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Professor Jose Valderas

Professor of Health Services and Policy Research

2755

+44 (0) 1392 722755

Smeall building

Smeall Building, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK

Overview

I am an Academic General Practitioner, with a commitment to research on patient centred care that is relevant for decision making in clinical practice and health policy. I lead the Health Services & Policy Research Group at the University of Exeter Medical School. I am the lead for Education and Training at the Exeter Collaboration for Academic Primary Care (APEx), NIHR School for Primary Care Research and a member of the NIHR Applied Research Collaboration South West Peninsula (PenARC).

My research interests focus on the use of patient reports on their own health for decision making in clinical practice and health policy, and the improvement of processes of care (quality and safety), with a particular interest in patients with multiple conditions (multimorbidity). I have participated in over 40 research projects and have authored over 200 publications, including papers, books and book chapters, editorials, letters, and scientific communications and provided expert policy advice to the World Health Organization, Organization for the Economic Cooperation and Development, and NHS England, among others. I serve as Field Chief Editor for Frontiers in Health Services and have been served as elected President of the International Society for Quality of Life Research.

Since completing my training as a General Practitioner I have maintained active clinical practice in different countries and in a variety of environments, including developing countries for very brief periods. I am also devoted to postgraduate teaching, particularly in areas where research meets clinical practice (Applied Health Services Research, Clinical Epidemiology and Evidence Based Practice).

Broad Research Specialisms

My main areas of expertise are in patient centred care, with a particular focus on the use of measures of Patient Reported Outcomes and Experiences (development, adaptation, application, interpretation and clinical applications of PROMs, qualitative methods for content generation, psychometrics and quantitative analyses (classical test theory and Item Response Theory Models), and appraisal of instruments), multi- and co-morbidity, and quality and safety in Primary Care.

Qualifications

• BMBS (University of Barcelona, Spain)
• General Practitioner (Department of Education, Spain)
• MPH (Pompeu Fabra University, Spain)
• PhD (Pompeu Fabra University, Spain)

Career

After combining my PhD (IMIM-Hospital del Mar and Pompeu Fabra University) and my training as a General Practitioner in Barcelona, Spain, I started my post-doctoral research at the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health under the supervision of the late Prof. Barbara Starfield. I then joined the National Primary Care Research and Development Centre, University of Manchester led by Prof. Martin Roland, and in 2010 arrived at the Nuffield Department of Primary Care Health Sciences at the University of Oxford to set up and lead the Health Services and Policy Research Group. In September 2013, I was appointed Chair in Health Services and Policy Research at the University of Exeter Medical School.

For a list of publications with citations, please see here

Research group links

Research

Research interests

Jose's main interest is in the further development of models of care that ensure that care is truly centred around the patients. To that aim his current interests are in Patient Reported Outcomes and Experiences Measurement (with a particular focus on the combined use of individualised and standardized measures), models of care for chronic conditions (with a focus on multi- and co-morbidity), and quality and safety in Primary Care.

Research projects

Improving the management of long term conditions with the clinical use of patient reported outcome measures in Primary Care
National Institute for Health Research, £996,226.00; 1 March 2011-28 February 2016
Role: Principal Investigator (PI)

Functionality and feedback: A realist synthesis of the collation, intepretation and utilisation of PROMs data to improve patient care
NIHR Service Delivery and Organization Programme, £202,881.6, Sart Date 1/1/2014-1/7/2015.
Role: Co-Applicant (PI: Prof. J Greenhalgh, University of Leeds, UK)

Information and value-based commissioning
NIHR Service Delivery and Organization Programme, £518,247, Support period: 2012-2014
Role: Co-applicant (PI: Dr. Barry MacCormick, University of Oxford, UK)

Introducing standardised and evidence based thresholds for hip and knee replacement surgery - the arthroplasty candidacy help engine (the ACHE tool).
National Institute for Health Research, Health Technology Assessment Programme, UK. £799,189 Support period: 1 September 2013-31 August 2016
Role: Co-applicant (PI: Prof. Andrew Price, University of Oxford, UK)

Systems of care and outcomes in TIA and minor stroke in the Hunter Valley, New South Wales
National Health and Medical Research Council, Australia APP1027794; AU$ 1,173,380 (ap. £750K)
Period: 1 January 2012-31 December 2015
Role: Co-applicant (PI: Christopher Levi, University of Newcastle, Australia)

Primary Care Prevention and Health Promotion Research Network
Carlos III Research Institute, Spain: €3,022,478.53
Role: Co-Investigator (PI: Bolivar B, IDIAP Primary Care Research Institute)

