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Multimorbid outpatients: A high frequency of FP appointments and/or family difficulties, should alert FPs to the possibility of death or acute hospitalization occurring within six months; A primary care feasibility study
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 definition was tested as a model to assess death or acute hospitalization...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5667834/ https://www.ncbi.nlm.nih.gov/pubmed/29095849 http://dx.doi.org/10.1371/journal.pone.0186931 |
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author | Le Reste, Jean Yves Nabbe, Patrice Billot Grasset, Alice Le Floch, Bernard Grall, Pauline Derriennic, Jeremy odorico, Michele Lalande, Sophie le Goff, Delphine Barais, Marie Chiron, Benoit Lingner, Heidrun Guillou, Morgane Barraine, Pierre |
author_facet | Le Reste, Jean Yves Nabbe, Patrice Billot Grasset, Alice Le Floch, Bernard Grall, Pauline Derriennic, Jeremy odorico, Michele Lalande, Sophie le Goff, Delphine Barais, Marie Chiron, Benoit Lingner, Heidrun Guillou, Morgane Barraine, Pierre |
author_sort | Le Reste, Jean Yves |
collection | PubMed |
description | 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 definition was tested as a model to assess death or acute hospitalization in multimorbid outpatients. OBJECTIVE: To assess which criteria in the EGPRN concept of multimorbidity could detect outpatients at risk of death or acute hospitalization in a primary care cohort at a 6-month follow-up and to assess whether a large scale cohort with FPs would be feasible. METHOD: Family Physicians included a random sample of multimorbid patients who attended appointments in their offices 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. 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) completed the process with a projection of illustrative variables. A logistic regression was finally performed in order to identify and quantify risk factors for decompensation. RESULTS: 19 FPs participated in the study. 96 patients were analyzed. 3 different clusters were identified. MCA showed the central function of psychosocial factors and peaceful versus conflictual relationships with relatives in all clusters. While taking into account the limit of a small cohort, age, frequency of family physician visits and extent of family difficulties were the factors which predicted death or acute hospitalization. CONCLUSION: A large scale cohort seems feasible in primary care. A sense of alarm should be triggered to prevent death or acute hospitalization in multimorbid older outpatients who have frequent family physician visits and who experience family difficulties. |
format | Online Article Text |
id | pubmed-5667834 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-56678342017-11-17 Multimorbid outpatients: A high frequency of FP appointments and/or family difficulties, should alert FPs to the possibility of death or acute hospitalization occurring within six months; A primary care feasibility study Le Reste, Jean Yves Nabbe, Patrice Billot Grasset, Alice Le Floch, Bernard Grall, Pauline Derriennic, Jeremy odorico, Michele Lalande, Sophie le Goff, Delphine Barais, Marie Chiron, Benoit Lingner, Heidrun Guillou, Morgane Barraine, Pierre PLoS One Research Article 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 definition was tested as a model to assess death or acute hospitalization in multimorbid outpatients. OBJECTIVE: To assess which criteria in the EGPRN concept of multimorbidity could detect outpatients at risk of death or acute hospitalization in a primary care cohort at a 6-month follow-up and to assess whether a large scale cohort with FPs would be feasible. METHOD: Family Physicians included a random sample of multimorbid patients who attended appointments in their offices 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. 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) completed the process with a projection of illustrative variables. A logistic regression was finally performed in order to identify and quantify risk factors for decompensation. RESULTS: 19 FPs participated in the study. 96 patients were analyzed. 3 different clusters were identified. MCA showed the central function of psychosocial factors and peaceful versus conflictual relationships with relatives in all clusters. While taking into account the limit of a small cohort, age, frequency of family physician visits and extent of family difficulties were the factors which predicted death or acute hospitalization. CONCLUSION: A large scale cohort seems feasible in primary care. A sense of alarm should be triggered to prevent death or acute hospitalization in multimorbid older outpatients who have frequent family physician visits and who experience family difficulties. Public Library of Science 2017-11-02 /pmc/articles/PMC5667834/ /pubmed/29095849 http://dx.doi.org/10.1371/journal.pone.0186931 Text en © 2017 Le Reste et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Le Reste, Jean Yves Nabbe, Patrice Billot Grasset, Alice Le Floch, Bernard Grall, Pauline Derriennic, Jeremy odorico, Michele Lalande, Sophie le Goff, Delphine Barais, Marie Chiron, Benoit Lingner, Heidrun Guillou, Morgane Barraine, Pierre Multimorbid outpatients: A high frequency of FP appointments and/or family difficulties, should alert FPs to the possibility of death or acute hospitalization occurring within six months; A primary care feasibility study |
title | Multimorbid outpatients: A high frequency of FP appointments and/or family difficulties, should alert FPs to the possibility of death or acute hospitalization occurring within six months; A primary care feasibility study |
title_full | Multimorbid outpatients: A high frequency of FP appointments and/or family difficulties, should alert FPs to the possibility of death or acute hospitalization occurring within six months; A primary care feasibility study |
title_fullStr | Multimorbid outpatients: A high frequency of FP appointments and/or family difficulties, should alert FPs to the possibility of death or acute hospitalization occurring within six months; A primary care feasibility study |
title_full_unstemmed | Multimorbid outpatients: A high frequency of FP appointments and/or family difficulties, should alert FPs to the possibility of death or acute hospitalization occurring within six months; A primary care feasibility study |
title_short | Multimorbid outpatients: A high frequency of FP appointments and/or family difficulties, should alert FPs to the possibility of death or acute hospitalization occurring within six months; A primary care feasibility study |
title_sort | multimorbid outpatients: a high frequency of fp appointments and/or family difficulties, should alert fps to the possibility of death or acute hospitalization occurring within six months; a primary care feasibility study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5667834/ https://www.ncbi.nlm.nih.gov/pubmed/29095849 http://dx.doi.org/10.1371/journal.pone.0186931 |
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