Due to the heterogeneous and systemic nature of the chronic obstructive pulmonary disease (COPD), the new guidelines are oriented toward individualized attention. Multidimensional scales could ...facilitate its proper clinical and prognostic assessment, but not all of them were validated in an international primary care cohort, different from the original ones used for model development. Therefore, our main aim is to assess the prognostic capacity of the ADO, BODEx and DOSE indices in primary care for predicting mortality in COPD patients and to validate the models obtained in subgroups of patients, classified by revised Global Initiative for Chronic Obstructive Lung Disease (2011) and updated Spanish Guideline (2014). Besides, we want to confirm that the prognostic capacity of all indices increases if the number of exacerbations is substituted by the interval between them and to assess the impact on health of the patient's lifestyle, social network and adherence to treatment.
Design: External validation of scales, open and prospective cohort study in primary care.
36 health centres in 6 European high, medium and low income countries.
477 patients diagnosed with COPD, captured in clinical visit by their General Practitioner/Nurse.
Detailed patient history, exacerbations, lung function test and questionnaires at baseline.
Exacerbations, all-cause mortality and specific mortality, within 5 years of recruitment.
Multivariate logistic regression and Cox regression will be used. Possible non-linear effect of the indices will be studied by using Structured Additive Regression models with penalised splines. Subsequently, we will assess different aspects of the regression models: discrimination, calibration and diagnostic precision. Clinical variables modulated in primary care and the interval between exacerbations will be considered and incorporated into the analysis.
The Research Agenda for General Practice/Family Medicine highlights that the evidence on predictive values of prognostic indices in primary care is scarce. A prospective cohort like that of PROEPOC/COPD provides good opportunities for research into COPD and make communication easier between family practitioners, nursing staff, pneumologists and other professionals, supporting a multi-disciplinary approach to the treatment of these patients.
ISRCTN52402811 . Date: 15/01/2015. Prospectively registered.
Multimorbidity is a health issue with growing importance. During the last few decades the populations of most countries in the world have been ageing rapidly. Bulgaria is affected by the issue ...because of the high prevalence of ageing population in the country with multiple chronic conditions. The AIM of the present study was to validate the translated definition of multimorbidity from English into the Bulgarian language.
The present study is part of an international project involving 8 national groups. We performed a forward and backward translation of the original English definition of multimorbidity using a Delphi consensus procedure.
The physicians involved accepted the definition with a high percentage of agreement in the first round. The backward translation was accepted by the scientific committee using the Nominal group technique.
Some of the GPs provided comments on the linguistic expressions which arose in order to improve understanding in Bulgarian. The remarks were not relevant to the content. The conclusion of the discussion, using a meta-ethnographic approach, was that the differences were acceptable and no further changes were required.
A native version of the published English multimorbidity definition has been finalized. This definition is a prerequisite for better management of multimorbidity by clinicians, researchers and policy makers.
ВВЕДЕНИЕ: Значение полиморбидности становится всё более существенным. За последние несколько десятилетий наблюдается всё более значительное старение населения большинства стран в мире. Проблема ...касается и Болгарии, ввиду высокого распространения стареющего населения со множеством хронических заболеваний. ЦЕЛЬЮ данного обследования является валидизация определения полиморбидности в переводе с английского на болгарский язык. МАТЕРИАЛ И МЕТОДЫ: Настоящее обследование является частью международного проекта, включающего участников из восьми стран. Исследование основано на переводе определения с применением процедуры Дельфи. РЕЗУЛЬТАТЫ: Участвующие в обследовании врачи приняли определение на первом этапе с высоким процентом согласия. Перевод с болгарского языка на английский принято исследовательским комитетом с использованием техники Номинальной группы. ДИСКУССИЯ: Частью общепрактикующих врачей были обсуждены конкретные выражения с целью лучшего понимания на болгарском языке. Отправленные замечания не касаются содержания. Проведённый мета-этнографический подход привёл к заключению, что различия приемлемы и нет необходимости в дальнейших изменениях. ЗАКЛЮЧЕНИЕ: Болгарский перевод определения полиморбидности осуществлён. Данное определение является предпосылкой для лучшего управления полиморбидностью клиницистами, исследователями и политиками.
