Multimorbid outpatients: A high frequency of FP appointments and/or family difficulties, should alert FPs to the possibility of death or acute hospitalization occurring within six months; A primary care feasibility study

• Published in: PloS one 2017-11, Vol.12 (11), p.e0186931-e0186931
• Main Authors: Le Reste, Jean Yves, Nabbe, Patrice, Billot Grasset, Alice, Le Floch, Bernard, Grall, Pauline, Derriennic, Jeremy, Odorico, Michele, Lalande, Sophie, le Goff, Delphine, Barais, Marie, Chiron, Benoit, Lingner, Heidrun, Guillou, Morgane, Barraine, Pierre
• Format: Article
• Language: English
• Subjects: Aged; Alarm systems; Analysis; Appointments and Schedules; Biology and Life Sciences; Chronic illnesses; Cluster analysis; Collaboration; Comorbidity; Criteria; Death; Decision analysis; Decision making; Europe; Family physicians; Feasibility Studies; Female; Forecasting; Frailty; General Practitioners; Health aspects; Health care; Hospitalization; Humans; Life Sciences; Literature reviews; Male; Medical personnel; Medicine and Health Sciences; Morbidity; Mortality; Multiple Chronic Conditions - mortality; Multivariate analysis; Occupations; Older people; Outpatients; Patients; People and Places; Physicians; Practice; Primary care; Public health; Qualitative research; Quality of life; Regression analysis; Risk analysis; Risk Factors; Santé publique et épidémiologie; Social Sciences; Statistical analysis
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0186931

The European General Practitioners Research Network (EGPRN) designed and validated a comprehensive definition of multimorbidity using a systematic literature review and qualitative research throughout Europe. This definition was tested as a model to assess death or acute hospitalization in multimorbid outpatients. To assess which criteria in the EGPRN concept of multimorbidity could detect outpatients at risk of death or acute hospitalization in a primary care cohort at a 6-month follow-up and to assess whether a large scale cohort with FPs would be feasible. Family Physicians included a random sample of multimorbid patients who attended appointments in their offices from July to December 2014. Inclusion criteria were those of the EGPRN definition of Multimorbidity. Exclusion criteria were patients under legal protection and those unable to complete the 2-year follow-up. Statistical analysis was undertaken with uni- and multivariate analysis at a 6-month follow-up using a combination of approaches including both automatic classification and expert decision making. A Multiple Correspondence Analysis (MCA) completed the process with a projection of illustrative variables. A logistic regression was finally performed in order to identify and quantify risk factors for decompensation. 19 FPs participated in the study. 96 patients were analyzed. 3 different clusters were identified. MCA showed the central function of psychosocial factors and peaceful versus conflictual relationships with relatives in all clusters. While taking into account the limit of a small cohort, age, frequency of family physician visits and extent of family difficulties were the factors which predicted death or acute hospitalization. A large scale cohort seems feasible in primary care. A sense of alarm should be triggered to prevent death or acute hospitalization in multimorbid older outpatients who have frequent family physician visits and who experience family difficulties.