Quality and Outcomes of Care for Chronic Conditions in Older Patients Diagnosed with Breast, Colorectal, or Prostate Cancer Compared to Non-Cancer Controls: An Observational Study Using the Clinical Practice Research Datalink (CPRD).
Funder: Cancer Research UK (£296,000.0)
Support period: 1 July 2013-31 December 2015
Role: PI

Prioritising and optimising multiple medications in elderly multi-morbid patients in general practice (PRIMUM). - A pragmatic cluster-randomised controlled trial.
BundesMinisterium fuer Bildung und Forschung, €500,860.00
Period: 1 March 2010-28 February 2012
Role: Scientific Advisory Board (PI: Dr C Muth, Johann Wolfgang Goethe University, Frankfurt am Main, Germany)
Web: http://clinicaltrials.gov/ct2/show/NCT01171339

Developing, testing and implementing the NSPCR Patient Safety Toolkit in general practices in England.
NIHR School for Primary Care Research, England; £569,740.0; 1 October 2011-31 Dec. 2013
Role: Co-applicant (PI: Prof. Tony Avery, University of Nottingham, UK)

Patients’ perspectives and understanding of high-performing, safety conscious general practice: an exploratory study
Support period: 2012-2013, £139,959
NIHR School for Primary Care Research
Role: Co-applicant (PI: Dr. Stephen Campbell, University of Manchester, UK)

An investigation of the Quality and Outcomes Framework (QOF) using the General Practice Research Database (GPRD)
Support period: 2012-2014, £55,523.0
NIHR School for Primary Care Research
Role: Co-applicant (PI: Dr. Evan Kontopantelis, University of Manchester, UK)

Grants/Funding

Patterns of co-morbidity and poly-pharmacy in Primary Care in Catalonia, Spain
Instituto de Salud Carlos III, Spain (PI12/00427): €48,400.00
Period: 1 October 2011-31 December 2012.
Role: Co-Applicant (PI: Dr. Quinti Foguet, IDIAP Jordi Gol, Barcelona, Spain

BiblioPRO: virtual library of patient reported outcomes
RecerCaixa, €99,732.25; 1 January 2011-31 December 2012
Role: Co-Applicant (PI: Prof. J Alonso, Universitat Pompeu Fabra, Spain)
Web: http://bibliopro.imim.es

Safety netting to improve early cancer diagnosis in primary care: development of consensus guidelines.
Department of Health, £19,990.00
Period: 1 January 2011-1 June 2011
Role: Co-Applicant (PI: Dr. C Bankhead, University of Oxford, UK)

Attribution of Patient Reported Outcomes to the effects of care providers
Medical Research Council, £337,675.00; 1 April 2010-31 March 2013
Role: Co-Applicant (PI: Prof. M Sutton, University of Manchester, UK)

Patient and professional experience of managing co-morbid long-term conditions in primary care
NIHR School of Primary Care Research, £200,206.00.
Support period: 2010-2013
Role: Co-applicant (PI: Prof C Salisbury, University of Bristol, UK)
Web: http://www.nspcr.ac.uk/rP3.43

Health status evaluation of the general Spanish population using the International Classification of Functioning, Disability and Health (ICF)
Fondo de Investigación Sanitaria, Spain (PI 061579 and PI 051542)
Role: Co-Applicant (PI: Dr. Montse Ferrer, IMIM-Hospital del Mar, Spain)
Web: http://www.imim.es/programesrecerca/epidemiologia/en_cifrecerca.html

Trajectories of perceived health and use of health care services in a Spanish population sample of children and adolescents 8 to 18 years old.
Instituto de Salud Carlos III, Spain (Red IRYSS G03/202) and Fondo de Investigación Sanitaria (PI042504 y PI042315)
Role: Co- Applicant (Co-PI: Prof. Jordi J Alonso, Universitat Pompeu Fabra, Spain; Dr. Luis Rajmil, Agència d’Avaluació de Tecnologia Mèdica, Spain)

Development, application, and validation of a new tool for the standardized evaluation of patient reported outcome measures (EMPRO)
Instituto de Salud Carlos III, Spain (Red de Investigación Cooperativa IRYSS, G03/202 and CM 300118), PI06/90483 and ETE06/450104884), CIBERESP – MET010)
Role: Co-Applicant (PI: Dr. Montse Ferrer, IMIM-Hospital del Mar, Spain)

RED IRYSS (Health and Health Services Outcomes Research Network)
Instituto de Salud Carlos III, Spain (G03/202)
Support period: 2002-2006
Role: Co-Applicant (PI: Dr JMV Pons, Agència d’Avaluació de Tecnologia Mèdica, Spain)

Developing priority criteria for patients on waiting lists for cataract surgery and hip and knee arthroplasty in Catalonia, Spain
Fondo de Investigación Sanitaria, Spain (01/0921)
Period: 1999-2002
Role: Co-Applicant (PI: Dr. M Espallargues, Agència d’Avaluació de Tecnologia Mèdica, Spain).

