Multimorbidity Management Supported by a Digital Platform

Official title

Protocol for a Cluster Randomised Trial of a Goal-Oriented Care Approach for Multimorbidity Patients Supported by a Digital Platform

Overview

This study aims to assess whether the use of the METHIS digital platform using a patient-centered approach contributes to an improvement in the quality of life, mental health and physical activity of patients with multimorbidity followed up in Primary Health Care. Practices will be randomly allocated between: providing access to consultations through the METHIS platform (intervention) or following patients by the traditional method (control). They will complete questionnaires on quality of life, mental health and report the number of steps taken, at the beginning and end of the study.

Detailed description

A superiority, cluster randomised trial will be conducted at Primary Health Care Practices (1:1 allocation ratio). All public practices in the Lisbon and Tagus Valley Region, Portugal, not involved in a previous pilot trial, will be eligible. The intervention combines a training programme and a customised Information System (METHIS). Both are designed to help clinicians to adopt a Goal-Oriented Care Model approach and to encourage patients and carers to play a more active role in autonomous healthcare.

Interventions

• Device METHIS Platform
  The METHIS platform is a digital healthcare platform, supported by three databases using PostreSQL (based in relational SQL). One of the databases allows adequate internal testing before production. Another database of production (secured with unique access codes) will be created to retrieve data from the practices' and the last database for the research data, where pseudonymised production data can be analysed for research purposes. The platform is integrated (via FCCN Scientific Computation Un
• Other Goal-Oriented Care Training Program
  The training program will have three stages: initial face-to-face training, which will happen before the data collection, followed by remote, asynchronous training during a 12-month period, and a final seminar to discuss the results and inquire about the usability of the GOC model and the METHIS platform. The course will be offered to the intervention group one month before the start of patient recruitment, and for the control group at least one month after the end of data collection.

Primary outcome measures

• Health related quality of life [Time frame: Participants will be asked to fill in the SF-12 questionnaire at baseline and at 12 months.]

Secondary outcome measures (4)

• Mental health status [Time frame: Participants will complete the HADS-A and HADS-D questionnaire at baseline and at 12 months.]
• Physical activity [Time frame: Participants will wear the SmartBand for 12 months.]
• Number of serious adverse events (clinician-reported) [Time frame: Family physicians will be asked, at 6 and 12 months after randomization, to check the life status of enrolled patients and whether patients in the trial were admitted to a hospital or had a visit to an emergency service since the randomization date.]
• Number of potentially missed diagnoses (clinician-reported) [Time frame: Potentially missed diagnoses will be reported 6 months after the intervention phase. In this way a compromise between avoiding recall bias and allowing enough time for a missed diagnosis to become clinically apparent is achieved.]

Eligibility criteria

Inclusion criteria

• community-dwelling people
• aged 50 or older
• with complex multimorbidity (co-occurrence of three or more chronic conditions affecting three or more different body systems)
• with access to an Internet connection and a communication technology device

Exclusion criteria

• inability to: provide informed consent, to read or write, inability to access an email or electronic device, even when helped by an informal caregiver

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Health services research

Study locations

Center list to be confirmed — check the primary protocol.

Publications

• Onder G, Palmer K, Navickas R, Jureviciene E, Mammarella F, Strandzheva M, Mannucci P, Pecorelli S, Marengoni A; Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS). Time to face the challenge of multimorbidity. A European perspective from the joint action on chronic diseases and promoting healthy ageing across the life cycle (JA-CHRODIS). Eur J Intern PMID 25797840
• Mercer S, Furler J, Moffat K, Fischbacher-Smith D, Sanci LA, World Health Organization, et al. Multimorbidity: Technical Series on Safer Primary Care. Geneva, Switzerland: World Health Organization; 2016
• Quinaz Romana G, Kislaya I, Salvador MR, Cunha Goncalves S, Nunes B, Dias C. [Multimorbidity in Portugal: Results from The First National Health Examination Survey]. Acta Med Port. 2019 Feb 1;32(1):30-37. doi: 10.20344/amp.11227. Epub 2019 Feb 1. Portuguese. PMID 30753801
• Amer Nordin A, Mohd Hairi F, Choo WY, Hairi NN. Care Recipient Multimorbidity and Health Impacts on Informal Caregivers: A Systematic Review. Gerontologist. 2019 Sep 17;59(5):e611-e628. doi: 10.1093/geront/gny072. PMID 29982539
• van der Aa MJ, van den Broeke JR, Stronks K, Plochg T. Patients with multimorbidity and their experiences with the healthcare process: a scoping review. J Comorb. 2017 Jan 27;7(1):11-21. doi: 10.15256/joc.2017.7.97. eCollection 2017. PMID 29090185
• Fortin M, Lapointe L, Hudon C, Vanasse A, Ntetu AL, Maltais D. Multimorbidity and quality of life in primary care: a systematic review. Health Qual Life Outcomes. 2004 Sep 20;2:51. doi: 10.1186/1477-7525-2-51. PMID 15380021
• Makovski TT, Schmitz S, Zeegers MP, Stranges S, van den Akker M. Multimorbidity and quality of life: Systematic literature review and meta-analysis. Ageing Res Rev. 2019 Aug;53:100903. doi: 10.1016/j.arr.2019.04.005. Epub 2019 Apr 30. PMID 31048032
• Marengoni A, von Strauss E, Rizzuto D, Winblad B, Fratiglioni L. The impact of chronic multimorbidity and disability on functional decline and survival in elderly persons. A community-based, longitudinal study. J Intern Med. 2009 Feb;265(2):288-95. doi: 10.1111/j.1365-2796.2008.02017.x. PMID 19192038

Identifiers

NCT: NCT05593835 · METHIS_CRTMB2022

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