Multimorbidity and consultation time: a systematic review

Tadeu, A. C. R.; Rosendo, I. R. C. e. S.; Santiago, L. M.; Figueiredo, I. J.

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.