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Table 1 Characteristics of included studies

From: Identifying and understanding the health and social care needs of older adults with multiple chronic conditions and their caregivers: a scoping review

Author and year Continent Inclusion criteria Study design Data collection methods Sampling Strategy Analysis methods used
Adeniji 2015 Europe Recruited from 4 large general practices in UK. Identified from registers of long term conditions, have at least two MCC (of COPD, coronary heart disease, diabetes, osteoarthritis, and depression) Cross Sectional Observational Mailed questionnaires Convenience Descriptive statistics and multivariable regression analysis
Ancker 2015 North American Adult English speaking patients with MCC, as well as health care providers with experience providing care for patients with MCC Qualitative One to one Interviews Purposive Grounded theory, thematic analysis
Ansari 2014 Australia One or more pre-existing comorbidity along with a new diagnosis of COPD in last 24 months; age 40–85; history of smoking; from primary care setting Qualitative One to one interview Purposive Thematic analysis
Bardach 2012 North America Physicians from family medicine and internal medicine specialties were recruited from rural and urban practices, community and academic settings 1 obstetrics-gynecology physician was included, as they serve as primary care provider for some women. Qualitative One to one, semi structured interviews Purposive Content, Thematic analysis
Barstow 2015 North America OT were identified by those attending an online forum and at a national conference who provided direct care to older adults with low vision > 1 year. Older adults with confirmed low vision from an age-related eye disease, aged 65 years and over, with at least 1 comorbid condition and no more than mild cognitive impairment Mixed Method (cross sectional observation and qualitative) Online surveys for OTs; one to one interviews with older adults Convenience for OTs; Purposive for older adults Descriptive statistics for surveys. Content analysis for qualitative.
Bayliss 2003 North America Individuals were recruited through flyers in family medicine practices in Denver for participants who self-identified as having 2 or more chronic illnesses. They screened out those with active terminal illness, HIV, and uncontrolled psychiatric illnesses. Qualitative One to one interviews Purposive Qualitative comparative analysis
Bayliss 2007 North America Participants of a health maintenance organization who were 65 years or older and had a diagnosis of diabetes, depression and osteoarthritis for a period of 2 years prior to the study and they were drawn from disease specific registries validated against ICD codes Cross sectional Survey Convenience for survey; random for qualitative interview. Descriptive statistics, Multivariate linear regression
Beverly 2011 North America Mentally alert community-dwelling adults, aged 60 years or older, reporting a diagnosis of Type 2 diabetes and the presence of one or more chronic conditions in addition to diabetes Qualitative Eight 90 min Focus groups of 2–6 patients Purposive Thematic analysis
Bunn 2017 Europe They recruited purposive samples of people living with dementia and at least one of the following three conditions: diabetes, stroke or vision impairment. They also recruited family carers and healthcare professionals who organise and deliver care for people with stroke, diabetes and VI in primary and secondary care. Qualitative Focus groups with HCPs; one to one interviews with patients and caregivers; one to one interviews with HCPs as well. Purposive Thematic and ontent analysis informed by theories of continuity of care and access to care.
