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Multimorbilidad. Cronicidad

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By M. Carmen Martinez Velasco Internal Medicine
U T Kadam, I Roberts, S White, R Bednall, K Khunti, P M Nilsson, C A Lawson
With older and ageing populations, patients experience multiple chronic diseases at the same time. Individual chronic disease guidelines often recommend pharmacological therapies as a key intervention, resulting in patients being prescribed multiple regular medications for their different diseases. Whilst the term 'polypharmacy' has been applied to the use of multiple medications, there is no consistent definition and this term is now being used all inclusively. To improve both scientific rigor and optimal patient care, it is crucial that a standard terminology is used which reclassifies the term 'polypharmacy' into distinct phenotypes relating to the index chronic disease, additional conditions to the index ('comorbidity') or the experience of multiple chronic conditions at the same time (multimorbidity)...
October 29, 2018: Journal of Clinical Epidemiology
Eli Manning, Marilou Gagnon
Over the last decade, the concept of the "complex patient" has not only been more widely used in multidisciplinary healthcare teams and across various healthcare disciplines, but it has also become more vacuous in meaning. The uptake of the concept of the "complex patient" spans across disciplines, such as medicine, nursing, and social work, with no consistent definition. We review the chronological evolution of this concept and its surrogate terms, namely "comorbidity," "multimorbidity," "polypathology," "dual diagnosis," and "multiple chronic conditions...
March 2017: Nursing & Health Sciences
Pei-Jung Lin, David M Kent, Aaron Winn, Joshua T Cohen, Peter J Neumann
OBJECTIVES: Multiple chronic comorbidities (MCCs) are an issue of growing significance in diabetes because they are highly prevalent and can increase disease burden and costs. We examined MCC patterns among patients with type 2 diabetes mellitus and identified specific comorbidity clusters associated with poor patient outcomes. STUDY DESIGN AND METHODS: We conducted a cross-sectional analysis of 161,174 patients with diabetes using electronic health record data supplied by US providers in the 2008 to 2012 Humedica data sets...
January 1, 2015: American Journal of Managed Care
Mary E Tinetti, Ling Han, Gail J McAvay, David S H Lee, Peter Peduzzi, John A Dodson, Cary P Gross, Bingqing Zhou, Haiqun Lin
IMPORTANCE: Randomized trials of anti-hypertensive treatment demonstrating reduced risk of cardiovascular events in older adults included participants with less comorbidity than clinical populations. Whether these results generalize to all older adults, most of whom have multiple chronic conditions, is uncertain. OBJECTIVE: To determine the association between anti-hypertensive medications and CV events and mortality in a nationally representative population of older adults...
2014: PloS One
P Hopcroft, N M Peel, A Poudel, I A Scott, L C Gray, R E Hubbard
For frail older people, admission to hospital is an opportunity to review the indications for specific medications. This research investigates prescribing for 206 older people discharged into residential aged care facilities from 11 acute care hospitals in Australia. Patients had multiple comorbidities (mean 6), high levels of dependency, and were prescribed a mean of 7.2 regular medications at admission to hospital and 8.1 medications on discharge, with hyper-polypharmacy (≥10 drugs) increasing from 24.3% to 32...
October 2014: Internal Medicine Journal
D Etxeberria-Lekuona, J M Casas Fernández de Tejerina, I Méndez López, J Oteiza Olaso, M Arteaga Mazuelas, V Jarne Betran
BACKGROUND AND OBJECTIVES: Patient who require multiple hospitalizations result in a considerable consumption of healthcare resources. In this study, we analyzed the factors associated with the multiple hospitalizations of a cohort of patients treated at a department of internal medicine. PATIENTS AND METHODS: A total of 613 consecutive hospitalizations were analyzed. A multiple-hospitalization patient was defined as one who at the time of admission had been hospitalized 3 or more times in the past year...
January 2015: Revista Clínica Española
Richard A Goodman, Cynthia Boyd, Mary E Tinetti, Isabelle Von Kohorn, Anand K Parekh, J Michael McGinnis
BACKGROUND: The increasing prevalence of Americans with multiple (2 or more) chronic conditions raises concerns about the appropriateness and applicability of clinical practice guidelines for patient management. Most guidelines clinicians currently rely on have been designed with a single chronic condition in mind, and many such guidelines are inattentive to issues related to comorbidities. PURPOSE: In response to the need for guideline developers to address comorbidities in guidelines, the Department of Health and Human Services convened a meeting in May 2012 in partnership with the Institute of Medicine to identify principles and action options...
