Clinical Trial Details
— Status: Completed
Administrative data
| NCT number |
NCT03088982 |
| Other study ID # |
FDPM - 05122011 |
| Secondary ID |
|
| Status |
Completed |
| Phase |
N/A
|
| First received |
March 14, 2017 |
| Last updated |
March 23, 2017 |
| Start date |
June 2014 |
| Est. completion date |
June 2015 |
Study information
| Verified date |
March 2017 |
| Source |
University Hospital, Brest |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Observational
|
Clinical Trial Summary
Background :The European General Practitioners Research Network (EGPRN) designed and
validated a comprehensive definition of multimorbidity using a systematic literature review
and qualitative research throughout Europe. This survey assessed which criteria in the EGPRN
concept of multimorbidity could detect decompensating patients in residential care within a
primary care cohort at a 6-month follow-up.
Method: Family Physicians included all multimorbid patients encountered in their residential
care homes from July to December 2014. Inclusion criteria were those of the EGPRN definition
of Multimorbidity. Exclusion criteria were patients under legal protection and those unable
to complete the 2-year follow-up. Decompensation was defined as the occurrence of death or
hospitalization for more than seven days. Statistical analysis was undertaken with uni- and
multivariate analysis at a 6-month follow-up using a combination of approaches including
both automatic classification and expert decision making. A Multiple Correspondence Analysis
(MCA) and a Hierarchical Clustering on Principal Components (HCPC) confirmed the consistency
of the results. Finally a logistic regression was performed in order to identify and
quantify risk factors for decompensation.
Description:
The concept of multimorbidity was first published in 1976. Multimorbidity has been defined
by the World Health Organization (WHO) as people being affected by two or more chronic
health conditions. Multimorbidity is a very interesting and challenging concept particularly
for Family Medicine (FM), given the increasing prevalence of chronic illness in an aging
population across all developed countries. It is closely related to a global or
comprehensive view of the patient, which is a core competency of FM, as defined, for
instance, by the World Organization of National Colleges, Academies and Academic
Associations of General Practitioners/Family Physicians (WONCA). It is a global 'functional'
view (useful for Long-Term Care) versus a 'disease' centered point of view (useful for acute
care).
The European General Practice Research Network (EGPRN) has created a research agenda
specifically designed for methodological and instrumental research, which includes the
development of primary care epidemiology, focusing on patient-centered health. A
comprehensive definition of the concept of multimorbidity (i.e. one which is both
understandable and usable for further collaborative research) was an important objective for
this research network. The objective was to help researchers in FM to investigate the
complexity of patients' conditions and their overall impact on patients' health. This
concept of multimorbidity could be an additional tool for Family Physicians (FPs), enabling
them to prevent decompensation.
A research team, including 9 national groups, all active within the EGPRN, has created a
research community for the purpose of clarifying the concept of multimorbidity for FM
throughout Europe. This group produced a comprehensive definition of the concept of
multimorbidity through a systematic review of literature. This concept was translated into
most European languages for use in further collaborative research. Finally, it was validated
using qualitative research throughout Europe and a specific research agenda was issued. The
EGPRN concept of multimorbidity included a set of different variables assessing patients'
multimorbidity, multimorbidity modulating factors and multimorbidity consequences.
Decompensation (i.e. death or hospitalization in acute care) is a challenge for FM as FPs,
being familiar with their patient's health status, could miss tiny factors which, if
noticed, could help to prevent decompensation. A predictive model that could be integrated
into their clinical practice could help them to prevent decompensation and avoid serious
health outcomes for their patients. The EGPRN concept of multimorbidity was considered
highly suitable for a purpose such as this. It could lead to a usable model for preventing
decompensation.
The French population is aging, with one in three people over 60 years of age in 2050.
Consequently, the number of dependent patients, some requiring institutionalization in Care
homes (CHs), is growing. Patients residing in CHs are included in the EGPRN definition of
multimorbidity. In France, as in most European countries, patients in residential care are
treated by FPs.
The purpose of this research was to assess which criteria in the EGPRN concept of
multimorbidity could detect decompensating patients in residential care within a primary
care cohort at a 6-month follow-up.
