A complex intervention for multimorbidity in primary care: A feasibility study

Hanne Birke; Ramune Jacobsen; Alexandra Br Jønsson; Ann Dorrit Kristiane Guassora; Marie Walther; Thomas Saxild; Jannie T Laursen; Maria Helena Dominquez Vall-Lamora; Anne Frølich

doi:10.1177/2235042X20935312

A complex intervention for multimorbidity in primary care: A feasibility study

J Comorb. 2020 Jul 30:10:2235042X20935312. doi: 10.1177/2235042X20935312. eCollection 2020 Jan-Dec.

Authors

Hanne Birke¹, Ramune Jacobsen², Alexandra Br Jønsson³, Ann Dorrit Kristiane Guassora³, Marie Walther⁴, Thomas Saxild⁵, Jannie T Laursen⁶, Maria Helena Dominquez Vall-Lamora⁷, Anne Frølich⁸

Affiliations

¹ Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Frederiksberg, Denmark.
² Department of Pharmacy, Section of Social and Clinical Pharmacy, Copenhagen Ø, Denmark.
³ Section of General Practice in Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen K, Denmark.
⁴ Center for Health and Care, Helsingoer, Denmark.
⁵ General Practice, Groendalslaegerne, Vanloese, Denmark.
⁶ Falck Hospital & Health Care, Copenhagen SV, Denmark.
⁷ Department of Cardiology Y, Bispebjerg-Frederiksberg University Hospital, Copenhagen, Denmark; Department of Biomedicine, University of Copenhagen, Denmark.
⁸ Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark.

Abstract

Aim: To assess the feasibility of a patient-centered complex intervention for multimorbidity (CIM) based on general practice in collaboration with community health-care centers and outpatient clinics.

Methods: Inclusion criteria were age ≥18 years, diagnoses of two or more of three chronic conditions (diabetes, chronic obstructive pulmonary disease (COPD), and chronic heart conditions), and a hospital contact during the previous year. The CIM included extended consultations and nurse care manager support in general practice and intensified cross-sectorial collaboration. Elements included a structured care plan based on patients' care goals, coordination of services, and, if appropriate, shifting outpatient clinic visits to general practice, medication review, referral to rehabilitation, and home care. The acceptability dimension of feasibility was assessed with validated questionnaires, observations, and focus groups.

Results: Forty-eight patients were included (mean age 72.2 (standard deviation (SD) 9.5, range 52-89); 23 (48%) were men. Thirty-seven patients had two diseases; most commonly COPD and cardiovascular disease (46%), followed by diabetes and cardiovascular disease (23%), and COPD and diabetes (15%). Eleven (23%) patients had all three conditions. Focus group interviews with patients with multimorbidity identified three main themes: (1) lack of care coordination existed across health-care sectors before the CIM, (2) extended consultations provided better care coordination, and (3) patients want to be involved in planning their treatment and care. In focus groups, health-care professionals discussed two main themes: (1) patient-centered care and (2) culture and organizational change. Completion rates for questionnaires were 98% (47/48).

Conclusions: Patients and health-care professionals found the CIM acceptable.

Keywords: Multimorbidity; cross-sectional collaboration; extended consultations; feasibility study; health-care organization; integrated care; medicine assessment; patient involvement; primary care.