Radost Assenova

The European General Practice Research Network Presents the Translations of Its Comprehensive Definition of Multimorbidity in Family Medicine in Ten European Languages

Background 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. Objective To translate that English definition into European languages and to validate the semantic, conceptual and cultural homogeneity of the translations for further research. Method 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 Results 229 European medical expert FPs participated in the study. Ten consensual translations of the EGPRN comprehensive definition of multimorbidity were achieved. Conclusion A comprehensive definition of multimorbidity is now available in English and ten European languages for further collaborative research in FM and long-term care.

What research agenda could be generated from the European General Practice Research Network concept of Multimorbidity in Family Practice

BackgroundMultimorbidity is an intuitively appealing, yet challenging, concept for Family Medicine (FM). An EGPRN working group has published a comprehensive definition of the concept based on a systematic review of the literature which is closely linked to patient complexity and to the biopsychosocial model. This concept was identified by European Family Physicians (FPs) throughout Europe using 13 qualitative surveys. To further our understanding of the issues around multimorbidity, we needed to do innovative research to clarify this concept. The research question for this survey was: what research agenda could be generated for Family Medicine from the EGPRN concept of Multimorbidity?MethodsNominal group design with a purposive panel of experts in the field of multimorbidity. The nominal group worked through four phases: ideas generation phase, ideas recording phase, evaluation and analysis phase and a prioritization phase.ResultsFifteen international experts participated. A research agenda was established, featuring 6 topics and 11 themes with their corresponding study designs. The highest priorities were given to the following topics: measuring multimorbidity and the impact of multimorbidity. In addition the experts stressed that the concept should be simplified. This would be best achieved by working in reverse: starting with the outcomes and working back to find the useful variables within the concept.ConclusionThe highest priority for future research on multimorbidity should be given to measuring multimorbidity and to simplifying the EGPRN model, using a pragmatic approach to determine the useful variables within the concept from its outcomes.

How do general practitioners recognize the definition of multimorbidity? A European qualitative study

Abstract Background: Multimorbidity is a challenging concept for general practice. An EGPRN working group has published a comprehensive definition of the concept of multimorbidity. As multimorbidity could be a way to explore complexity in general practice, it was of importance to explore whether European general practitioners (GPs) recognize this concept and whether they would change it. Objectives: To investigate whether European GPs recognize the EGPRN concept of multimorbidity and whether they would change it. Methods: Focus group meetings and semi-structured interviews as data collection techniques with a purposive sample of practicing GPs from every country. Data collection continued until saturation was reached in every country. The analysis was undertaken using a grounded theory based method. In each national team, four independent researchers, working blind and pooling data, carried out the analysis. To ensure the internationalization of the data, an international team of 10 researchers pooled the axial and selective coding of all national teams to check the concept and highlight emerging themes. Results: The maximal variation and saturation of the sample were reached in all countries with 211 selected GPs. The EGPRN definition was recognized in all countries. Two additional ideas emerged, the use of Wonca’s core competencies of general practice, and the dynamics of the doctor–patient relationship for detecting and managing multimorbidity and patient’s complexity. Conclusion: European GPs recognized and enhanced the EGPRN concept of multimorbidity. These results open new perspectives regarding the management of complexity using the concept of multimorbidity in general practice. Key Messages European general practitioners recognize the EGPRN enhanced, comprehensive concept of multimorbidity. They add the use of Wonca’s core competencies and the patient–doctor relationship dynamics for detecting and managing multimorbidity. The EGPRN concept of multimorbidity leads to new perspectives for the management of complexity.

Which positive factors determine the GP satisfaction in clinical practice? A systematic literature review

BackgroundLooking at what makes General Practitioners (GPs) happy in their profession, may be important in increasing the GP workforce in the future. The European General Practice Research Network (EGPRN) created a research team (eight national groups) in order to clarify the factors involved in GP job satisfaction throughout Europe. The first step of this study was a literature review to explore how the satisfaction of GPs had been studied before. The research question was “Which factors are related to GP satisfaction in Clinical Practice?”MethodsSystematic literature review according to the PRISMA statement. The databases searched were Pubmed, Embase and Cochrane. All articles were identified, screened and included by two separate research teams, according to inclusion or exclusion criteria. Then, a qualitative appraisal was undertaken. Next, a thematic analysis process was undertaken to capture any issue relevant to the research question.ResultsThe number of records screened was 458. One hundred four were eligible. Finally, 17 articles were included. The data revealed 13 subthemes, which were grouped into three major themes for GP satisfaction. First there were general profession-related themes, applicable to many professions. A second group of issues related specifically to a GP setting. Finally, a third group was related to professional life and personal issues.ConclusionsA number of factors leading to GP job satisfaction, exist in literature They should be used by policy makers within Europe to increase the GP workforce. The research team needs to undertake qualitative studies to confirm or enhance those results.

One consensual depression diagnosis tool to serve many countries: a challenge! A RAND/UCLA methodology

ObjectiveFrom a systematic literature review (SLR), it became clear that a consensually validated tool was needed by European General Practitioner (GP) researchers in order to allow multi-centred collaborative research, in daily practice, throughout Europe. Which diagnostic tool for depression, validated against psychiatric examination according to the DSM, would GPs select as the best for use in clinical research, taking into account the combination of effectiveness, reliability and ergonomics? A RAND/UCLA, which combines the qualities of the Delphi process and of the nominal group, was used. GP researchers from different European countries were selected. The SLR extracted tools were validated against the DSM. The Youden index was used as an effectiveness criterion and Cronbach’s alpha as a reliability criterion. Ergonomics data were extracted from the literature. Ergonomics were tested face-to-face.ResultsThe SLR extracted 7 tools. Two instruments were considered sufficiently effective and reliable for use: the Hospital Anxiety and Depression Scale and the Hopkins Symptoms Checklist-25 (HSCL-25). After testing face-to-face, HSCL-25 was selected. A multicultural consensus on one diagnostic tool for depression was obtained for the HSCL-25. This tool will provide the opportunity to select homogeneous populations for European collaborative research in daily practice.

How General Practitioners in Bulgaria Tackle Palliative Care?: A Cross-Sectional Study

ABS TRACT Objective: One of the substantial reforms of the health care system in Bulgaria was the establishment of primary medical care provided by the general practitioners (GPs). This type of care is particularly important for the provision of palliative care in the community. To present GPs’ opinion on palliative care related to current situation in the health care system. Material and Methods: Questionnaire-based study among 337 GPs. Results: The demographic indices showed prevalence of the age groups over 40, almost 2/3 were women. The group included GPs working in different types of inhabited places. The responders pointed out organization and financing as the main difficulties in providing palliative care. A half of the physicians stated that they provided care for more than ten patients per year, who were in a severe condition. These patients in the greater part of the cases (81.00%) remained in their homes. There was an adjustment in the most of GPs to coordinate palliative care in home setting, if it can be organized appropriately. The GPs shared the opinion that palliative care should be provided in cases of life expectancy amounting to one year. Almost 2/3 of the respondents evaluated quality of life/care subjectively and not systemically. Need of training was pointed out by 2/3 of the GPs. Conclusion: GPs accept and realize their role in palliative care providing, but they face the lack of organizational and financial security.

Cross-Cultural Validation of the Definition of Multimorbidity in the Bulgarian Language / Культуральная Валидность Определения Полиморбидности В Болгарском Языке

Abstract INTRODUCTION: 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. MATERIALS AND METHODS: 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. RESULTS: 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. DISCUSSION: 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. CONCLUSIONS: 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. Резюме 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.