The Ariadne principles: how to handle multimorbidity in primary care consultations

BMC Medicine

Paul P Glasziou^1,12  Hendrik van den Bussche^1,13  Ulrich Thiem¹  Martin Scherer^1,13  Alexandra Prados-Torres³  Rafael Perera⁴  Hanna Kirchner⁸  Jochen Gensichen⁶  Martin Beyer⁸  Annette Becker⁷  François G Schellevis⁵  Justine Rochon^1,10  Christian D Mallen²  Jeanet W Blom⁹  Marjan van den Akker^1,11  Christiane Muth⁸ 

[1] Department of Geriatrics, Marienhospital Herne, Clinical Centre of the Ruhr University, Widumer Str. 8, Herne, 44627, Germany;Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK;EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute, IIS Aragón, Paseo Isabel La Católica 1-3, Zaragoza, 50009, Spain;Department of Primary Care Health Sciences, University of Oxford, 23-38 Hythe Bridge Street, Oxford OX1 2ET, UK;Department of General Practice and Elderly care medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands;Department of General Practice and Family Medicine, University Hospital, Friedrich Schiller University, Bachstraße 18, Jena, D-07740, Germany;Department of Family Medicine, Preventive and Rehabilitative Medicine, Philipps University of Marburg, Karl-von-Frisch-Str. 4, Marburg, D-35043, Germany;Institute of General Practice, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, Frankfurt, D-60590, Germany;Department of Public Health and Primary Care, Leiden University Medical Center, Postbus 9600, Leiden, 2300 RC, The Netherlands;Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Im Neuenheimer Feld 305, Heidelberg, D‐69120, Germany;Department of General Practice, Katholieke Universiteit Leuven, Kapucijnenvoer 33, blok J, Leuven, 3000, Belgium;The Centre for Research in Evidence-Based Practice (CREBP), Bond University, Gold Coast QLD 4226, Robina, Australia;Department of Primary Medical Care, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany

关键词: Primary care;    Patient preference;    Patient care planning;    Patient-centered care;    Multimorbidity;    Goal-oriented care;    General practice;    Decision making;    Comorbidity;   

Others  :  1118064
DOI  :  10.1186/s12916-014-0223-1

 received in 2014-07-04, accepted in 2014-11-04,  发布年份 2014

【 摘 要 】

Multimorbidity is a health issue mostly dealt with in primary care practice. As a result of their generalist and patient-centered approach, long-lasting relationships with patients, and responsibility for continuity and coordination of care, family physicians are particularly well placed to manage patients with multimorbidity. However, conflicts arising from the application of multiple disease oriented guidelines and the burden of diseases and treatments often make consultations challenging. To provide orientation in decision making in multimorbidity during primary care consultations, we developed guiding principles and named them after the Greek mythological figure Ariadne. For this purpose, we convened a two-day expert workshop accompanied by an international symposium in October 2012 in Frankfurt, Germany. Against the background of the current state of knowledge presented and discussed at the symposium, 19 experts from North America, Europe, and Australia identified the key issues of concern in the management of multimorbidity in primary care in panel and small group sessions and agreed upon making use of formal and informal consensus methods. The proposed preliminary principles were refined during a multistage feedback process and discussed using a case example. The sharing of realistic treatment goals by physicians and patients is at the core of the Ariadne principles. These result from i) a thorough interaction assessment of the patient’s conditions, treatments, constitution, and context; ii) the prioritization of health problems that take into account the patient’s preferences – his or her most and least desired outcomes; and iii) individualized management realizes the best options of care in diagnostics, treatment, and prevention to achieve the goals. Goal attainment is followed-up in accordance with a re-assessment in planned visits. The occurrence of new or changed conditions, such as an increase in severity, or a changed context may trigger the (re-)start of the process. Further work is needed on the implementation of the formulated principles, but they were recognized and appreciated as important by family physicians and primary care researchers.

Please see related article: http://www.biomedcentral.com/1741-7015/12/222 webcite.

【 授权许可】

   
2014 Muth et al.; licensee BioMed Central Ltd.

【 图 表 】

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