Burton 2016 Europe Eligible patients were identified from clinics and support groups but no inclusion criteria reported Qualitative One to one interviews Not clear. Thematic analysis
Cheraghi-Sohi 2013 Europe Patients who had osteoarthritis (OA) whose transcript contained narrative of one or more condition in addition to OA and include information pertaining to condition prioritization. Secondary analysis of qualitative data Secondary data of one to one qualitative interviews Purposive Amplified secondary analysis, content analysis
Clarke 2014 North America Aged 70 years and older and had at least 3 chronic conditions of which one of them had to be arthritis/ back problems/ cataracts/ glaucoma/ diabetes/ heart disease Qualitative One to one interviews Purposive Thematic analysis (Marshall and Rossman’s (2006) seven key analytic procedure)
Coventry 2014 Europe To include 5 patients per criterion: age, gender, combination of illnesses and level of deprivation. Socioeconomic deprivation (defined by Index of Multiple Deprivation), number and type of long term conditions, age and gender. HCP inclusion criteria: Tried to recruit 5 in each criterion: deprivation status of the practice area; role (i.e. salaried family physician, practice nurse); and number of years’ experience. Qualitative One to one interviews Convenience- HCP. Purposive- patients Thematic analysis
DiNapoli 2016 North America Aged 50 years and over with at least a CIRS-G 2 score in three or more organ systems and MMSE> 24 and no deficit in language skills, bipolar disorder or other chronic psychotic disorders or no other neurodegenerative disorders Qualitative One to one interview Purposive Descriptive statistics, thematic analysis
Fortin 2005 North America Adult patients without cognitive impairment or uncontrolled illnesses, have at least 4 chronic conditions and not followed by other researchers. Qualitative Focus groups Purposive Other
Fried 2008 North America Aged 65 and older and were taking five or more medications daily; undergoing treatment for multiple conditions; English speaking. People with severe hearing loss or cognitive impairment, defined as inability to remember two or more items on a three-item test of short-term recall were excluded Qualitative Focus groups Purposive Thematic and content analyses using constant comparative method
Gill 2014 North America Patients: 65 years or older, diagnosed with 2 or more chronic conditions, with an informal caregiver who participated in the patient’s healthcare; spoke English as a first language; could provide consent Qualitative One to one interviews Purposive Inductive thematic analysis with saturation of themes
Grundberg 2016 Europe Being a district nurse with experience with caring for community-dwelling homebound older adults with MCC Qualitative One to one interviews, focus groups Snowballing Content analysis
Hansen 2015 Europe Community dwelling; 3 or more coexisting chronic conditions; being a regular patient of the participating family physician practice; ability to participate in interview (no blindness/ deafness); ability to speak German; no lethal illness in last 3 months; ability to consent e.g. no dementia; no participation in other studies at the current time; Qualitative Focus groups Purposive Content analysis
Kuluski 2013 North America 65 years or older; ability to communicate in English; two or more chronic diagnoses; ability to give informed consent; an informal caregiver who agreed to participate in an interview Qualitative One to one interview Purposive Descriptive statistics; Thematic analysis
Lo 2016 Australia Patients with diabetes and chronic kidney disease (stages 3–5, eGFR < 60 mL/min/1.73 m2) and their carers; capable of giving consent and stable mental state. These patients from Monash health, Alfred health in Melbourne and the royal north shore and concord hospital in Sydney. Qualitative Focus groups for patients; semi structured interviews for carers Purposive Generic inductive thematic approach
Loeb 2003 North America Mentally alert community-dwelling adults, aged 55 or older, who reported the presence of at least two chronic conditions Qualitative Focus Groups Purposive Thematic and content analyses
Mason 2016 Europe Having advanced multimorbidity defined as having multiple life-limiting illnesses or progressively deteriorating health due to several long-term conditions. Patients with moderate to severe cognitive impairment were excluded. Patients were asked to nominate a family carer who consented separately Qualitative One to one interviews. Serial interviews at 8–12 week intervals. Among 87 interviews, 42 with patients alone, 2 with carers alone, 43 were joint interviews Purposive Constructivist thematic analysis.
