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      Exploring patient priorities among long-term conditions in multimorbidity: A qualitative secondary analysis


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          A lack of agreement between health-care providers and patient priorities can impact the health-care provider–patient relationship, treatment concordance and potentially health outcomes. Evidence suggests that people living with multiple morbidities do prioritise among their long-term conditions. However, the evidence revealing the underlying reasons behind this prioritisation remains limited. Given the potential implications for day-to-day self-management activity and ultimately patient outcomes, this study aims to explore how and why people with multimorbidity prioritise some long-term conditions over others and what the potential implications may be for self-management activity, and in turn, suggest how such information may help clinicians negotiate the management of multimorbidity patients.


          A secondary analysis of qualitative data was conducted utilising four existing data sets collated from the three research centres involved. Purposive sampling provided a sample of 41 participants who had multimorbidity. The research team collectively coded and analysed the data thematically.


          All participants, except two, identified one ‘main’ priority long-term condition. Current priorities were arrived at by participants making comparisons between their long-term conditions, specifically by trading off the various attributes, impacts and perceived consequences of their individual long-term conditions. Two main themes emerged as to why participants identified a particular main long-term condition: (a) proximate issues surrounding barriers to functional health and (b) prioritisation of long-term conditions perceived to have a particular future risk.


          The recent focus on multimorbidity within the medical literature reflects its prevalence. It is therefore important to understand the complexities of the multimorbidity illness experience. We have added to the limited literature on condition prioritisation by revealing some novel understandings of the process of condition prioritisation which can feed into patient–provider consultations in order to allow better communication and treatment planning as well as, ultimately, optimise patient outcomes.

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              Psychological distress and multimorbidity in primary care.

              Psychological distress may decrease adherence to medical treatments and lead to poorer health outcomes of chronic diseases. The aim of this study was to evaluate the relationship between psychological distress and multimorbidity among patients seen in family practice after controlling for potential confounding variables and taking into account the severity of diseases. We evaluated 238 patients to construct quintiles of increasing multimorbidity based on the Cumulative Illness Rating Scale (CIRS), which is a comprehensive multimorbidity index that takes into account disease severity. Patients completed a psychiatric symptom questionnaire as a measurement of their psychological distress. In the first model of logistic regression analyses, we used the counted number of chronic diseases as the independent variable. In subsequent models, we used the quintiles of CIRS. After adjusting for confounding factors, multimorbidity measured by a simple count of chronic diseases was not related to psychological distress (OR, 1.12; 95% CI, 0.97-1.29; P = .188), whereas multimorbidity measured by the CIRS remained significantly associated (OR, 1.67; 95% CI, 1.19-2.37; P = .002). The estimate risk of psychological distress by quintile of CIRS was as follows: Q1/2 = 1.0; Q3 = OR, 1.72; 95% CI, 0.53-5.86; Q4 = OR, 2.99; 95% CI, 1.01-9.74; Q5 = OR, 4.67; 95% CI, 1.61-15.16. Psychological distress increased with multimorbidity when we accounted for disease severity. Clinicians should be aware of the possible presence of psychological distress, which can further complicate the comprehensive management of these complex patients.

                Author and article information

                SAGE Open Med
                SAGE Open Med
                SAGE Open Medicine
                SAGE Publications (Sage UK: London, England )
                20 September 2013
                : 1
                : 2050312113503955
                [1 ]NIHR School for Primary Care Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
                [2 ]Arthritis Research UK, Primary Care Centre, Keele University, Staffordshire, UK
                [3 ]Faculty of Health Sciences, University of Southampton, Southampton, UK
                [4 ]Research Department of Primary Care and Population Health, University College London, London, UK
                Author notes
                [*]Sudeh Cheraghi-Sohi, NIHR School for Primary Care Research, Manchester Academic Health Science Centre, The University of Manchester, 6th Floor Williamson Building, Oxford Road, Manchester, M139PL, UK. Email: sudeh.cheraghi-sohi@ 123456manchester.ac.uk
                © The Author(s) 2013
                Original Article
                Custom metadata
                January - December 2013

                multimorbidity,primary care,priorities,self-management,risk
                multimorbidity, primary care, priorities, self-management, risk


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