TY - JOUR T1 - OPTIMAL, an occupational therapy led self-management support programme for people with multimorbidity in primary care: a randomized controlled trial JF - BMC Family Practice Y1 - 2015 A1 - Garvey, J A1 - Connolly, D A1 - Boland, F A1 - Smith, SM KW - multimorbidity KW - Occupational therapy KW - Randomised controlled trial KW - Self-management AB - Background We investigated the effectiveness of an occupational therapy led self-management support programme, OPTIMAL, designed to address the challenges of living with multiple chronic conditions or multimorbidity in a primary care setting. Methods Pragmatic feasibility randomised controlled trial including fifty participants with multimorbidity recruited from family practice and primary care settings. OPTIMAL is a six-week community-based programme, led by occupational therapy facilitators and focuses on problems associated with managing multimorbidity. The primary outcome was frequency of activity participation. Secondary outcomes included self-perception of, satisfaction with and ability to perform daily activities, independence in activities of daily living, anxiety and depression, self-efficacy, health-related quality of life, self-management support, healthcare utilisation and individualised goal attainment. Outcomes were collected within two weeks of intervention completion. Results There was a significant improvement in frequency of activity participation, measured using the Frenchay Activities Index, for the intervention group compared to the control group (Adjusted Mean Difference at follow up 4.22. 95% Confidence Interval 1.59-6.85). There were also significant improvements in perceptions of activity performance and satisfaction, self-efficacy, independence in daily activities and quality of life. Additionally, the intervention group demonstrated significantly higher levels of goal achievement, following the intervention. No significant differences were found between the two groups in anxiety, depression, self-management scores or healthcare utilisation. Conclusions OPTIMAL significantly improved frequency of activity participation, self-efficacy and quality of life for patients with multimorbidity. Further work is required to test the sustainability of these effects over time but this study indicates that it is a promising intervention that can be delivered in primary care and community settings. Trial registration Trial Number: ISRCTN67235963 VL - 16 UR - http://www.biomedcentral.com/1471-2296/16/59/abstract IS - 59 ER - TY - JOUR T1 - Managing patients with multimorbidity in primary care JF - BMJ Y1 - 2015 A1 - Wallace, E A1 - Salisbury, C A1 - Guthrie, Bruce A1 - Lewis, Cliona A1 - Fahey, T A1 - Smith, SM KW - multimorbidity KW - primary care VL - 350 UR - http://www.bmj.com/content/350/bmj.h176 IS - h176 ER - TY - JOUR T1 - Improving the external validity of clinical trials: the case of multiple chronic conditions JF - Journal of Comorbidity Y1 - 2013 A1 - Fortin, M A1 - Smith, SM KW - clinical trials KW - Comorbidity KW - external validity KW - internal validity KW - multimorbidity KW - multiple chronic conditions AB - The U.S. Department of Health and Human Services vision and strategic framework on multiple chronic conditions(MCCs) incorporates recommendations designed to facilitate research that will improve our knowledge about interventions and systems that will benefit individuals with MCCs (or multimorbidity). The evidence base supporting the management of patients with MCCs will be built through intervention trials specifi cally designed to address multimorbidity and identifi cation of MCCs in participants across the clinical trial range. This article specifically focuses on issues relating to external validity with specifi c reference to trials involving patients with MCCs. The exclusion of such patients from clinical trials has been well documented. Randomized control trials (RCTs) are considered the “gold standard” of evidence, but may have drawbacks in relation to external validity, particularly in relation to multimorbidity. It may, therefore, be necessary to consider a broader range of research methods that can provide converging evidence on intervention effects to address MCCs. Approaches can also be taken to increase the usefulness of RCTs in general for providing evidence to inform multimorbidity management. Additional improvements to RCTs would include better reporting of inclusion and exclusion criteria and participant characteristics in relation to MCCs. New trials should be considered in terms of how they will add to the existing evidence base and should inform how interventions may work in different settings and patient groups. Research