Table 1 Characteristics of included studies
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 65Â years or older and had a diagnosis of diabetes, depression and osteoarthritis for a period of 2Â 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 3Â 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 | 65Â 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. 55Â 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 | 65Â 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 (19Â 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 18Â 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 65Â 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 |