Akishita M. Geriatric management of older patients with multimorbidity. Geriatr Gerontol Int 2020; 20: 1105-1111.
Aoki T, Yamamoto Y, Ikenoue T, Onishi Y, Fukuhara S. Multimorbidity patterns in relation to polypharmacy and dosage frequency: a nationwide, cross-sectional study in a Japanese population. Sci Rep 2018; 8: 3806.
Mitsutake S, Ishizaki T, Teramoto C, Shimizu S, Ito H. Patterns of co-occurrence of chronic disease among older adults in Tokyo, Japan. Prev Chronic Dis 2019; 16: E11.
Wallace E, Salisbury C, Guthrie B, Lewis C, Fahey T, Smith SM. Managing patients with multimorbidity in primary care. BMJ 2015; 350: h176.
Kato D, Kawachi I, Saito J, Kondo N. Complex multimorbidity and mortality in Japan: a prospective propensity-matched cohort study. BMJ Open 2021; 11: e046749.
Honda Y, Nakamura M, Aoki T, Ojima T. Multimorbidity patterns and the relation to self-rated health among older Japanese people: a nationwide cross-sectional study. BMJ Open 2022; 12: e063729.
Palmer K, Marengoni A, Forjaz MJ et al. Multimorbidity care model: recommendations from the consensus meeting of the joint action on chronic diseases and promoting healthy ageing across the life cycle (JA-CHRODIS). Health Policy 2018; 122: 4-11.
National Institute for Health and Care Excellence. Multi-Morbidity: Clinical Assessment and Management. London: NICE, 2016; NG56. [not revised; cited 21 Jan 2023]. Available from: https://www.nice.org.uk/guidance/ng56.
American Geriatrics Society expert panel on the Care of Older Adults with multimorbidity. Guiding principles for the care of older adults with multimorbidity: an approach for clinicians. J Am Geriatr Soc 2012; 60: E1-E25.
Smith SM, Wallace E, Clyne B, Boland F. Martin Fortin: interventions for improving outcomes in patients with multimorbidity in primary care and community setting: a systematic review. Cochrane Database Syst Rev 2021; 10: 271.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-383.
Quan H, Li B, Couris CM et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 2011; 173: 676-682.
Muth C, van den Akker M, Blom JW et al. The Ariadne principles: how to handle multimorbidity in primary care consultations. BMC Med 2014; 12: 223.
Luijks HD, Loeffen MJ, Lagro-Janssen AL, van Weel C, Lucassen PL, Schermer TR. GPs' considerations in multimorbidity management: a qualitative study. Br J Gen Pract 2012; 62: e503-e510.
Schiøtz ML, Høst D, Christensen MB et al. Quality of care for people with multimorbidity-a case series. BMC Health Serv Res 2017; 17: 745.
Oksavik JD, Kirchhoff R, Sogstad MKR, Solbjør M. Sharing responsibility: municipal health professionals' approaches to goal setting with older patients with multi-morbidity-a grounded theory study. BMC Health Serv Res 2020; 20: 141.
Cramm JM, Nieboer AP. Validation of an instrument for the assessment of patient-centred care among patients with multimorbidity in the primary care setting: the 36-item patient-centred primary care instrument. Fam Pract 2018; 19: 143.
Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 2013; 48: 452-458.
Prados-Torres A, Calderón-Larrañaga A, Hancco-Saavedra J, Poblador-Plou B, van den Akker M. Multimorbidity patterns: a systematic review. J Clin Epidemiol 2014; 67: 254-266.