on treatments and interventions for patients with MCCs is badly needed. It is important that this research includes patient-centered measures and that generalizability issues be explicitly addressed. VL - 3 UR - http://jcomorbidity.com/index.php/test/article/view/27 IS - 2 ER - TY - JOUR T1 - How to design and evaluate interventions to improve outcomes for patients with multimorbidity JF - Journal of Comorbidity Y1 - 2013 A1 - Smith, SM A1 - Bayliss, EA A1 - Mercer, Stewart W A1 - Gunn, J A1 - Vestergaard, M A1 - Wyke, Sally A1 - Salisbury, C A1 - Fortin, M KW - Comorbidity KW - Family Practice KW - interventions KW - multimorbidity AB - Multimorbidity is a major challenge for patients and healthcare providers. The limited evidence of the effectiveness of interventions for people with multimorbidity means that there is a need for much more research and trials of potential interventions. Here we present a consensus view from a group of international researchers working to improve care for people with multimorbidity to guide future studies of interventions. We suggest that there is a need for careful consideration of whom to include, how to target interventions that address specific problems and that do not add to treatment burden, and selecting outcomes that matter both to patients and the healthcare system. Innovative design of these interventions will be necessary as many will be introduced in service settings and it will be important to ensure methodological rigour, relevance to service delivery, and generalizability across healthcare systems VL - 3 UR - http://jcomorbidity.com/index.php/test/article/view/21 IS - 1 ER - TY - JOUR T1 - The development of the PROMPT (PRescribing Optimally in Middle-aged People’s Treatments) criteria JF - BMC Health Services Research Y1 - 2014 A1 - Cooper, J A1 - Ryan, C A1 - Smith, SM A1 - Wallace, E A1 - Bennett, K A1 - Cahir, C A1 - Williams, David A1 - Teeling, Mary A1 - Hughes, CM A1 - PROMPT Steering Group KW - Delphi technique KW - Explicit criteria KW - Middle-age KW - multimorbidity KW - Polypharmacy KW - potentially inappropriate prescribing AB - Abstract Background Whilst multimorbidity is more prevalent with increasing age, approximately 30% of middle-aged adults (45–64 years) are also affected. Several prescribing criteria have been developed to optimise medication use in older people (≥65 years) with little focus on potentially inappropriate prescribing (PIP) in middle-aged adults. We have developed a set of explicit prescribing criteria called PROMPT (PRescribing Optimally in Middle-aged People’s Treatments) which may be applied to prescribing datasets to determine the prevalence of PIP in this age-group. Methods A literature search was conducted to identify published prescribing criteria for all age groups, with the Project Steering Group (convened for this study) adding further criteria for consideration, all of which were reviewed for relevance to middle-aged adults. These criteria underwent a two-round Delphi process, using an expert panel consisting of general practitioners, pharmacists and clinical pharmacologists from the United Kingdom and Republic of Ireland. Using web-based questionnaires, 17 panellists were asked to indicate their level of agreement with each criterion via a 5-point Likert scale (1 = Strongly Disagree, 5 = Strongly Agree) to assess the applicability to middle-aged adults in the absence of clinical information. Criteria were accepted/rejected/revised dependent on the panel’s level of agreement using the median response/interquartile range and additional comments. Results Thirty-four criteria were rated in the first round of this exercise and consensus was achieved on 17 criteria which were accepted into the PROMPT criteria. Consensus was not reached on the remaining 17, and six criteria were removed following a review of the additional comments. The second round of this exercise focused on the remaining 11 criteria, some of which were revised following the first exercise. Five criteria were accepted from the second round, providing a final list of 22 criteria [gastro-intestinal system (n = 3), cardiovascular system (n = 4), respiratory system (n = 4), central nervous system (n = 6), infections (n = 1), endocrine system (n = 1), musculoskeletal system (n = 2), duplicates (n = 1)]. Conclusions PROMPT is the first set of prescribing criteria developed for use in middle-aged adults. The utility of these criteria will be tested in future studies using prescribing datasets. Keywords: Potentially inappropriate prescribing; Explicit criteria; Delphi technique; Middle-age; Polypharmacy; Multimorbidity VL - 14 UR - http://www.biomedcentral.com/1472-6963/14/484 ER -