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Clinical Trial Details — Status: Not yet recruiting

Administrative data

NCT number NCT05593835
Other study ID # METHIS_CRTMB2022
Secondary ID
Status Not yet recruiting
Phase N/A
First received
Last updated
Start date June 1, 2025
Est. completion date May 31, 2027

Study information

Verified date November 2023
Source Universidade Nova de Lisboa
Contact Luís V. Lapão, PhD
Phone +351 937234449
Email luis.lapao@nms.unl.pt
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

This study aims to assess whether the use of the METHIS digital platform using a patient-centered approach contributes to an improvement in the quality of life, mental health and physical activity of patients with multimorbidity followed up in Primary Health Care. Practices will be randomly allocated between: providing access to consultations through the METHIS platform (intervention) or following patients by the traditional method (control). They will complete questionnaires on quality of life, mental health and report the number of steps taken, at the beginning and end of the study.


Description:

A superiority, cluster randomised trial will be conducted at Primary Health Care Practices (1:1 allocation ratio). All public practices in the Lisbon and Tagus Valley Region, Portugal, not involved in a previous pilot trial, will be eligible. The intervention combines a training programme and a customised Information System (METHIS). Both are designed to help clinicians to adopt a Goal-Oriented Care Model approach and to encourage patients and carers to play a more active role in autonomous healthcare.


Recruitment information / eligibility

Status Not yet recruiting
Enrollment 1380
Est. completion date May 31, 2027
Est. primary completion date January 30, 2026
Accepts healthy volunteers No
Gender All
Age group 50 Years and older
Eligibility Inclusion Criteria: - community-dwelling people - aged 50 or older - with complex multimorbidity (co-occurrence of three or more chronic conditions affecting three or more different body systems) - with access to an Internet connection and a communication technology device Exclusion Criteria: - inability to: provide informed consent, to read or write, inability to access an email or electronic device, even when helped by an informal caregiver

Study Design


Related Conditions & MeSH terms


Intervention

Device:
METHIS Platform
The METHIS platform is a digital healthcare platform, supported by three databases using PostreSQL (based in relational SQL). One of the databases allows adequate internal testing before production. Another database of production (secured with unique access codes) will be created to retrieve data from the practices' and the last database for the research data, where pseudonymised production data can be analysed for research purposes. The platform is integrated (via FCCN Scientific Computation Unit of the Portuguese Fundação para a Ciência e a Tecnologia) with the Software Zoom® to allow encrypted teleconsultations, with a guarantee that each patient connection is unique. The digital platform is web-based, and it can be used in multiple devices.
Other:
Goal-Oriented Care Training Program
The training program will have three stages: initial face-to-face training, which will happen before the data collection, followed by remote, asynchronous training during a 12-month period, and a final seminar to discuss the results and inquire about the usability of the GOC model and the METHIS platform. The course will be offered to the intervention group one month before the start of patient recruitment, and for the control group at least one month after the end of data collection.

Locations

Country Name City State
n/a

Sponsors (6)

Lead Sponsor Collaborator
Universidade Nova de Lisboa Administração Regional de Saúde de Lisboa e Vale do Tejo, Portugal, NOVA Medical School, NOVA School of Science and Technology i FCT NOVA, Universidade Lusófona de Humanidades e Tecnologias, University Hospital, Geneva

References & Publications (42)

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Kraef C, van der Meirschen M, Free C. Digital telemedicine interventions for patients with multimorbidity: a systematic review and meta-analysis. BMJ Open. 2020 Oct 13;10(10):e036904. doi: 10.1136/bmjopen-2020-036904. — View Citation

Lamprell K, Tran Y, Arnolda G, Braithwaite J. Nudging clinicians: A systematic scoping review of the literature. J Eval Clin Pract. 2021 Feb;27(1):175-192. doi: 10.1111/jep.13401. Epub 2020 Apr 27. — View Citation

Lapao LV, Peyroteo M, Maia M, Seixas J, Gregorio J, Mira da Silva M, Heleno B, Correia JC. Implementation of Digital Monitoring Services During the COVID-19 Pandemic for Patients With Chronic Diseases: Design Science Approach. J Med Internet Res. 2021 Aug 26;23(8):e24181. doi: 10.2196/24181. — View Citation

Makovski TT, Schmitz S, Zeegers MP, Stranges S, van den Akker M. Multimorbidity and quality of life: Systematic literature review and meta-analysis. Ageing Res Rev. 2019 Aug;53:100903. doi: 10.1016/j.arr.2019.04.005. Epub 2019 Apr 30. — View Citation

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Muth C, Blom JW, Smith SM, Johnell K, Gonzalez-Gonzalez AI, Nguyen TS, Brueckle MS, Cesari M, Tinetti ME, Valderas JM. Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus. J Intern Med. 2019 Mar;285(3):272-288. doi: 10.1111/joim.12842. Epub 2018 Dec 10. Erratum In: J Intern Med. 2019 Oct;286(4):487. — View Citation

