key: cord-0276074-nyowj4up authors: Tadeu, A. C. R.; Rosendo, I. R. C. e. S.; Santiago, L. M.; Figueiredo, I. J. title: Multimorbidity and consultation time: a systematic review date: 2019-09-23 journal: nan DOI: 10.1101/19007328 sha: 2282bdddc8cb18da2dea22769c05f86a3f24262c doc_id: 276074 cord_uid: nyowj4up Background: Multimorbidity (MM) is one of the major challenges currently facing health systems at the international level and tends to occupy a considerable part of the daily activity of physicians around the world. It is important to think about the medical approach to dealing with patients with multimorbidity in order to maximize the quality of the services provided by national health services, and thus to secure a better quality of life for these patients. Information about the time spent in a medical consultation with a patient with MM criteria is essential to better organize and deliver healthcare. As far as we know, no previous review has summarized the data relating to how having MM affects the length of the average consultation time. Objective: To review all the experimental observational studies that describe the impact of having MM on the average time of a medical consultation. Methods: This systematic review was performed considering the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines for systematic reviews and meta-analysis. The systematic online searches of the Embase and PubMed databases were undertaken, from January 2000 to August 2018. The studies were independently screened by two reviewers to decide which ones met the inclusion criteria. (Kappa=0.84 and Kappa=0.82). Differing opinions were solved by a third person. This systematic review included people with MM criteria as participants (two or more chronic conditions in the same individual). The type of outcome included was explicitly defined - the length of medical appointments with patients with MM criteria. Any strategies aiming to analyse the impact of MM on the average consultation time were considered. The comparator used was the length of time of medical appointment for patients without MM criteria. Experimental and observational studies were included. Results: Of 85 articles identified, only 1 observational study was included. The study shows that there is a clear trend for patients with MM criteria to have longer consultations than patients without MM criteria (p<0.001). The global quality of this study was considered Satisfactory. Conclusions: It is imperative to study the consultation time spent on patients with MM criteria. Finding a longer consultation time indicates it is important to rethink and adapt GPs lists and time planning to be able to give better medical care to patients with MM by providing agendas that have specific times set aside for these patients and allocating enough time for every task required. . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint . https://doi.org/10.1101/19007328 doi: medRxiv preprint 4 Information about the length-time of a consultation with a patient with MM is essential 67 to better organize and deliver healthcare. To our knowledge, no previous review has 68 summarized data related to: "What is the impact of having MM on the medical consultation?" 69 "Is the average length-time consultation with a patient with MM longer than for a patient without CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint . https://doi.org/10.1101/19007328 doi: medRxiv preprint This systematic review was conducted using Covidence13, the standard production 125 platform used for Cochrane reviews, which was used for the data and records management. CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint . https://doi.org/10.1101/19007328 doi: medRxiv preprint CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint . https://doi.org/10.1101/19007328 doi: medRxiv preprint 8 The main relevant features and outputs of the study were extracted for the purpose of 150 this systematic review and are summed up in Table 1 . The included study was conducted between 2008 and 2009 in Denmark, over 12 152 months. It involved 404 general practitioners (GPs) participants and a total of 8236 contacts. It included patients aged 40 years or more, grouped as those without any chronic condition 154 and those with one, two, three or more chronic conditions. During the study period, the GPs completed a one-page registration form for each of 156 their patient contacts. Of the various items that were registered, the ones relevant forthis 157 review were information on chronic diseases and length-time of consultation. Quality 158 assessment result, performed as described in methodology, is presented in Table 2 . The 159 quality of the study was considered satisfactory (score 6 out of a maximum score of 10), its CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint . https://doi.org/10.1101/19007328 doi: medRxiv preprint The present systematic review sought to answer the following question: "Is the average The data analysis must be evaluated using objective validated laboratory methods 243 and, if possible, it should be a blind assessment. Statistical tests used to analyse the data 244 must be appropriate and clearly described. Measures of association, including confidence 245 intervals and the P value, must be presented. The main limitation of this systematic review was the difficulty in ensuring that all the 247 relevant literature was included. Even though the research used two of the main databases - Pubmed and Embasethere could be other relevant material in grey literature. The scarcity of the literature that was found was a limitation for this review. The one This "impact of MM on the duration of a consultation" has hardly been studied, this 259 systematic review shows. A tendency for consultations of patients with MM to take longer than those without MM 261 was found in the only one study with "satisfactory" quality which met the inclusion criteria. . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint . https://doi.org/10.1101/19007328 doi: medRxiv preprint No author states financial and non-financial competing interests for this work. . 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