Multimorbidity, according to the World Health Organization, exists when there are two or more chronic conditions in one patient. This definition seems inaccurate for the holistic approach to Family ...Medicine (FM) and long-term care. To avoid this pitfall the European General Practitioners Research Network (EGPRN) designed a comprehensive definition of multimorbidity using a systematic literature review.
To translate that English definition into European languages and to validate the semantic, conceptual and cultural homogeneity of the translations for further research.
Forward translation of the EGPRN's definition of multimorbidity followed by a Delphi consensus procedure assessment, a backward translation and a cultural check with all teams to ensure the homogeneity of the translations in their national context. Consensus was defined as 70% of the scores being higher than 6. Delphi rounds were repeated in each country until a consensus was reached.
229 European medical expert FPs participated in the study. Ten consensual translations of the EGPRN comprehensive definition of multimorbidity were achieved.
A comprehensive definition of multimorbidity is now available in English and ten European languages for further collaborative research in FM and long-term care.
Abstract
Introduction
To reduce inappropriate polypharmacy, deprescribing should be part of patients’ regular care. Yet deprescribing is difficult to implement, as shown in several studies. ...Understanding patients’ attitudes towards deprescribing at the individual and country level may reveal effective ways to involve older adults in decisions about medications and help to implement deprescribing in primary care settings. In this study we aim to investigate older adults’ perceptions and views on deprescribing in different European countries. Specific objectives are to investigate the patients’ willingness to have medications deprescribed by medication type and to have herbal or dietary supplements reduced or stopped, the role of the Patient Typology (on medication perspectives), and the impact of the patient-GP relationship in these decisions.
Methods and analysis
This cross-sectional survey study has two parts: Part A and Part B. Data collection for Part A will take place in nine countries, in which per country 10 GPs will recruit 10 older patients (≥65 years old) each (
n
= 900). Part B will be conducted in Switzerland only, in which an additional 35 GPs will recruit five patients each and respond to a questionnaire themselves, with questions about the patients’ medications, their willingness to deprescribe those, and their patient-provider relationship. For both Part A and part B, a questionnaire will be used to assess the willingness of older patients with polypharmacy to have medications deprescribed and other relevant information. For Part B, this same questionnaire will have additional questions on the use of herbal and dietary supplements.
Discussion
The international study design will allow comparisons of patient perspectives on deprescribing from different countries. We will collect information about willingness to have medications deprescribed by medication type and regarding herbal and dietary supplements, which adds important information to the literature on patients’ preferences. In addition, GPs in Switzerland will also be surveyed, allowing us to compare GPs’ and patients’ views and preferences on stopping or reducing specific medications. Our findings will help to understand patients’ attitudes towards deprescribing, contributing to improvements in the design and implementation of deprescribing interventions that are better tailored to patients’ preferences.
Abstract Background Recruitment for surveys has been a great challenge, especially in general practice. Methods Here, we reported recruitment strategies, data collection, participation rates (PR) and ...representativeness of the PRICOV-19 study, an international comparative, cross-sectional, online survey among general practices (GP practices) in 37 European countries and Israel. Results Nine (24%) countries reported a published invitation; 19 (50%) had direct contact with all GPs/GP practices; 19 (50%) contacted a sample of GPs /GP practices; and 7 (18%) used another invitation strategy. The median participation rate was 22% (IQR = 10%, 28%). Multiple invitation strategies ( P -value 0.93) and multiple strategies to increase PR ( P -value 0.64) were not correlated with the PR. GP practices in (semi-) rural areas, GP practices serving more than 10,000 patients, and group practices were over-represented ( P -value < 0.001). There was no significant correlation between the PR and strength of the primary care (PC) system Spearman’s r 0.13, 95% CI (-0.24, 0.46); P -value 0.49; the COVID-19 morbidity Spearman’s r 0.19, 95% CI (-0.14, 0.49); P -value 0.24, or COVID-19 mortality Spearman’s r 0.19, 95% CI (-0.02, 0.58); P -value 0.06 during the three months before country-specific study commencement. Conclusion Our main contribution here was to describe the survey recruitment and representativeness of PRICOV-19, an important and novel study.
