Short summary

Many people suffer from multimorbidity. This can lead to incoherence in treatment and care which in turn can lead to reduced life quality. Multidisciplinary team conferences (MDT) seek to gather medical specialists across specialities to jointly assess a patient. This study will examine if MDT can function in a clinical hospital setting: feasibility. Process, organisation and patient information will be gathered prospectively. We will use descriptive statistics. The study precedes a future RCT.

Rationale

WHO defines multimorbidity as the coexistence of two or more chronic diseases in the same person. Due to increasing life-expectancy, an ever increasing number of people struggle with chronic conditions and complex multimorbidity. Diabetes is one of the four major groups of non-communicable diseases as defined by the WHO, with a global prevalence in 2019 estimated to 463 million people. The same year diabetes caused 2 million premature deaths worldwide. Diabetes is associated with several other comorbidities, such as cardiovascular diseases, mental health disorders, and cancer. In Canada, researchers report that 90% of people with type 2 diabetes also have one chronic conditions and an Australian study found that nearly 40% of people with type 2 diabetes had two or more concurrent chronic diseases. A systematic review reported that one of the most frequent combinations of chronic conditions is that of cardio-metabolic conditions such as high blood pressure, diabetes, obesity and ischaemic heart disease. In people with type 2 diabetes, the all-cause mortality rises with increasing number of chronic conditions.

Having multiple chronic conditions may often entail clinical check-ups at several different departments and seeing many different clinicians. Coordinating medical treatment, including prescription drugs, is a great challenge for these patients. The lack of coordination may lead to confusion, mental exhaustion, loss of autonomy, decreased adherence and compliance, and ultimately reduction of life quality and -expectancy. The patient may travel like a nomad between departments, specialists, and across sectors, possibly left uncertain of whom to contact if problems arise. Multidisciplinary team conferences (MDT) are nowadays utilised in many parts of the healthcare system and serve as a well-established tool to aid clinical decision-making. MDTs promote coordination and coherence in patient care and management. Care and management can be tailored to suit the individual patient with complex needs by bringing together expertise from different medical specialties and healthcare professionals. The MDT approach has historically been anchored in an oncological context where the complexity of diagnostics and treatments often is high. This approach has been reported beneficial, yet researchers encourage further research in the impact of MDT on quality of life, and in further strategies to incorporate patient perspectives in the MDTs.

In recent years, the MDT concept has been implemented in different non-oncological fields. We have recently conducted a scoping review on the topic of physician-led in-hospital MDTs in chronic non-malignant diseases, where we conclude that MDT care for patients with multimorbidity may positively affect the treatment, but the literature is scarce. Another recent review reports that MDT for people with diabetes and comorbidities has a positive effect in glycaemic control and mental health outcomes, but suggests a more cross-sectorial approach in future studies.

Thus, a concept of MDT has been developed by Steno Diabetes Centre Odense (SDCO) called "Network Of doctors for Multimorbidity And Diabetes - NOMAD" and is now ready to be feasibility tested before moving on to a large-scale randomised controlled trial (RCT). We have formed the following hypotheses for the feasibility test: - The NOMAD intervention can function in a clinical setting and is acceptable to intervention providers and recipients - The present concept will be feasible in a future RCT

Description of the cohort

All patients who have been referred to MDT and has returned a written consent to participate. Criteria for referral are: - Patient has diabetes - Patient has at least one other chronic condition within heart, lungs or kidney - Patient/physician experience some kind of complexity in treatment/care

Inclusion area is Funen. Patients can be referred from hospital dept. or general practice. Children under 18 years are excluded.

Data and biological material

Data collected are: demographic, diagnostics, medications, questionnaires, hospital contacts and process data related to MDT. Data come from electronic patient records, observation and national health registries.

Collaborating researchers and departments

Department of Pharmacology, OUH

Department of Cardiology, OUH

Department of Respiratory Medicine, OUH

Department of Nephrology, OUH

General Practice on Funen

Publications associated with the project

Henriksen DP, Ennis ZN, Panou V, Hangaard J, Jensen PB, Johansson SL, et al. Physician-led in-hospital multidisciplinary team conferences with multiple medical specialities present - A scoping review. J Multimorb Comorbidity. 2022;12:26335565221141744.