May 2014: Annals of Family Medicine
Elizabeth A Bayliss, Denise E Bonds, Cynthia M Boyd, Melinda M Davis, Bruce Finke, Michael H Fox, Russell E Glasgow, Richard A Goodman, Suzanne Heurtin-Roberts, Sue Lachenmayr, Cristin Lind, Elizabeth A Madigan, David S Meyers, Suzanne Mintz, Wendy J Nilsen, Sally Okun, Sarah Ruiz, Marcel E Salive, Kurt C Stange
PURPOSE: An isolated focus on 1 disease at a time is insufficient to generate the scientific evidence needed to improve the health of persons living with more than 1 chronic condition. This article explores how to bring context into research efforts to improve the health of persons living with multiple chronic conditions (MCC). METHODS: Forty-five experts, including persons with MCC, family and friend caregivers, researchers, policy makers, funders, and clinicians met to critically consider 4 aspects of incorporating context into research on MCC: key contextual factors, needed research, essential research methods for understanding important contextual factors, and necessary partnerships for catalyzing collaborative action in conducting and applying research...
May 2014: Annals of Family Medicine
Janice L Palmer, Joanne C Langan, Jean Krampe, Mary Krieger, Rebecca A Lorenz, Joanne K Schneider, Judith M Smith, Helen W Lach
Because of the cost of nursing home care and desire of older adults to stay in their homes, it is important for health care providers to understand the factors that place older adults at risk for nursing home placement. This integrative review of 12 years of research, as published in 148 articles, explores the risk factors for nursing home placement of older adults. Using the framework of the vulnerable populations conceptual model developed by Flaskerud and Winslow (1998), we explored factors related to resource availability, relative risks, and health status...
2014: Research and Theory for Nursing Practice
Juliana J Petersen, Michael A Paulitsch, Karola Mergenthal, Jochen Gensichen, Heike Hansen, Siegfried Weyerer, Steffi G Riedel-Heller, Angela Fuchs, Wolfgang Maier, Horst Bickel, Hans-Helmut König, Birgitt Wiese, Hendrik van den Bussche, Martin Scherer, Anne Dahlhaus
BACKGROUND: In primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views...
2014: BMC Health Services Research
Anand K Parekh, Richard Kronick, Marilyn Tavenner
No abstract text is available yet for this article.
September 24, 2014: JAMA: the Journal of the American Medical Association
Liza Heslop, Rebecca Power, Kathryn Cranwell
BACKGROUND: The care coordination workforce includes a range of clinicians who manage care for patients with multiple chronic conditions both within and outside a hospital, in the community, or in a patient's home. These patients require a multi-skilled approach to support complex care and social support needs as they are typically high users of health, community, and social services. In Australia, workforce structures have not kept pace with this new and emerging workforce. The aim of the study was to develop, map, and analyse workforce functions of a care coordination team...
2014: Human Resources for Health
Susan C Miller, Michael Lepore, Julie C Lima, Renee Shield, Denise A Tyler
OBJECTIVES: To understand whether nursing home (NH) introduction of culture change practices is associated with improved quality. DESIGN: NH-level panel study using multivariate fixed-effects statistical modeling to estimate the effect of culture change introduction on quality outcomes. SETTING: Eight hundred twenty-four U.S. NHs with culture change practice involvement beginning between 2005 and 2010. PARTICIPANTS: Directors of nursing and nursing home administrators...
September 2014: Journal of the American Geriatrics Society
Rupert A Payne, Gary A Abel, Bruce Guthrie, Stewart W Mercer
BACKGROUND: Multimorbidity, the presence of more than 1 long-term disorder, is associated with increased use of health services, but unplanned admissions to hospital may often be undesirable. Furthermore, socioeconomic deprivation and mental health comorbidity may lead to additional unplanned admissions. We examined the association between unplanned admission to hospital and physical multimorbidity, mental health and socioeconomic deprivation. METHODS: We conducted a retrospective cohort study using data from 180 815 patients aged 20 years and older who were registered with 40 general practices in Scotland...
March 19, 2013: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
Samuel L Brilleman, Chris Salisbury
BACKGROUND: An increasing proportion of people are living with multiple health conditions, or 'multimorbidity'. Measures of multimorbidity are useful in studies of interventions in primary care to take account of confounding due to differences in case-mix. OBJECTIVES: Assess the predictive validity of commonly used measures of multimorbidity in relation to a health outcome (mortality) and a measure of health service utilization (consultation rate). METHODS: We included 95372 patients registered on 1 April 2005 at 174 English general practices included in the General Practice Research Database...
April 2013: Family Practice
Kurt C Stange
No abstract text is available yet for this article.
January 2012: Annals of Family Medicine
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