Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

What are the effective elements in patient-centered and multimorbidity care? A scoping review

Authors: Marie-Eve Poitras, Marie-Eve Maltais, Louisa Bestard-Denommé, Moira Stewart, Martin Fortin

Published in: BMC Health Services Research | Issue 1/2018

Login to get access

Abstract

Background

Interventions to improve patient-centered care for persons with multimorbidity are in constant growth. To date, the emphasis has been on two separate kinds of interventions, those based on a patient-centered care approach with persons with chronic disease and the other ones created specifically for persons with multimorbidity. Their effectiveness in primary healthcare is well documented. Currently, none of these interventions have synthesized a patient-centered care approach for care for multimorbidity. The objective of this project is to determine the particular elements of patient-centered interventions and interventions for persons with multimorbidity that are associated with positive health-related outcomes for patients.

Method

A scoping review was conducted as the method supports the rapid mapping of the key concepts underpinning a research area and the main sources and types of evidence available. A five-stage approach was adopted: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; and (5) collating, summarizing and reporting results. We searched for interventions for persons with multimorbidity or patient-centered care in primary care. Relevant studies were identified in four systematic reviews (Smith et al. (2012;2016), De Bruin et al. (2012), and Dwamena et al. (2012)). Inductive analysis was performed.

Results

Four systematic reviews and 98 original studies were reviewed and analysed. Elements of interventions can be grouped into three main types and clustered into seven categories of interventions: 1) Supporting decision process and evidence-based practice; 2) Providing patient-centered approaches; 3) Supporting patient self-management; 4) Providing case/care management; 5) Enhancing interdisciplinary team approach; 6) Developing training for healthcare providers; and 7) Integrating information technology. Providing patient-oriented approaches, self-management support interventions and developing training for healthcare providers were the most frequent categories of interventions with the potential to result in positive impact for patients with chronic diseases.

