CHWs (110) What are the effective elements in patient-centered and multimorbidity care? A scoping review

1 July, 2019

(h/t Alberto Fernandez, EASP/WHO-CC, lead moderator HIFA-Spanish)

Citation, abstract and comment from me below.

CITATION: BMC Health Serv Res. 2018 Jun 14;18(1):446. doi: 10.1186/s12913-018-3213-8.

What are the effective elements in patient-centered and multimorbidity care? A scoping review.

Poitras ME1, Maltais ME2, Bestard-Denommé L3, Stewart M3, Fortin M2.


BACKGROUND: Interventions to improve patient-centered care for persons with multimorbidity are in constant growth. To date, the emphasis has been on two separate kinds of interventions, those based on a patient-centered care approach with persons with chronic disease and the other ones created specifically for persons with multimorbidity. Their effectiveness in primary healthcare is well documented. Currently, none of these interventions have synthesized a patient-centered care approach for care for multimorbidity. The objective of this project is to determine the particular elements of patient-centered interventions and interventions for persons with multimorbidity that are associated with positive health-related outcomes for patients.

METHOD: A scoping review was conducted as the method supports the rapid mapping of the key concepts underpinning a research area and the main sources and types of evidence available. A five-stage approach was adopted: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; and (5) collating, summarizing and reporting results. We searched for interventions for persons with multimorbidity or patient-centered care in primary care. Relevant studies were identified in four systematic reviews (Smith et al. (2012;2016), De Bruin et al. (2012), and Dwamena et al. (2012)). Inductive analysis was performed.

RESULTS: Four systematic reviews and 98 original studies were reviewed and analysed. Elements of interventions can be grouped into three main types and clustered into seven categories of interventions: 1) Supporting decision process and evidence-based practice; 2) Providing patient-centered approaches; 3) Supporting patient self-management; 4) Providing case/care management; 5) Enhancing interdisciplinary team approach; 6) Developing training for healthcare providers; and 7) Integrating information technology. Providing patient-oriented approaches, self-management support interventions and developing training for healthcare providers were the most frequent categories of interventions with the potential to result in positive impact for patients with chronic diseases.

CONCLUSION: This scoping review provides evidence for the adaption of patient-centered interventions for patients with multimorbidity. Findings from this scoping review will inform the development of a toolkit to assist chronic disease prevention and management programs in reorienting patient care.

COMMENT (NPW): From the perspective of our CHW discussion, the complexity of modern healthcare and increasing levels of multimorbidity in LMICs provide a further rationale for integrating CHWs into the health system as the first level of care, with referral to higher levels in the system as needed. Of course, this implies adequate knowledge of co-morbidities among CHWs as well as integrity of the system as a whole to deal with cases requiring higher levels of care.

Best wishes, Neil

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