Publications

Key publications | Publications by category | Publications by year

Publications by category

Journal articles

Hjollund NHI, Valderas JM, Kyte D, Calvert MJ (In Press). Health Data Processes: a Framework for Analyzing and Discussing Efficient Use and Reuse of Health Data with a Focus on Patient-Reported Outcome Measures (Preprint).

. UNSTRUCTURED
. The collection and use of patient health data are central to any kind of activity in the health care system. These data may be produced during routine clinical processes or obtained directly from the patient using patient-reported outcome (PRO) measures. Although efficiency and other reasons justify data availability for a range of potentially relevant uses, these data are nearly always collected for a single specific purpose. The health care literature reflects this narrow scope, and there is limited literature on the joint use of health data for daily clinical use, clinical research, surveillance, and administrative purposes. The aim of this paper is to provide a framework for discussing the efficient use of health data with a specific focus on the role of PRO measures. PRO data may be used at an individual patient level to inform patient care or shared decision making and to tailor care to individual needs or group-level needs as a complement to health record data, such as that on mortality and readmission, in order to inform service delivery and measure the real-world effectiveness of treatment. PRO measures may be used either for their own sake, to provide valuable information from the patient perspective, or as a proxy for clinical data that would otherwise not be feasible to collect. We introduce a framework to analyze any health care activity that involves health data. The framework consists of four data processes (patient identification, data collection, data aggregation and data use), further structured into two dichotomous dimensions in each data process (level: group vs patient; timeframe: ad hoc vs systematic). This framework is used to analyze various health activities with respect to joint use of data, considering the technical, legal, organizational, and logistical challenges that characterize each data process. Finally, we propose a model for joint use of health data with data collected during follow-up as a base. Demands for health data will continue to increase, which will further add to the need for the concerted use and reuse of PRO data for parallel purposes. Repeated and uncoordinated PRO data collection for the same patient for different purposes results in misuse of resources for the patient and the health care system as well as reduced response rates owing to questionnaire fatigue. PRO data can be routinely collected both at the hospital (from inpatients as well as outpatients) and outside of hospital settings; in primary or social care settings; or in the patient’s home, provided the health informatics infrastructure is in place. In the future, clinical settings are likely to be a prominent source of PRO data; however, we are also likely to see increased remote collection of PRO data by patients in their own home (telePRO). Data collection for research and quality surveillance will have to adapt to this circumstance and adopt complementary data capture methods that take advantage of the utility of PRO data collected during daily clinical practice. The European Union’s regulation with respect to the protection of personal data—General Data Protection Regulation—imposes severe restrictions on the use of health data for parallel purposes, and steps should be taken to alleviate the consequences while still protecting personal data against misuse.
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Abstract.

Valderas Martinez JM, Hjollund NHI, Kyte D, Calvert MJ (In Press). Health data processes. A framework for analysing and discussing efficient use and reuse of health data with focus on Patient Reported Outcome (PRO) measures. Journal of Medical Internet Research Full text.

Lloyd H, Wheat H, Horrell J, Sugavanam T, Fosh B, Valderas JM, Close J (In Press). Patient-Reported Measures for Person-Centered Coordinated Care: a Comparative Domain Map and Web-Based Compendium for Supporting Policy Development and Implementation.