Conclusion

This scoping review provides evidence for the adaption of patient-centered interventions for patients with multimorbidity. Findings from this scoping review will inform the development of a toolkit to assist chronic disease prevention and management programs in reorienting patient care.
Appendix
Available only for authorised users
Literature
1.
2.
Almirall J, Fortin M. The coexistence of terms to describe the presence of multiple concurrent diseases. J Comorbidity. 2013;3:4–9.CrossRef
3.
Picco, L., et al., Economic burden of multimorbidity among older adults: impact on healthcare and societal costs. BMC Health Serv Res, 2016. 16(1): p. 173–173.
4.
Williams JS, Egede LE. The association between multimorbidity and quality of life, health status and functional disability. Am J Med Sci. 2016;352(1):45–52.CrossRefPubMed
5.
Agborsangaya CB, et al. Health-related quality of life and healthcare utilization in multimorbidity: results of a cross-sectional survey. Qual Life Res. 2013;22(4):791–9.CrossRefPubMed
6.
Smith DJ, et al. Depression and multimorbidity: a cross-sectional study of 1,751,841 patients in primary care. J Clin Psychiatry. 2014;75(11):1202–8.
7.
Gunn, J.M., et al., The association between chronic illness, multimorbidity and depressive symptoms in an Australian primary care cohort. Soc Psychiatry Psychiatr Epidemiol, 2012(1433–9285 (Electronic)).
8.
Gallacher K, et al. Understanding patients’ experiences of treatment burden in chronic heart failure using process theory. Ann Fam Med. 2011;9:235–43.CrossRefPubMedPubMedCentral
9.
Smith S, et al. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev. 2012;4:1469–93. (X (Electronic))
10.
Brettschneider C, et al. Relative impact of multimorbid chronic conditions on health-related quality of life--results from the MultiCare cohort study. PLoS One. 2013;8(6):e66742.CrossRefPubMedPubMedCentral
11.
Mercer SW, Watt GC. The inverse care law: clinical primary care encounters in deprived and affluent areas of Scotland. Ann Fam Med. 2007;5(6):503–10.CrossRefPubMedPubMedCentral
12.
13.
Gallacher KI, et al. Treatment burden and multimorbidity. In: ABC of multimorbidity. Oxford: Wiley-Blackwell; 2014. p. 30–3.
14.
Vogeli C, et al. Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. J Gen Intern Med. 2007;22(Suppl 3):391–5.CrossRefPubMedPubMedCentral
15.
Fortin, M., et al., Canadian guidelines for clinical practice: an analysis of their quality and relevance to the care of adults with comorbidity. BMC Fam Pract, 2011. 12: p. 74–74.
16.
Upshur R. Looking for rules in a world of exceptions: reflections on evidence-based practice. Perspect Biol Med. 2005;48(4):477–89.CrossRefPubMed
17.
18.
Mercer SW, et al. Multimorbidity in primary care: developing the research agenda. Fam Pract. 2009;26(2):79–80.CrossRefPubMed
19.
20.
Smith, S.M., Soubhi, H., Fortin, M., Hudon, C. & O'Dowd, T., Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. BMJ. 2012. 345: p. e5205-e5205.
21.
Noël PH, et al. Depression and comorbid illness in elderly primary care patients: impact on multiple domains of health status and well-being. Ann Fam Med. 2004;2(6):555–62.CrossRefPubMedPubMedCentral
22.
Fortin M, et al. Randomized controlled trials: do they have external validity for patients with multiple comorbidities? Ann Fam Med. 2006;4(2):104–8.CrossRefPubMedPubMedCentral
23.
Dwamena F, Holmes-Rovner M, Gaulden C, Jorgenson S, Sadigh G, Sikorskii A, Lewin S, Smith R, Coffey J, Olomu A. Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database Syst Rev. 2012;12:CD003267.PubMed
24.
de Bruin SR, Versnel N, Lemmens LC, Molema CM, Schellevis FG, Nijpels G, Baan CA. Comprehensive care programs for patients with multiple chronic conditions: a systematic literature review. Health Policy. 2012;107(2–3):108–45.CrossRefPubMed
25.
Garvey, J., et al., OPTIMAL, an occupational therapy led self-management support programme for people with multimorbidity in primary care: a randomized controlled trial. BMC Fam Pract. 2015. 16: p. 59–59.
26.
Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32.CrossRef
27.
Smith SM, et al. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev. 2016;(3).
28.
Brien SE, et al. Overview of a formal scoping review on health system report cards. Implement Sci. 2010;5(1):1–12.CrossRef
29.
Grimshaw J. A knowledge synthseis chapter. Ottawa: University of Ottawa; 2010. p. 56.
30.
31.
Alamo MM, Moral RR, Pérula de Torres LA. Evaluation of a patient-centred approach in generalized musculoskeletal chronic pain/fibromyalgia patients in primary care. Patient Educ Couns. 2002;48(1):23–31.CrossRefPubMed
32.
Boult C, et al. Early effects of "guided care" on the quality of health care for multimorbid older persons: a cluster-randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2008;63A(3):321–7.CrossRef
33.
Boyd CM, et al. The effects of guided care on the perceived quality of health care for multi-morbid older persons: 18-month outcomes from a cluster-randomized controlled trial. J Gen Intern Med. 2010;25(3):235–42.CrossRefPubMed
34.
Burns R, et al. Impact of continued geriatric outpatient management on health outcomes of older veterans. Arch Intern Med. 1995;155(12):1313–8.CrossRefPubMed
