Family Medicine

Recommendations

Info

Original abstract World Book of Family Medicine – European Edition 2015 http://www.woncaeurope.org/content/3851-prevention-and-health-promotion-clinical-practice-views-general-practitionerseurope References 1. Brotons C , Björkelund C, Bulc M, Ciurana R, Godycki-Cwirko M, Jurgova E, et al. on behalf of the EUROPREV network. Prevention and health promotion in clinical practice: the views of general practitioners in Europe. Prev Med 2005; 40:595- 601. 2. Brotons C, Bulc M, Sammut M , Sheehan M, da Silva Martins C M, Björkelund C, et al. Attitudes toward preventive services and lifestyle: the views of primary care patients in Europe. The EUROPREVIEW patient study. Family practice 2012; 29 (suppl. 1): i168-i176. 3. Johansson K, Bendtsen P, Akerlind I. Advice to patients in Swedish primary care regarding alcohol and other lifestyle habits: how patients report the actions of GPs in relation to their own expectations and satisfaction with the consultation. Eur J Public Health 2005; 15: 615-20. 4. Cervical Cytology Screening. The American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin 2009; 109: 1-12. 5. Yabroff KR, Saraiya M, Meissner HI, Haggstrom DA, Wideroff L, Yuan G, et al. Specialty Differences in Primary Care Physician Reports of Papanicolaou Test Screening Practices: A National Survey, 2006 to 2007. Ann Int Med 2009; 151: 602- 11. 6. Chamot E, Charvet A, Perneger TV. Overuse of mammography during the first round of an organized breast cancer screening programme. J Eval Clin Pract 2009; 15: 620-5. 72
World Book of Family Medicine – European Edition 2015 Marjan van den Akker, MD, PhD marjan.vandenakker@maastrichtuniversity.nl 22 – Determinants of Multimorbidity Marjan van den Akker, MD, PhD Maastricht University, School CAPHRI, dept of Family Medicine, KU Leuven,dept of General Practice Co-authors Christiane Muth, Job FM Metsemakers, J André Knottnerus, Frank Buntinx Introduction Multimorbidity, often defined as the co-occurrence of two or more (chronic) diseases within a patient, without an index disease being specified (1), is the rule rather than the exception in daily clinical practice. In Western countries the prevalence of multimorbidity in the general population ranges around 20-30% when the whole population was considered, and ranges between 55-98% when only older persons were included (2), with Asian studies showing similar results. Risk Factors Associated for Multimorbidity The main risk factor for multimorbidity seems to be age: in older populations the prevalence of the most common diseases, such as heart failure and dementia, is much higher than among younger patients, resulting in frequent co-occurrence of diseases. Multimorbidity is therefore often positioned as a condition of older patients. This is confirmed when looking at relative numbers, but increasingly it is recognized, that in absolute numbers the majority of patients suffering from multimorbidity is less than 65 years of age, with Barnett et al (3) reporting just over half of the people with multimorbidity to be 65 years of age or less. Secondly, women and persons from low social classes consistently appeared to be more prone to multimorbidity across Western and Asian studies (2, 4). In a Brazilian study, Andrade et al (5) reported that somatic and mental disorders also frequently co-occur in a population sample of a developing country. The results suggest that substantial proportions of both chronic medical and psychiatric morbidities are not attributable to disorder-specific risks but rather to a few generic liability factors associated with many disorders, like lifestyle and distress. This supports the notion of general disease susceptibility (6). Thirdly, ethnic, educational and cultural differences seem to play an important role: Black Americans had significantly higher initial levels of multimorbidity relative to white Americans in a national representative sample of US adults (7). The same study by Quinones et al. showed that higher education is associated with fewer reported diseases. Methodological Influences on Prevalence Estimates Already in the late 1990s it was recognized that many of the choices related to design of the study, definition and operationalisation of multimorbidity strongly influence the reported prevalence and incidence of multimorbidity (8). The influence of methodological decisions on the reported amount of multimorbidity is considerable. Starting with the various definitions of multimorbidity, where the minimum numbers of diseases differ (two vs three or more chronic conditions), or where multimorbidity is defined as the simultaneous presence of diseases/symptoms, cognitive and physical functional limitations, or the 73
Page 1 and 2:
The World Book of Family Medicine -
Page 3 and 4:
World Book of Family Medicine - Eur
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
The WP workshops on Ethics describe
Page 19 and 20:
Page 21 and 22: World Book of Family Medicine - Eur
Page 45 and 46: References: World Book of Family Me
Page 51 and 52: Original Abstract World Book of Fam
Page 71: World Book of Family Medicine - Eur
Page 81 and 82: Original abstract World Book of Fam
Page 93 and 94: Original Abstract World Book of Fam
Page 107 and 108: References World Book of Family Med
Page 123 and 124:
Original Abstract World Book of Fam
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
References World Book of Family Med
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Original abstract World Book of Fam
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Take home messages World Book of
Page 205 and 206:
Page 207 and 208:
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
Page 215 and 216:
Page 217 and 218:
Page 219 and 220:
Page 221 and 222:
Page 223 and 224:
Page 225 and 226:
Page 227 and 228:
Page 229 and 230:
Page 231 and 232:
Page 233 and 234:
Page 235 and 236:
Page 237 and 238:
Page 239 and 240:
Page 241 and 242:
Page 243 and 244:
Page 245 and 246:
Page 247 and 248:
Page 249 and 250:
Page 251 and 252:
Page 253 and 254:
Page 255 and 256:
Page 257 and 258:
Page 259 and 260:
Page 261 and 262:
Page 263 and 264:
Page 265 and 266:
Page 267 and 268:
Page 269 and 270:
Page 271 and 272:
Page 273 and 274:
Page 275 and 276:
Page 277 and 278:
Page 279 and 280:
Page 281 and 282:
Page 283 and 284:
Page 285 and 286:
Page 287 and 288:
Quaternary Prevention rubric (www.p
Page 289 and 290:
Page 291 and 292:
Page 293 and 294:
Page 295 and 296:
Page 297 and 298:
Page 299 and 300:
Page 301 and 302:
Page 303 and 304:
Page 305 and 306:
Page 307 and 308:
Page 309 and 310:
Page 311 and 312:
Page 313 and 314:
show all

Family Medicine

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?