Cluster Randomised Trial of a Goal-Oriented Care Approach for multimorbidity patients supported by a digital platform

Mariana Peyroteo, Margarida Gil Conde, Ana Maria Jesus, Mélanie Maia, João Gregório, Marília Silva Paulo, Marta Alves, Ana Papoila, Bruno Heleno, Luís Velez Lapão

Keywords: Multimorbidity, Primary Health Care, Information Management, Research Design

Background:

Multimorbidity has been increasingly studied, with these patients having poorer clinical outcomes, disruption of their lives, and higher financial burden. Nowadays, the treatment approach is carried out with multiple single-organ management guidelines, which is highly detrimental. The Goal-Oriented Care (GOC) approach is an integrated model, prioritizing patient preferences and agreeing on shared treatment goals that allows patients to voice their concerns and expectations, leading to greater engagement and adherence.

Research questions:

This study aims to evaluate the impact of using of a digital healthcare platform that assists patients and primary care clinicians in managing multimorbidity within a GOC framework on improving quality of life, anxiety, depression, and serious adverse events.

Method:

A cluster randomized superiority trial will be conducted in Primary Health Care Practices in Lisbon. Eligible patients will be people with complex multimorbidity, 50 years or older, with internet access and a technology device. This study intervention combines the implementation of a training program and a customized digital platform designed to nudge clinicians to adopt a GOC approach. The training program will include the concept of personalized care, methods of goal elation, implications and how METHIS platform can be used to support the application of GOC in healthcare practice.

Results:

The primary outcome is Health-related Quality of Life, measured at 12 months with the SF-12 questionnaire. Secondary outcomes include mental health. We will also assess serious adverse events (hospitalization and use of hospital emergency services). Finally, at 18 months, we will ask general practitioners (GPs) for any potential missed diagnoses.

Conclusions:

This study creates the possibility of improving care to patients with multimorbidity and research in health services directed to these patients. Digital platforms should be adapted to the needs of an aging and more complex population and the changes must be guided by evidence.

Points for discussion:

What is the role of digital transformation in the care for patients with multimorbidity?

How does a GOC approach adjust to disease management in patients with multimorbidity?

How to measure the effects of complex interventions?

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