In August 2016, the PACE in MM Team sponsored a Multimorbidity Symposium that facilitated an afternoon of research presentation and discussion. Four junior researchers came together to present their work on topics focused around the complexity of multimorbidity. The purpose of this symposium was to facilitate a conversation around the pertinent issues faced by those providing care for and living with multimorbidity. This symposium created an important and valued platform for an in-depth discussion among the presenters and the audience, who came from multidisciplinary disciplines.
These presentations covered wide-ranging, yet interlinked topics related to multimorbidity. These included the topics of disability, long-term care, goal-oriented care, measurement issues, patterns and progression of multimorbidity, interdisciplinary clinical approaches, health-related quality of life and the holistic implications of living with multimorbidity. Details of the presenters, as well as the key facts and messages presented, are included below.
Presenter: Dr. Natasha Lane
Trainee of the Institute of Health Policy, Management and Evaluation & MD/PhD Program, University of Toronto
Trainee of the Health System Performance Research Network
Presentation Title: Multimorbidity and Disability in Long-Term Care Residents: Where do Geriatric Syndromes Fit in this Clinical Story?
In Ontario long-term care homes, resident characteristics explained the vast majority of differences in resident disability levels.
Presence of geriatric syndromes – such as balance impairment, urinary and bowel incontinence and cognitive impairment – explained 50% of the variation in resident disability.
Characteristics of long-term care homes – such as for-profit ownership, prevalence of restraint use and rehabilitation – explained only 2% of the variation in resident disability.
Characteristics of residents – not characteristics of the long-term care homes in which they live – explain the vast majority of differences in resident disability levels in Ontario.
Interventions to reduce disability in long-term care home residents may benefit from targeting geriatric syndromes or other resident-level predictors of disability.
Presenter: Dr. Pauline Boeckxstaens
Post-Doctoral Fellow with Patient-Centred Innovations for Persons with Multimorbidity (PACE in MM) Team at Western University.
Family Physician at an Inter-Professional Team in a Community Health Centre in Ghent, Belgium.
Researcher in the Department of Family Medicine and Primary Health Care at Ghent University
Presentation Title: Goal Oriented Care for Multimorbidity: From Measuring Multimorbidity as a Clinician-Researcher towards the Development of an Interdisciplinary Clinical Approach that can be Measured
The definition of multimorbidity and how it relates to the definition of chronic diseases was presented. This included an assessment of the strengths and limitations of the key measures of multimorbidity.
The clinical perspective on defining and measuring multimorbidity was established by discussing the related importance of goal-oriented care.
Goal-oriented care was highlighted as a challenging but promising approach to person-centred care for those living with multimorbidity.
The International Classification of Functioning and Disability in health (ICF, WHO 2001) was presented as a tool for team-based person-centred care.
Importantly, researchers and clinicians must recognize that the patient with multimorbidity is not just a sum of diseases, but instead is a person with challenges and strengths.
This can be approached with the appropriate application of goal-oriented care.
Presenter: Dr. Carri Lyn Hand
Assistant Professor in the School of Occupational Therapy at Western University.
Occupational Therapist and PhD in Rehabilitation Science from McMaster University.
Presentation Title: Measuring Holistic, Patient-Reported Outcomes in Inter-Professional Primary Health Care
The use of holistic, patient-reported outcome measures in inter-professional primary health care can support screening for issues, evaluation of services, and service development for older adults and patients with multimorbidity.
The World Health Organization Quality of Life Scale (WHOQOL-BREF) is based on a broad definition of health, assesses several aspects of the environment and includes many items that relate to the person's own life and goals.
Two relevant outcome areas are participation and health-related quality of life (HRQOL). Participation involves engagement in meaningful roles and activities (such as leisure, mobility, work or social engagement) and health-related quality of life can be defined as those aspects that are relevant to health, including the environment in which a person lives.
The measurement of holistic, patient-reported outcomes appears to be a gap in inter-professional primary health care.
As such, the existing participation and HRQOL measurement tools are appropriate and necessary to address this gap.
Testing these tools in primary health care settings can help to better understand their benefits and how they can be integrated into inter-professional care.
Presenter: Kathryn Nicholson
Doctoral Candidate in the Department of Epidemiology and Biostatistics at Western University.
Trainee of the Patient-Centred Innovations for Persons with Multimorbidity (PACE in MM) Team at Western University.
Presentation Title: Examining the Prevalence, Patterns and Progression of Multimorbidity among Adults in Primary Health Care
From a national electronic medical record database, the prevalence of multimorbidity among adult and older adult primary health care (PHC) patients is significant in Canada. More specifically, about one-half of adult PHC patients were living with two or more chronic diseases and one-third of adult PHC patients were living with three or more chronic diseases. This burden is consistent with the international literature.
A total of 10,411 combinations and 24,647 permutations were detected among patients with multimorbidity. The time-to-event analysis indicated an increased rate (33.0%) of chronic disease accumulation, as well as periods of quicker progression. This burden indicated that these patients with multimorbidity represented complex clinical profiles.
After exploring the clinical profiles of individuals living with multimorbidity in a large, longitudinal database, this research provides empirical evidence that supports the need for patient- and family-centred care for all patients with multimorbidity.
These findings will contribute the Canadian context to the international multimorbidity literature, and can be used strategically to inform more effective health care delivery and health policy decisions for adults living with multimorbidity in Canada.
This Multimorbidity Symposium provided an important and constructive experience for the four junior researchers to share their expertise and to engage in a discussion about patient-centred care for individuals living with multimorbidity. A fruitful discussion was had before, during and following the symposium. This was a wonderful way to foster new relationships among the presenters. In fact, each of the presenters commented that being able to meet like-minded scientists for the afternoon was particularly timely in their own work. All presenters stated that this afternoon provided an invigorating and meaningful discussion that was much appreciated.
In fact, the in-depth conversations that were held throughout the afternoon resulted in new collaborations for the presenters, including a scoping review on treatment goal setting, a commentary on the methodological challenges of defining and measuring relevant outcomes for those with multimorbidity and a commentary to highlight the limitations of cluster analysis in multimorbidity research. The PACE in MM Team administrative staff ensured that the afternoon was well-advertised, as well as very professional and organized. Importantly, this opportunity was made possible by the excellent mentorship of the PACE in MM Team and co-Principal Investigators.