35.
Chumbler NR, et al. The association of home-telehealth use and care coordination with improvement of functional and cognitive functioning in frail elderly men. Telemed J E Health. 2004;10(2):129–37.CrossRefPubMed
36.
Coleman EA, et al. Chronic care clinics: a randomized controlled trial of a new model of primary care for frail older adults. J Am Geriatr Soc. 1999;47(7):775–83.CrossRefPubMed
37.
Counsell SR, et al. Geriatric care management for low-income seniors: a randomized controlled trial. JAMA. 2007;298(22):2623–33.CrossRefPubMed
38.
Courtney M, et al. Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program. J Am Geriatr Soc. 2009;57(3):395–402.CrossRefPubMed
39.
Daly BJ, et al. Trial of a disease management program to reduce hospital readmissions of the chronically critically ill. CHEST. 2005;128(2):507–17.CrossRefPubMed
40.
Dorr DA, et al. Implementing a multidisease chronic care model in primary care using people and technology. Dis Manag. 2006;9(1):1–15.CrossRefPubMed
41.
Dorr DA, et al. The effect of technology-supported, multidisease care management on the mortality and hospitalization of seniors. J Am Geriatr Soc. 2008;56(12):2195–202.CrossRefPubMed
42.
Douglas SL, et al. Chronically critically ill patients: health-related quality of life and resource use after a disease management intervention. Am J Crit Care. 2007;16(5):447–57.PubMedPubMedCentral
43.
Duke C. The frail elderly community-based case management project. Geriatr Nurs. 2005;26(2):122–7.CrossRefPubMed
44.
Eakin EG, et al. Resources for health: a primary-care-based diet and physical activity intervention targeting urban Latinos with multiple chronic conditions. Health Psychol. 2007;26(4):392–400.CrossRefPubMed
45.
Gitlin LN, et al. Long-term effect on mortality of a home intervention that reduces functional difficulties in older adults: results from a randomized trial. J Am Geriatr Soc. 2009;57(3):476–81.CrossRefPubMedPubMedCentral
46.
Gitlin LN, et al. A randomized trial of a multicomponent home intervention to reduce functional difficulties in older adults. J Am Geriatr Soc. 2006;54(5):809–16.CrossRefPubMed
47.
Hochhalter AK, et al. Making the most of your healthcare intervention for older adults with multiple chronic illnesses. Patient Educ Couns. 2010;81(2):207–13.CrossRefPubMed
48.
49.
Kobb R, et al. Enhancing elder chronic care through technology and care coordination: report from a pilot. Telemed J E Health. 2003;9(2):189–95.CrossRefPubMed
50.
Krause CM, et al. The impact of a multidisciplinary, integrated approach on improving the health and quality of care for individuals dealing with multiple chronic conditions. Am J Orthop. 2006;76(1):109–14.CrossRef
51.
Leveille SG, et al. Preventing disability and managing chronic illness in frail older adults: a randomized trial of a community-based partnership with primary care. J Am Geriatr Soc. 1998;46(10):1191–8.CrossRefPubMed
52.
Liddy C, et al. Telehomecare for patients with multiple chronic illnesses: pilot study. Can Fam Physician. 2008;54(1):58–65.PubMedPubMedCentral
53.
Markle-Reid M, et al. Health promotion for frail older home care clients. J Adv Nurs. 2006;54(3):381–95.CrossRefPubMed
54.
Mitton C, et al. Nurse-physician collaborative partnership: a rural model for the chronically ill. Can J Rural Med. 2007;12(4):208–16.PubMed
55.
Naylor MD, et al. Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. J Am Geriatr Soc. 2004;52(5):675–84. [corrected] [published erratum appears in J AM GERIATR SOC 2004 Jul;52(7):1228]CrossRefPubMed
56.
Procter S, Single A. Home telehealthcare: findings from a pilot study in north-East London. Br J Healthcare Comput Inform Manage. 2006;23(8):10–3.
57.
Smith RC, et al. Primary care clinicians treat patients with medically unexplained symptoms: a randomized controlled trial. J Gen Intern Med. 2006;21(7):671–7.CrossRefPubMedPubMedCentral
58.
Sommers LS, et al. Physician, nurse, and social worker collaboration in primary care for chronically ill seniors. Arch Intern Med. 2000;160(12):1825–33.CrossRefPubMed
59.
Sorrento T, Casselman MB, Noonan J. A consultant pharmacist’s role on a geriatric assessment service. Consult Pharm. 2007;22(11):935–43.CrossRefPubMed
60.
Taylor CB, et al. Evaluation of a nurse-care management system to improve outcomes in patients with complicated diabetes. Diabetes Care. 2003;26(4):1058–63.CrossRefPubMed
61.
Tibaldi V, et al. A randomized controlled trial of a home hospital intervention for frail elderly demented patients: behavioral disturbances and caregiver's stress. Arch Gerontol Geriatr Suppl. 2004;(9):431–6.
62.
Wright K, et al. The AD-LIFE trial: working to integrate medical and psychosocial care management models. Home Healthc Nurse. 2007;25(5):308–14.CrossRefPubMed
63.
Zhang NJ, et al. Evaluation of chronic disease management on outcomes and cost of care for Medicaid beneficiaries. Health Policy. 2008;86(2–3):345–54.CrossRefPubMed
64.
Bognor HR, de Vries HF. Integration of depression and hypertension treatment: a pilot, randomized controlled trial. Ann Fam Med. 2008;6(4):295–301.CrossRef
