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Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data

We aimed to examine the complex relationships between patient safety processes and outcomes and multimorbidity using a comprehensive set of constructs: multimorbidity, polypharmacy, discordant comorbidity (diseases not sharing either pathogenesis nor management), morbidity burden and patient complex...

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Autores principales: Ricci-Cabello, Ignacio, Yañez-Juan, Aina María, Fiol-deRoque, Maria A., Leiva, Alfonso, Llobera Canaves, Joan, Parmentier, Fabrice B. R., Valderas, Jose M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8073542/
https://www.ncbi.nlm.nih.gov/pubmed/33923906
http://dx.doi.org/10.3390/jcm10081782
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author Ricci-Cabello, Ignacio
Yañez-Juan, Aina María
Fiol-deRoque, Maria A.
Leiva, Alfonso
Llobera Canaves, Joan
Parmentier, Fabrice B. R.
Valderas, Jose M.
author_facet Ricci-Cabello, Ignacio
Yañez-Juan, Aina María
Fiol-deRoque, Maria A.
Leiva, Alfonso
Llobera Canaves, Joan
Parmentier, Fabrice B. R.
Valderas, Jose M.
author_sort Ricci-Cabello, Ignacio
collection PubMed
description We aimed to examine the complex relationships between patient safety processes and outcomes and multimorbidity using a comprehensive set of constructs: multimorbidity, polypharmacy, discordant comorbidity (diseases not sharing either pathogenesis nor management), morbidity burden and patient complexity. We used cross-sectional data from 4782 patients in 69 primary care centres in Spain. We constructed generalized structural equation models to examine the associations between multimorbidity constructs and patient-reported patient safety (PREOS-PC questionnaire). These associations were modelled through direct and indirect (mediated by increased interactions with healthcare) pathways. For women, a consistent association between higher levels of the multimorbidity constructs and lower levels of patient safety was observed via either pathway. The findings for men replicated these observations for polypharmacy, morbidity burden and patient complexity via indirect pathways. However, direct pathways showed unexpected associations between higher levels of multimorbidity and better safety. The consistent association between multimorbidity constructs and worse patient safety among women makes it advisable to target this group for the development of interventions, with particular attention to the role of comorbidity discordance. Further research, particularly qualitative research, is needed for clarifying the complex associations among men.
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spelling pubmed-80735422021-04-27 Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data Ricci-Cabello, Ignacio Yañez-Juan, Aina María Fiol-deRoque, Maria A. Leiva, Alfonso Llobera Canaves, Joan Parmentier, Fabrice B. R. Valderas, Jose M. J Clin Med Article We aimed to examine the complex relationships between patient safety processes and outcomes and multimorbidity using a comprehensive set of constructs: multimorbidity, polypharmacy, discordant comorbidity (diseases not sharing either pathogenesis nor management), morbidity burden and patient complexity. We used cross-sectional data from 4782 patients in 69 primary care centres in Spain. We constructed generalized structural equation models to examine the associations between multimorbidity constructs and patient-reported patient safety (PREOS-PC questionnaire). These associations were modelled through direct and indirect (mediated by increased interactions with healthcare) pathways. For women, a consistent association between higher levels of the multimorbidity constructs and lower levels of patient safety was observed via either pathway. The findings for men replicated these observations for polypharmacy, morbidity burden and patient complexity via indirect pathways. However, direct pathways showed unexpected associations between higher levels of multimorbidity and better safety. The consistent association between multimorbidity constructs and worse patient safety among women makes it advisable to target this group for the development of interventions, with particular attention to the role of comorbidity discordance. Further research, particularly qualitative research, is needed for clarifying the complex associations among men. MDPI 2021-04-20 /pmc/articles/PMC8073542/ /pubmed/33923906 http://dx.doi.org/10.3390/jcm10081782 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ricci-Cabello, Ignacio
Yañez-Juan, Aina María
Fiol-deRoque, Maria A.
Leiva, Alfonso
Llobera Canaves, Joan
Parmentier, Fabrice B. R.
Valderas, Jose M.
Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data
title Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data
title_full Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data
title_fullStr Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data
title_full_unstemmed Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data
title_short Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data
title_sort assessing the impact of multi-morbidity and related constructs on patient reported safety in primary care: generalized structural equation modelling of observational data
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8073542/
https://www.ncbi.nlm.nih.gov/pubmed/33923906
http://dx.doi.org/10.3390/jcm10081782
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