From chronic conditions to relevance in multimorbidity: a four-step study in family medicine
From chronic conditions to relevance in multimorbidity: a four-step study in family medicine
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DOI：
10.1093/fampra/cmw030
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发表时间：
2016-08-01
期刊：
影响因子：
2.2
通讯作者：
Herzig, Lilli
中科院分区：
文献类型：
--
作者：
N'Goran, Alexandra A.;Blaser, Jeremie;Herzig, Lilli
慢性病和多发性骨髓瘤（MM）是家庭医学（FM）的主要关注点。根据国际初级保健分类，第二版（ICPC-2），这项研究的目的是列出（i）慢性疾病和（ii）FM中与MM最相关的疾病。FM专家小组使用四步过程来确定ICPC中的慢性疾病-他们还评估了先前在文献中确定的表征慢性疾病的八个标准的重要性。第一步涉及由五名专家组成的重点小组。第二、三和四步分别涉及10、25和25名专家。他们使用Likert量表通过在线问卷对ICPC-2项目进行了评分，评分范围为1（在MM中从不慢性/不相关）至9（在MM中总是慢性/总是相关）。使用中位数临界值评价每个项目的适当性，并根据对称性调整百分位数间范围，以确定专家之间的一致性/不一致性。与此同时，在第二步和第三步中，专家们使用Likert量表从1（强烈反对）9在ICPC-2的686个项目中，专家们确定了139种慢性病，其中75种被认为与MM最相关。八项标准中的四项被保留为定义慢性病的重要标准：持续时间，后遗症，复发/模式和诊断本身。使用这个列表中的75个最相关的慢性疾病的背景下，MM应提高研究的有效性MM FM。
Chronic conditions and multimorbidity (MM) are major concerns in family medicine (FM).Based on the International Classification of Primary Care, Second Edition (ICPC-2), this study aimed to list (i)the chronic conditions and (ii)those most relevant to MM in FM.A panel of FM experts used a four-step process to identify chronic conditions among ICPC-2 items and list chronic conditions most relevant in MM. They also evaluated the importance of eight criteria, previously identified in the literature, for characterizing chronic conditions. Step one involved a focus group of five experts. Steps two, three and four involved 10, 25 and 25 experts, respectively. They rated ICPC-2 items via an online questionnaire using a Likert scale from 1 (never chronic/irrelevant in MM) to 9 (always chronic/always relevant in MM). A median value cut-off was used to evaluate appropriateness of each item and the inter-percentile range adjusted for symmetry to determine the agreement/disagreement between experts. In parallel, in steps two and three, experts rated the importance of eight criteria to characterize chronic conditions, using a Likert scale from 1 (strongly disagree) to 9 (strongly agree).Of the ICPC-2's 686 items, experts identified 139 chronic conditions, of which 75 were deemed most relevant in the context of MM. Four of the eight criteria were retained as important to define chronic conditions: duration, sequelae, recurrence/pattern and the diagnosis itself.Using this list of 75 chronic conditions most relevant in the context of MM should enhance the validity of studies of MM in FM.