The Ariadne principles: How to handle multimorbidity in primary care consultations

Christiane Muth, Marjan van den Akker, Jeanet W. Blom, Christian D. Mallen, Justine Rochon, François G. Schellevis, Annette Becker, Martin Beyer, Jochen Gensichen, Hanna Kirchner, Rafael Perera, Alexandra Prados-Torres, Martin Scherer, Ulrich Thiem, Hendrik van den Bussche, Paul P. Glasziou

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Abstract

Multimorbidity is a health issue mostly dealt with in primary care practice. As a result of their generalist and patientcentered approach, long-lasting relationships with patients, and responsibility for continuity and coordination of care, family physicians are particularly well placed to manage patients with multimorbidity. However, conflicts arising from the application of multiple disease oriented guidelines and the burden of diseases and treatments often make consultations challenging. To provide orientation in decision making in multimorbidity during primary care consultations, we developed guiding principles and named them after the Greek mythological figure Ariadne. For this purpose, we convened a two-day expert workshop accompanied by an international symposium in October 2012 in Frankfurt, Germany. Against the background of the current state of knowledge presented and discussed at the symposium, 19 experts from North America, Europe, and Australia identified the key issues of concern in the management of multimorbidity in primary care in panel and small group sessions and agreed upon making use of formal and informal consensus methods. The proposed preliminary principles were refined during a multistage feedback process and discussed using a case example. The sharing of realistic treatment goals by physicians and patients is at the core of the Ariadne principles. These result from i) a thorough interaction assessment of the patient's conditions, treatments, constitution, and context; ii) the prioritization of health problems that take into account the patient's preferences - his or her most and least desired outcomes; and iii) individualized management realizes the best options of care in diagnostics, treatment, and prevention to achieve the goals. Goal attainment is followed-up in accordance with a re-assessment in planned visits. The occurrence of new or changed conditions, such as an increase in severity, or a changed context may trigger the (re-)start of the process. Further work is needed on the implementation of the formulated principles, but they were recognized and appreciated as important by family physicians and primary care researchers.

Original languageEnglish
Article number223
JournalBMC Medicine
Volume12
Issue number1
DOIs
Publication statusPublished - 8 Dec 2014

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Comorbidity
Primary Health Care
Referral and Consultation
Family Physicians
Continuity of Patient Care
Patient Preference
Constitution and Bylaws
Health
Therapeutics
North America
Germany
Consensus
Decision Making
Research Personnel
Guidelines
Physicians
Education

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Muth, C., van den Akker, M., Blom, J. W., Mallen, C. D., Rochon, J., Schellevis, F. G., ... Glasziou, P. P. (2014). The Ariadne principles: How to handle multimorbidity in primary care consultations. BMC Medicine, 12(1), [223]. https://doi.org/10.1186/s12916-014-0223-1
Muth, Christiane ; van den Akker, Marjan ; Blom, Jeanet W. ; Mallen, Christian D. ; Rochon, Justine ; Schellevis, François G. ; Becker, Annette ; Beyer, Martin ; Gensichen, Jochen ; Kirchner, Hanna ; Perera, Rafael ; Prados-Torres, Alexandra ; Scherer, Martin ; Thiem, Ulrich ; van den Bussche, Hendrik ; Glasziou, Paul P. / The Ariadne principles : How to handle multimorbidity in primary care consultations. In: BMC Medicine. 2014 ; Vol. 12, No. 1.
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Muth, C, van den Akker, M, Blom, JW, Mallen, CD, Rochon, J, Schellevis, FG, Becker, A, Beyer, M, Gensichen, J, Kirchner, H, Perera, R, Prados-Torres, A, Scherer, M, Thiem, U, van den Bussche, H & Glasziou, PP 2014, 'The Ariadne principles: How to handle multimorbidity in primary care consultations' BMC Medicine, vol. 12, no. 1, 223. https://doi.org/10.1186/s12916-014-0223-1

The Ariadne principles : How to handle multimorbidity in primary care consultations. / Muth, Christiane; van den Akker, Marjan; Blom, Jeanet W.; Mallen, Christian D.; Rochon, Justine; Schellevis, François G.; Becker, Annette; Beyer, Martin; Gensichen, Jochen; Kirchner, Hanna; Perera, Rafael; Prados-Torres, Alexandra; Scherer, Martin; Thiem, Ulrich; van den Bussche, Hendrik; Glasziou, Paul P.

In: BMC Medicine, Vol. 12, No. 1, 223, 08.12.2014.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Mallen, Christian D.

AU - Rochon, Justine

AU - Schellevis, François G.

AU - Becker, Annette

AU - Beyer, Martin

AU - Gensichen, Jochen

AU - Kirchner, Hanna

AU - Perera, Rafael

AU - Prados-Torres, Alexandra

AU - Scherer, Martin

AU - Thiem, Ulrich

AU - van den Bussche, Hendrik

AU - Glasziou, Paul P.

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Muth C, van den Akker M, Blom JW, Mallen CD, Rochon J, Schellevis FG et al. The Ariadne principles: How to handle multimorbidity in primary care consultations. BMC Medicine. 2014 Dec 8;12(1). 223. https://doi.org/10.1186/s12916-014-0223-1