Keywords: multimorbidity; prefrailty; group visits (shared medical appointments); continuity of care; trust in physician;older adults

Background:

Multimorbidity and frailty are often associated in older adults. A systematic review reported that approximately 72% of frail individuals were multimorbid; the prevalence of frailty among multimorbid individuals was approximately 16%, and multimorbidity was associated with frailty. These findings suggest that multimorbid but prefrail older adults may be a suitable target group for preventive and organizational interventions.

Research questions:

1. Do group visits improve perceived continuity of care and trust in the family physician among prefrail, multimorbid older adults in primary care?
2. Do they reduce unplanned healthcare use (emergency department visits and unplanned visits)?
3. Are they associated with changes in medication burden indicators (e.g., number of medications and polypharmacy)?

Method:

The study has a pragmatic pilot, parallel-group, cluster-randomized design. To reduce contamination, randomization will be performed at the family physician unit level. Clusters will be defined as units served by the same family physician. Participant selection will not be limited to those who visit the primary health care center; cases (65 years and older with ≥2 chronic diseases) will be screened from the registered population list for which each family physician is responsible. Individuals deemed suitable will be invited by telephone and/or in person during routine visits; after written informed consent, prefrail eligibility (Fried 1–2 criteria) will be confirmed at the first in-person assessment. In the intervention group, the same micro-team will conduct monthly 90-minute group visits with 8–10 participants for 6 months; standard reminder calls will be used to encourage attendance. The control group will continue to receive routine primary care. Primary outcomes will be frailty level and trust in the physician, measured at baseline, 6 months, and 12 months.

Results:

Not yet available (research proposal).

Conclusions:

Group visits can be a scalable, relationship-based care model in primary care that aims to strengthen continuity and trust among prefrail, multimorbid older adults.

Points for discussion:

At the end of a group visit program, what change in pre-frailty status should be considered "significant": a reduction in progression to frailty or an improvement in functional and self-management indicators?

Through what mechanisms should the impact of group visits be expected among pre-frail individuals with multiple chronic diseases, such as reduced medication burden and increased adherence to treatment?