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      Patients with multimorbidity and their experiences with the healthcare process: a scoping review

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          Abstract

          Background

          The number of patients with multimorbidity (two or more conditions) is increasing. Observational research has shown that having multiple health problems is associated with poorer outcomes in terms of health, quality of care, and costs. Thus, it is imperative to understand how patients with multimorbidity experience their healthcare process. Insight into patient experiences can be used to tailor healthcare provision specifically to the needs of patients with multimorbidity.

          Objective

          To synthesize self-reported experiences with the healthcare process of patients with multimorbidity, and identify overarching themes.

          Design

          A scoping literature review that evaluates both qualitative and quantitative studies published in PubMed, Embase, MEDLINE, and PsycINFO. No restrictions were applied to healthcare setting or year of publication. Studies were included if they reported experiences with the healthcare process of patients with multimorbidity. Patient experiences were extracted and subjected to thematic analysis (interpretative), which revealed overarching themes by mapping their interrelatedness.

          Results

          Overall, 22 empirical studies reported experiences of patients with multimorbidity. Thematic analysis identified 12 themes within these studies. The key overarching theme was the experience of a lack of holistic care. Patients also experienced insufficient guidance from healthcare providers. Patients also perceived system-related issues such as problems stemming from poor professional-to-professional communication.

          Conclusions

          Patients with multimorbidity experience a range of system- and professional-related issues with healthcare delivery. This overview illustrates the diversity of aspects that should be considered in designing healthcare services for patients with multimorbidity.

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          Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.

          Karen Barnett, Stewart Mercer, Michael Norbury … (2012)
          Long-term disorders are the main challenge facing health-care systems worldwide, but health systems are largely configured for individual diseases rather than multimorbidity. We examined the distribution of multimorbidity, and of comorbidity of physical and mental health disorders, in relation to age and socioeconomic deprivation. In a cross-sectional study we extracted data on 40 morbidities from a database of 1,751,841 people registered with 314 medical practices in Scotland as of March, 2007. We analysed the data according to the number of morbidities, disorder type (physical or mental), sex, age, and socioeconomic status. We defined multimorbidity as the presence of two or more disorders. 42·2% (95% CI 42·1-42·3) of all patients had one or more morbidities, and 23·2% (23·08-23·21) were multimorbid. Although the prevalence of multimorbidity increased substantially with age and was present in most people aged 65 years and older, the absolute number of people with multimorbidity was higher in those younger than 65 years (210,500 vs 194,996). Onset of multimorbidity occurred 10-15 years earlier in people living in the most deprived areas compared with the most affluent, with socioeconomic deprivation particularly associated with multimorbidity that included mental health disorders (prevalence of both physical and mental health disorder 11·0%, 95% CI 10·9-11·2% in most deprived area vs 5·9%, 5·8%-6·0% in least deprived). The presence of a mental health disorder increased as the number of physical morbidities increased (adjusted odds ratio 6·74, 95% CI 6·59-6·90 for five or more disorders vs 1·95, 1·93-1·98 for one disorder), and was much greater in more deprived than in less deprived people (2·28, 2·21-2·32 vs 1·08, 1·05-1·11). Our findings challenge the single-disease framework by which most health care, medical research, and medical education is configured. A complementary strategy is needed, supporting generalist clinicians to provide personalised, comprehensive continuity of care, especially in socioeconomically deprived areas. Scottish Government Chief Scientist Office. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Enhancing the scoping study methodology: a large, inter-professional team’s experience with Arksey and O’Malley’s framework

            Helena ML Daudt, Catherine van Mossel, Samantha J Scott (2013)
            Background Scoping studies are increasingly common for broadly searching the literature on a specific topic, yet researchers lack an agreed-upon definition of and framework for the methodology. In 2005, Arksey and O’Malley offered a methodological framework for conducting scoping studies. In their subsequent work, Levac et al. responded to Arksey and O’Malley’s call for advances to their framework. Our paper builds on this collective work to further enhance the methodology. Discussion This paper begins with a background on what constitutes a scoping study, followed by a discussion about four primary subjects: (1) the types of questions for which Arksey and O’Malley’s framework is most appropriate, (2) a contribution to the discussion aimed at enhancing the six steps of Arskey and O’Malley’s framework, (3) the strengths and challenges of our experience working with Arksey and O’Malley’s framework as a large, inter-professional team, and (4) lessons learned. Our goal in this paper is to add to the discussion encouraged by Arksey and O’Malley to further enhance this methodology. Summary Performing a scoping study using Arksey and O’Malley’s framework was a valuable process for our research team even if how it was useful was unexpected. Based on our experience, we recommend researchers be aware of their expectations for how Arksey and O’Malley’s framework might be useful in relation to their research question, and remain flexible to clarify concepts and to revise the research question as the team becomes familiar with the literature. Questions portraying comparisons such as between interventions, programs, or approaches seem to be the most suitable to scoping studies. We also suggest assessing the quality of studies and conducting a trial of the method before fully embarking on the charting process in order to ensure consistency. The benefits of engaging a large, inter-professional team such as ours throughout every stage of Arksey and O’Malley’s framework far exceed the challenges and we recommend researchers consider the value of such a team. The strengths include breadth and depth of knowledge each team member brings to the study and time efficiencies. In our experience, the most significant challenges presented to our team were those related to consensus and resource limitations. Effective communication is key to the success of a large group. We propose that by clarifying the framework, the purposes of scoping studies are attainable and the definition is enriched.
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              Synthesising qualitative and quantitative evidence: A review of possible methods

              Mary Dixon-Woods, Shona Agarwal, David Jones … (2016)
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Comorb
                Journal ID (iso-abbrev): J Comorb
                Journal ID (publisher-id): joc
                Title: Journal of Comorbidity
                Publisher: Swiss Medical Press GmbH (Hochwald, Switzerland )
                ISSN (Electronic): 2235-042X
                Publication date (Electronic): 27 January 2017
                Publication date Collection: 2017
                Volume: 7
                Issue: 1
                Pages: 11-21
                Affiliations
                [1] 1Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
                [2] 2Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands
                Author notes
                Correspondence: Maartje J. van der Aa, Department of Health Services Research, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. Tel.: +31 43 38 81703; E-mail: m.vanderaa@ 123456maastrichtuniversity.nl
                Article
                Publisher ID: joc.2017.7.97
                DOI: 10.15256/joc.2017.7.97
                PMC ID: 5556434
                PubMed ID: 29090185
                SO-VID: 65ea6c12-dee5-4eb0-a765-d5dc0f9634df
                Copyright © Copyright: © 2017 The Authors
                License:

                This is an open-access article distributed under the Creative Commons Attribution-NonCommercial License, which permits all noncommercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 17 October 2016
                Date accepted : 9 December 2016
                Categories
                Subject: Original Article

                Keywords: multimorbidity,delivery of healthcare,patient experience,professional-patient relation,healthcare system,scoping review
                Data availability:
                Keywords: multimorbidity, delivery of healthcare, patient experience, professional-patient relation, healthcare system, scoping review

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