Onder G, Palmer K, Navickas R, Jureviciene E, Mammarella F, Strandzheva M, Mannucci P, Pecorelli S, Marengoni A; Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS). Time to face the challenge of multimorbidity. A European perspective from the joint action on chronic diseases and promoting healthy ageing across the life cycle (JA-CHRODIS). Eur J Intern Med. 2015 Apr;26(3):157-9. doi: 10.1016/j.ejim.2015.02.020. Epub 2015 Mar 18. — View Citation

Pascual-de la Pisa B, Palou-Lobato M, Marquez Calzada C, Garcia-Lozano MJ. [Effectiveness of interventions based on telemedicine on health outcomes in patients with multimorbidity in Primary Care: A systematic review]. Aten Primaria. 2020 Dec;52(10):759-769. doi: 10.1016/j.aprim.2019.08.004. Epub 2019 Dec 5. Spanish. — View Citation

Peyroteo M. O sistema de informação e o modelo de orientação na prestação de cuidados de saúde em pacientes com multimorbilidade numa unidade de saúde familiar em Lisboa: uma perspetiva dos profissionais de saúde Instituto de Higiene Tropical, Universidade NOVA de Lisboa; 2020. Available from: https://run.unl.pt/handle/10362/116922

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Tudor-Locke C, Craig CL, Aoyagi Y, Bell RC, Croteau KA, De Bourdeaudhuij I, Ewald B, Gardner AW, Hatano Y, Lutes LD, Matsudo SM, Ramirez-Marrero FA, Rogers LQ, Rowe DA, Schmidt MD, Tully MA, Blair SN. How many steps/day are enough? For older adults and special populations. Int J Behav Nutr Phys Act. 2011 Jul 28;8:80. doi: 10.1186/1479-5868-8-80. — View Citation

van der Aa MJ, van den Broeke JR, Stronks K, Plochg T. Patients with multimorbidity and their experiences with the healthcare process: a scoping review. J Comorb. 2017 Jan 27;7(1):11-21. doi: 10.15256/joc.2017.7.97. eCollection 2017. — View Citation

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* Note: There are 42 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Primary Health related quality of life Participants will be asked to fill in the SF-12 questionnaire which generates a physical component score (PCS) and a mental component score (MCS). The primary outcome will be the mean difference in the variation (delta) of the PCS of SF-12 between baseline and 12 months. The SF-12 can be filled in 2-4 minutes, and it is validated for the Portuguese population. Minimum important differences validated across large populations and multiple disease categories are a change in between 2 and 3 points from the population mean of 50. Participants will be asked to fill in the SF-12 questionnaire at baseline and at 12 months.
Secondary Mental health status Participants will be asked to complete the Hospital Anxiety and Depression Scale questionnaire (HADS-A and HADS-D, respectively). The investigators will calculate the mean difference in the variation (delta) in HADS-A and HADS-D between baseline and 12 months. Although HADS was designed for inpatients it was posteriorly validated in the primary care outpatient setting. A minimum important difference of 1.5 has been reported in other chronic disorders. Participants will complete the HADS-A and HADS-D questionnaire at baseline and at 12 months.
Secondary Physical activity Physical activity will be monitored through the number of steps walked daily. To assess the number of steps per day, a smart band with a triaxial Accelerometer will be used in both arms of the trial. Although traditional step counters use pedometers to detect daily step counts, accelerometers are more accurate and sensitive to lower force accelerations (e.g., slow walking) being considered the current standard for collecting physical activity data. Sedentary older adults and individuals living with disability and chronic illness benefit from a physically active lifestyle, with approximately 4,600- 5,500 daily steps. The lowest median values for steps/day found is in disabled older adults (1214 steps/day) and by people living with COPD (2237 steps/day). Participants will wear the SmartBand for 12 months.
Secondary Number of serious adverse events (clinician-reported) These will be the safety outcomes chosen for this trial. In both trial arms, data about patient mortality will be collected and combined with data on occurrence of emergency department visits and hospital admissions as a proxy for serious adverse events. This information is available through the Portuguese common EHR. Due to legal requirements, after death, the information about hospital admissions and other contacts with healthcare organisations ceases to be available to the attending physician. Family physicians will be asked, at 6 and 12 months after randomization, to check the life status of enrolled patients and whether patients in the trial were admitted to a hospital or had a visit to an emergency service since the randomization date.
Secondary Number of potentially missed diagnoses (clinician-reported) These will be a second safety outcome. The investigators will ask clinicians in the intervention arm if they are aware of any serious diagnosis that might have been missed due to the intervention. Potentially missed diagnoses will be reported 6 months after the intervention phase. In this way a compromise between avoiding recall bias and allowing enough time for a missed diagnosis to become clinically apparent is achieved.
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