To evaluate the precipitating factors for heart failure decompensation in primary care and associations with short-term prognosis. Design Prospective cohort study with a 30-d follow-up from an index ...consultation. Regression models to determine independent factors associated with hospitalisation or death.
Primary care in ten European countries. Patients Patients with diagnosis of heart failure attended in primary care for a heart failure decompensation (increase of dyspnoea, unexplained weight gain or peripheral oedema).
Potential precipitating factors for decompensation of heart failure and their association with the event of hospitalisation or mortality 30 d after a decompensation.
Of 692 patients 54% were women, mean age 81 (standard deviation SD 8.9) years; mean left ventricular ejection fraction (LVEF) 55% (SD 12%). Most frequently identified heart failure precipitation factors were respiratory infections in 194 patients (28%), non-compliance of dietary recommendations in 184 (27%) and non-compliance with pharmacological treatment in 157 (23%). The two strongest precipitating factors to predict 30 d hospitalisation or death were respiratory infections (odds ratio OR 2.8, 95% confidence interval CI (2.4-3.4)) and atrial fibrillation (AF) > 110 beats/min (OR 2.2, CI 1.5-3.2). Multivariate analysis confirmed the association between the following variables and hospitalisation/death: In relation to precipitating factors: respiratory infection (OR 1.19, 95% CI 1.14-1.25) and AF with heart rate > 110 beats/min (OR 1.22, 95% CI 1.10-1.35); and regarding patient characteristics: New York Heart Association (NYHA) III or IV (OR 1.22, 95% CI 1.15-1.29); previous hospitalisation (OR 1.15, 95% CI 1.11-1.19); and LVEF < 40% (OR 1.14, 95% CI 1.09-1.19).
In primary care, respiratory infections and rapid AF are the most important precipitating factors for hospitalisation and death within 30 d following an episode of heart failure decompensation.
Key points
Hospitalisation due to heart failure decompensation represents the highest share of healthcare costs for this disease.
So far, no primary care studies have analysed the relationship between precipitating factors and short term prognosis of heart failure decompensation episodes.
We found that in 692 patients with heart failure decompensation in primary care, the respiratory infection and rapid atrial fibrillation (AF) increased the risk of short-term hospital admission or death.
Patients with a hospital admission the previous year and a decompensation episode caused by respiratory infection were even more likely to be hospitalized or die within 30 d.
When identifying patients for palliative care, medical specialists find it necessary to disclose "hidden" patients: the patient's relatives. The issue has been discussed sporadically in Bulgaria; the ...present study was part of a larger investigation that examined the opinion of medical specialists, patients, and their relatives.
The study protocol was explained to participants who gave written informed consent. Patients (n=211) were followed up on by their general practitioners (GPs) (n=42) during one year. All relatives were invited, and 173 (82%) agreed and participated. A questionnaire created by the authors was used. The data were analyzed by frequency distribution (descriptive statistics) and nonparametric tests (Pearson's χ(2)) and statistically processed using SPSS 17.0 (SPSS Inc., Chicago, IL).
Relatives providing care were predominantly women, two-thirds over 60 years of age. There was a one-to-one ratio between caregivers for oncological and nononcological patients. The duration of care was more than one year in 53% of cases. Most relatives reported their loved ones found physical suffering "very hard to bear" (53%), while approximately 17% could not assess the extent of psychological suffering. The vast majority stated that they had difficulties in providing care, and 68% had financial problems in that respect.
Including relatives as users and part of the palliative care team has been discussed in the literature. In Bulgaria, participation is solely due to the lack of organized services for palliative care. Relatives participate in activities that are performed by trained staff in countries with developed palliative care; these activities, along with negative emotional experiences and economic difficulties, overburden these caregiving relatives significantly.
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