McDonnall 2016 North America Recruited from a previous study, from the centre for Deaf-Blind youths and adults, and ads and electronic discussion groups. 55 years and older who have dual sensory loss Cross sectional Survey Purposive Descriptive statistics Open-ended responses were independently coded by two the authors, and discrepancies were discussed until agreement was reached
Morales-Asencio 2016 Europe Patients experiencing situations with high probability of complexity, such as the coexistence of several chronic diseases impacting quality of life, the frequent interaction with health services, or the existence of health/social determinants. Gender was also included as a selection criterion because of the proven differences in significance granted by men and women to their health care events and to their process experience Qualitative One to one interview with caregiver present Purposive Qualitative inductive content analysis
Naganathan 2016 North America 65 years of age or older, and diagnosed with two or more chronic conditions, patient capacity to provide informed consent, presence of informal care-giver and patient English proficiency. Qualitative One to one interview Convenience Descriptive statistics, thematic analysis
Noël 2005 North America 8 primary care clinics in 4 regions in the US were selected. The study sites were chosen based on known regional variations in veteran’s health and differences in clinic size and organization. Four clinics were in large metropolitan settings and four were in rural areas. 4/8 were based in tertiary care hospitals and the others were free standing community clinics. Patients were invited by primary care physician if they had 2 or more diseases, have no severe cognitive/mental health illnesses. Qualitative Focus groups Purposive Thematic analysis
Ravenscroft 2010 North America Recruitment criteria: (1) adults (19 years or older) with diagnosed stage 1 to 4 Chronic Kidney Disease (CKD), (2) attending a clinic for management of their CKD, (3) coexisting diabetes mellitus and/or Cardiovascular disease, or both, and (4) capable of communicating in English Qualitative One to one interviews Purposive Thematic analysis
Richardson 2016 North America Be at least 18 years of age or older, (2) have a diabetes diagnosis, and (3) have at least two other diagnosed chronic conditions. Excluded patients with cognitive deficits, uncontrolled psychiatric illness. Qualitative One to one interview, chart review Purposive Descriptive statistics, content analysis with naturalistic approach
Roberge 2016 North America Clinicians from 3 different university affiliated family health teams in Quebec. Clinicians: 1) provision of services to patients with chronic diseases; 2) at least 12 months of clinical experience; Patients: 1) age 18 years or older, 2) presence of a chronic disease (e.g. diabetes, arthritis, chronic obstructive pulmonary disease); 3) depression or anxiety disorder (panic disorder, agoraphobia, social anxiety disorder or generalized anxiety disorder) in the past 2 years according to clinician’s diagnosis; 4) good knowledge of French or English; 5) having a family physician in one of the three clinics. Exclusion criteria for patients were the inability to provide consent, cognitive impairment, and a history of manic episodes or a psychotic disorder. Qualitative One to one interview Purposive Thematic analysis
Roberto 2005 North America Women 65 years or older with two or more of heart disease, diabetes or osteoporosis. Qualitative One to one interview Purposive Thematic analysis- based on life course perspective and trajectory model of chronic illness
Ryan 2016 North America Those who have high needs (combinations of major chronic conditions, under 65 and disabled, frail elderly with multiple functional limitations; insurance status). Cross sectional observational One to one interviews Random-The 2016 Commonwealth Fund Survey of High-Need Patients was conducted by SSRS from June 22 to September 14, 2016, as a part of SSRS’s weekly, nationally representative omnibus survey Prevalence reported only
Schoenberg 2011 North America 41 and over; diagnosis of two or more chronic illnesses, have ‘just enough money to get by’ or ‘not enough money to make ends meet’. Qualitative One to one interview Purposive Thematic and content analyses
Sheridan 2012 New Zealand Based on ethnicity (Maori, Pacific, Asian, or New Zealand European), 50 years or older, two or more chronic conditions, admitted to hospital two or more times for five or more bed days between Jan and Dec 2008 Qualitative One to one interviews Purposive Qualitative Descriptive approach
Smith 2010 Europe Family Physicians who also trained medical trainees were selected from Trinity College Dublin; Pharmacists were selected from pharmacists attending a chronic disease management resource group Qualitative Focus groups Purposive Thematic analysis
Zulman 2015 North America Individuals who receive care at an academic medical center or at a Veterans Affair facility in Northern California. eligibility criteria for the focus groups (≥3 chronic conditions and experience using technology to help them care for their health or manage their health care)
Did not exclude based on age, health status, functional/cognitive status.
Qualitative Focus groups Purposive Thematic and Content analyses
  1. CIRS-G Cumulative Illness Rating-Geriatrics
  2. COPD Chronic obstructive pulmonary disease
  3. eGFR estimated Glomerular Filtration Rate
  4. HCP Health care provider
  5. MCC Multiple Chronic Conditions
  6. MMSE Mini Mental State Examination
  7. OT Occupational therapist
  8. SD Standard deviation