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Identifier

000388611

Title

Πολλαπλή νοσηρότητα/ συννοσηρότητα και τυχαιοποιημένες κλινικές δοκιμές πολύπλευρων παρεμβάσεων στην πρωτοβάθμια φροντίδα υγείας : Συστηματική ανασκόπηση

Alternative Title

Multimorbidity/comorbidity and randomized controlled trials of multilateral interventions in primary care:

Author

Μπατιστάκης, Αντώνης

Thesis advisor

Λιονής, Χ.
Τατσιώνη, Α.
Μαζοκοπάκης, Η.

Abstract

General: As a result of the advances in technology and the improvement in health care and public health care policies, an increasing number of patients have survived medical conditions, which in the past used to be fatal. As a result, along with the aging of the population an increasing number of patients in primary health care develop multiple medical conditions. The purpose of this systematic review is firstly to look for in the international bibliographic literature and secondly to evaluate all randomized controlled trials (RCT) which involve population of primary medical care with an acknowledged co-morbidity – multi-morbidity which have been done comparing controlled multilateral intervention, as opposed to the usual care of the control group. The present systematic review aims at giving an answer which of the multilateral interventions are effective, and of the latter, for which outcome. Method: Electronic medical bibliography of PUBMED & COCHRANE Database of Clinical Trials has been reviewed for randomized clinical trials published up until September 2012. Words describing co-morbidity, multimorbidity, primary health care and the RCT type have been used in various combinations. A report of certain quality parameters from each article has been recorded according to the CONSORT tool. Results: The research has come to 28 possibly suitable studies from PUBMED & 14 from COCHRANE. From the bibliographic literature of these articles 4 more studies have been found. Eventually, from all articles the criteria of exclusion and inclusion were only met by 4 completed studies and 2 studies in progress. Conditions which were tested in the population and were included in multimorbidity were hypertension (in 3 out of 4 RCT), depression (in 3 out of 4 RCT), diabetes (in 2 out of 4 RCT), myoskeletal pain and hyperlipidemia (each of them in 1 out of 4 RCT). Multiple interventions was different in each clinical trial and, apart from the usual intervention, it also involved educating and supporting the patient, behavioral stimulation, telecommunication, telemedicine, monitoring and control using a special device or systematic cooperation, within a group of health care professionals, with or without the General Practice / Family Medicine & Primary Health Care Faculty of Medicine – University of Crete 5 participation of the patient. Compliance to the treatment was the most common objective. The results were conflicting but also the control and acceptance of the compliance occurred in each clinical trial in a different way. Also the effectiveness in improving blood pressure and depression was checked and thought to be efficient. Conclusions: Even though multimorbidity is a usual unquestionable fact in everyday clinical practice, there are actually no randomized clinical trials – at least not in primary health care – which involve the effectiveness of multi-intervention in the outcome of each different condition. The present systematic review only found 4 completed RCT published in the last 4 years, the results of which cannot easily be re-composed and lead to safe conclusions. So this field is open to further research.

Language

English

Subject

Co-morbidity

Multimorbidity

Primary Health care

Randomized control trials

Πολλαπλή νοσηρότητα

Πρωτοβάθμια Φροντίδα Υγείας

Συννοσηρότητα

Τυχαιοποιημένη κλινική δοκιμή

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