Multimorbidity care model: Recommendations from the consensus meeting of the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS).

Katie Palmer, Alessandra Marengoni, Maria João Forjaz, Elena Jureviciene, Tiina Laatikainen, Federica Mammarella, Christiane Muth, Rokas Navickas, Alexandra Prados-Torres, Mieke Rijken, Ulrike Rothe, Laurène Souchet, Jose Valderas, Theodore Vontetsianos, Jelka Zaletel, Graziano Onder

Journal: Health policy (Amsterdam, Netherlands) 2018;122(1):4-11

PMID: 28967492

Full Text on Elsevier Science View on PubMed

Abstract

Patients with multimorbidity have complex health needs but, due to the current traditional disease-oriented approach, they face a highly fragmented form of care that leads to inefficient, ineffective, and possibly harmful clinical interventions. There is limited evidence on available integrated and multidimensional care pathways for multimorbid patients. An expert consensus meeting was held to develop a framework for care of multimorbid patients that can be applied across Europe, within a project funded by the European Union; the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS). The experts included a diverse group representing care providers and patients, and included general practitioners, family medicine physicians, neurologists, geriatricians, internists, cardiologists, endocrinologists, diabetologists, epidemiologists, psychologists, and representatives from patient organizations. Sixteen components across five domains were identified (Delivery of Care; Decision Support; Self Management Support; Information Systems and Technology; and Social and Community Resources). The description and aim of each component are described in these guidelines, along with a summary of key characteristics and relevance to multimorbid patients. Due to the lack of evidence-based recommendations specific to multimorbid patients, this care model needs to be assessed and validated in different European settings to examine specifically how multimorbid patients will benefit from this care model, and whether certain components have more importance than others.

Address: The Italian Medicines Agency (AIFA), 181 via del Tritone, 00187, Rome, Italy. Electronic address: [email protected].; The Italian Medicines Agency (AIFA), 181 via del Tritone, 00187, Rome, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 23, 25123, Brescia, Italy.; National School of Public Health, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain.; Vilnius University Hospital Santariskiu Klinikos (VULSK), g. 2, Vilnius, Lithuania.; National Institute for Health and Welfare, University of Eastern Finland, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.; The Italian Medicines Agency (AIFA), 181 via del Tritone, 00187, Rome, Italy.; Institute of General Practice, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany.; Aragon Health Sciences Institute, IIS Aragón, REDISSEC (ISCIII), University of Zaragoza, Pl +2, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain.; Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513 CR Utrecht, The Netherlands.; Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany.; European Patients' Forum (EPF) 31 rue du Commerce, 1000 Brussels, Belgium.; Health Services & Policy Research, University of Exeter, St Luke's Campus, Magdalen Road, Exeter EX1 2LU, United Kingdom.; Sotiria General Hospital/1st RHA of Attica, Athens, 152 Mesogion Av., Athens 11527, Greece.; National Institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia.; The Italian Medicines Agency (AIFA), 181 via del Tritone, 00187, Rome, Italy; Department of Geriatrics, Centre on Aging (CEMI), Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.

DOI: 10.1016/j.healthpol.2017.09.006

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MeSH Terms: Case Management, Chronic Disease, Consensus, Europe, Health Promotion, Healthy Aging, Humans, Multimorbidity