65.
Song M-K, et al. A randomized, controlled trial to improve advance care planning among patients undergoing cardiac surgery. Med Care. 2005;43(10):1049–53.CrossRefPubMed
66.
Sørlie T, et al. Video information combined with individualized information sessions: effects upon emotional well-being following coronary artery bypass surgery--a randomized trial. Patient Educ Couns. 2007;65(2):180–8.CrossRefPubMed
67.
Morgan MAJ, et al. The TrueBlue model of collaborative care using practice nurses as case managers for depression alongside diabetes or heart disease: a randomised trial. BMJ Open. 2013;3(1):1–11. 
68.
Boult C, et al. The effect of guided care teams on the use of health services: results from a cluster-randomized controlled trial. Arch Intern Med. 2011;171(5):460–6.CrossRefPubMedPubMedCentral
69.
Dijkstra RF, et al. Patient-centred and professional-directed implementation strategies for diabetes guidelines: a cluster-randomized trial-based cost-effectiveness analysis. Diabet Med. 2006;23(2):164–70.CrossRefPubMed
70.
Elzen H, et al. Evaluation of the chronic disease self-management program (CDSMP) among chronically ill older people in the Netherlands. Soc Sci Med. 2007;64(9):1832–41.CrossRefPubMed
71.
Lorig KR, et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care. 1999;37(1):5–14.CrossRefPubMed
72.
Ory MG, et al. Successes of a national study of the chronic disease self-management program: meeting the triple aim of health care reform. Med Care. 2013;51(11):992–8.CrossRefPubMed
73.
Rose MA, et al. Evaluation of the chronic disease self-management program with low-income, urban, African American older adults. J Community Health Nurs. 2008;25(4):193–202.CrossRefPubMed
74.
Coventry, P., et al., Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease. BMJ. 2015. 350: p. h638-h638.
75.
Martin PR, et al. Cognitive behavior therapy for comorbid migraine and/or tension-type headache and major depressive disorder: an exploratory randomized controlled trial. Behav Res Ther. 2015;73:8–18.CrossRefPubMed
76.
Wakefield BJ, et al. Outcomes of a home telehealth intervention for patients with diabetes and hypertension. Telemed J E Health. 2012;18(8):575–9.CrossRefPubMed
77.
Boyd CM, 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.CrossRefPubMedPubMedCentral
78.
Chassany O, et al. Effects of training on general practitioners' management of pain in osteoarthritis: a randomized multicenter study. J Rheumatol. 2006;33(9):1827–34.PubMed
79.
Kinmonth AL, et al. Randomised controlled trial of patient centred care of diabetes in general practice: impact on current wellbeing and future disease risk. The diabetes care from diagnosis research team. BMJ. 1998;317(7167):1202–8.CrossRefPubMedPubMedCentral
80.
Roter DL, et al. Improving physicians' interviewing skills and reducing patients' emotional distress. A randomized clinical trial. Arch Intern Med. 1995;155(17):1877–84.CrossRefPubMed
81.
82.
Wilkinson S, et al. Effectiveness of a three-day communication skills course in changing nurses' communication skills with cancer/palliative care patients: a randomised controlled trial. Palliat Med. 2008;22(4):365–75.CrossRefPubMed
83.
84.
National Case Management Network, Canadian standard of practice for case management. 2009. Ottawa, Canada.
85.
García-Fernández FP, et al. Effect of hospital case-manager nurses on the level of dependence, satisfaction and caregiver burden in patients with complex chronic disease. J Clin Nurs. 2014;23(19–20):2814–21.CrossRefPubMed
86.
Trappenburg JCA, et al. Effect of an action plan with ongoing support by a case manager on exacerbation-related outcome in patients with COPD: a multicentre randomised controlled trial. Thorax. 2011;66(11):977–84.CrossRefPubMed
87.
Desveaux L, et al. Participant experiences of a community-based maintenance program post-pulmonary rehabilitation. Chron Respir Dis. 2014;11(1):23–30.CrossRefPubMed
88.
Metadata
Title
What are the effective elements in patient-centered and multimorbidity care? A scoping review
Authors
Marie-Eve Poitras
Marie-Eve Maltais
Louisa Bestard-Denommé
Moira Stewart
Martin Fortin
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3213-8

Other articles of this Issue 1/2018

BMC Health Services Research 1/2018 Go to the issue

Research article

Self-reported hypertension in Northern China: a cross-sectional study of a risk prediction model and age trends

Research article

Perspectives of primary health care staff on the implementation of a sexual health quality improvement program: a qualitative study in remote aboriginal communities in Australia

Research article

Comparing GPs’ risk attitudes for their own health and for their patients’ : a troubling discrepancy?

Research article

Validating an algorithm to identify metastatic gastric cancer in the absence of routinely collected TNM staging data

Research article

A prospective cohort study measuring cost-benefit analysis of the Otago Exercise Programme in community dwelling adults with rheumatoid arthritis

Research article

Disabled people’s experiences of accessing reasonable adjustments in hospitals: a qualitative study