Multimorbidity, eHealth and implications for equity: a cross-sectional survey of patient perspectives on eHealth.

OBJECTIVE: There is increasing awareness of the burden of medical care experienced by those with multimorbidity. There is also increasing interest and activity in engaging patients with chronic disease in technology-based health-related activities ('eHealth') in family practice. Little is known about patients' access to, and interest in eHealth, in particular those with a higher burden of care associated with multimorbidity. We examined access and attitudes towards eHealth among patients attending family medicine clinics with a focus on older adults and those with polypharmacy as a marker for multimorbidity. DESIGN: Cross-sectional survey of consecutive adult patients attending consultations with family physicians in the McMaster University Sentinel and Information Collaboration practice-based research network. We used univariate and multivariate analyses for quantitative data, and thematic analysis for free text responses. SETTING: Primary care clinics. PARTICIPANTS: 693 patients participated (response rate 70%). INCLUSION CRITERIA: Attending primary care clinic. EXCLUSIONS: Too ill to complete survey, cannot speak English. RESULTS: The majority of participants reported access to the internet at home, although this decreased with age. Participants 70 years and older were less comfortable using the internet compared with participants under 70. Univariate analyses showed age, multimorbidity, home internet access, comfort using the internet, privacy concerns and self-rated health all predicted significantly less interest in eHealth. In the multivariate analysis, home internet access and multimorbidity were significant predictors of disinterest in eHealth. Privacy and loss of relational connection were themes in the qualitative analysis. CONCLUSION: There is a significant negative association between multimorbidity and interest in eHealth. This is independent of age, computer use and comfort with using the internet. These findings have important implications, particularly the potential to further increase health inequity.

Atrial fibrillation in inherited cardiac channelopathies: From mechanisms to management.

Atrial fibrillation (AF) is prevalent in cardiac channelopathies and may be the presenting feature in some patients. The pathogenesis is related to the primary ion channel dysfunction in atrial myocytes that affects atrial conduction or repolarization. The development of AF is associated with adverse outcomes, and its management is challenging in these patients. In this article we review the current information on the prevalence, risk factors, pathophysiology, and treatment of AF in specific cardiac channelopathies.

Making patient values visible in healthcare: a systematic review of tools to assess patient treatment priorities and preferences in the context of multimorbidity.

OBJECTIVES: To identify studies of existing instruments available for clinicians to record overall patient preferences and priorities for care, suitable for use in routine primary care practice in patients with multimorbidity. To examine the data for all identified tools with respect to validity, acceptability and effect on health outcomes. DESIGN: Systematic Review. DATA SOURCES: MEDLINE, EMBASE and Cochrane databases, each with a predefined search strategy. ELIGIBILITY CRITERIA: Citations were included if they reported a tool used to record patient priorities or preferences for treatment, and quantitative or qualitative results following administration of the tool. RESULTS: Our search identified 189 potential studies of which 6 original studies and 2 discussion papers were included after screening for relevance. 5 of 6 studies (83%) were of cross-sectional design and of moderate quality. All studies reported on the usability of a tool in order to elicit patient preferences. No studies reported on changes to patient-specific healthcare outcomes as a consequence of recording preferences and priorities. 1 of 6 studies reported on eliciting patient preference in the context of multimorbidity. No studies incorporated patient preferences into an electronic medical record. CONCLUSIONS: Given the importance of eliciting patient priorities and preferences in providing patient-centred care in the context of multimorbidity and polypharmacy, we found surprisingly few relevant tools. Some aspects of the tools used for single-disease contexts may also be useful in the context of multimorbidity. There is an urgent need to develop ways to make patient priorities explicitly visible in the clinical record and medical decision-making and to test the effect on patient-relevant outcomes.