. BACKGROUND
. Patient-reported measure (PRM) questionnaires were originally used in research to measure outcomes of intervention studies. They have now evolved into a diverse family of tools measuring a range of constructs including quality of life and experiences of care. Current health and social care policy increasingly advocates their use for embedding the patient voice into service redesign through new models of care such as person-centered coordinated care (P3C). If chosen carefully and used efficiently, these tools can help improve care delivery through a variety of novel ways, including system-level feedback for health care management and commissioning. Support and guidance on how to use these tools would be critical to achieve these goals.
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. OBJECTIVE
. The objective of this study was to develop evidence-based guidance and support for the use of P3C-PRMs in health and social care policy through identification of PRMs that can be used to enhance the development of P3C, mapping P3C-PRMs against an existing model of domains of P3C, and integration and organization of the information in a user-friendly Web-based database.
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. METHODS
. A pragmatic approach was used for the systematic identification of candidate P3C-PRMs, which aimed at balancing comprehensiveness and feasibility. This utilized a number of resources, including existing compendiums, peer-reviewed and gray literature (using a flexible search strategy), and stakeholder engagement (which included guidance for relevant clinical areas). A subset of those candidate measures (meeting prespecified eligibility criteria) was then mapped against a theoretical model of P3C, facilitating classification of the construct being measured and the subsequent generation of shortlists for generic P3C measures, specific aspects of P3C (eg, communication or decision making), and condition-specific measures (eg, diabetes, cancer) in priority areas, as highlighted by stakeholders.
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. RESULTS
. In total, 328 P3C-PRMs were identified, which were used to populate a freely available Web-based database. of these, 63 P3C-PRMs met the eligibility criteria for shortlisting and were classified according to their measurement constructs and mapped against the theoretical P3C model. We identified tools with the best coverage of P3C, thereby providing evidence of their content validity as outcome measures for new models of care. Transitions and medications were 2 areas currently poorly covered by existing measures. All the information is currently available at a user-friendly web-based portal (p3c.org.uk), which includes all relevant information on each measure, such as the constructs targeted and links to relevant literature, in addition to shortlists according to relevant constructs.
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. CONCLUSIONS
. A detailed compendium of P3C-PRMs has been developed using a pragmatic systematic approach supported by stakeholder engagement. Our user-friendly suite of tools is designed to act as a portal to the world of PRMs for P3C, and have utility for a broad audience, including (but not limited to) health care commissioners, managers, and researchers.
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Abstract.

Serrano-Ripoll MJ, Fiol-DeRoque MA, Valderas JM, Zamanillo-Campos R, Llobera J, Olry de Labry Lima A, Pastor-Moreno G, Ricci-Cabello I (In Press). Piloting the SinergyAPS theory-based online intervention centred around the systematic patient feedback for improving patient safety in Primary Care: a mixed-methods feasibility study (Preprint).

. BACKGROUND
. Developing new strategies to support the provision of safer primary care (PC) is a major priority both internationally and in Spain, where around 3 million adverse events occur each year in the PC setting.
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. OBJECTIVE
. The primary aims of this mixed-methods feasibility study were to examine the feasibility and to explore the acceptability and perceived utility of the SinergiAPS intervention, a novel low-cost and scalable theory-based online intervention to improve patient safety in PC centres, based on the use of patient feedback. The secondary aim was to examine the potential impact of the intervention to improve patient safety culture and avoidable hospitalizations in PC centres.
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. METHODS
. We conducted a three-month, one-arm, feasibility trial in ten PC centres in Spain. Centres were fed back information regarding patients' experiences of safety (collected through PREOS-PC questionnaire) and were instructed to plan safety improvement actions based on it. We measured recruitment and follow-up rates, and intervention uptake (number of centres registering improvement plans). We explored the impact of the intervention on patient safety culture (MOSPSC questionnaire), and avoidable hospital admissions rate. We conducted semi-structured interviews with nine professionals to explore the acceptability and perceived utility of the intervention.
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. RESULTS
. of 256 professionals invited, 120 (47%) accepted to participate and 97 completed baseline and post-intervention measures. of 780 patients invited, 585 (77%) completed the PREOS-PC questionnaire. Five centres designed 27 improvement actions. Most of the actions addressed treatment-related safety problems and consisted in the provision of training to PC providers. Compared to baseline, post-intervention MOSPSC scores were significantly higher (indicating a higher level of culture) for the safety culture synthetic index (3.36/5 at baseline vs. 3.44/5 at post-intervention (2% increase); p=0.01). No differences (p=0.11) were observed in avoidable admissions rate before (median (IQR)=0.78 (0.7 to 0.9) vs. after the intervention (0.45 (0.33 to 0.83)). The interviews revealed that the intervention was perceived as a novel strategy that could produce long-term safety improvements by raising their awareness and improving their technical knowledge about patient safety.
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. CONCLUSIONS
. The proposed intervention is feasible to deliver and perceived as acceptable and useful by PC professionals if the barriers identified are addressed. The effectiveness of the refined intervention will be assessed in a trial involving 59 centres.
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. CLINICALTRIAL
. clinicaltrials.gov NCT03837912
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Abstract.

Arias-de la Torre J, Puigdomenech E, García X, Valderas JM, Eiroa-Orosa FJ, Fernández-Villa T, Molina AJ, Martín V, Serrano-Blanco A, Alonso J, et al (In Press). Relationship Between Depression and the Use of Mobile Technologies and Social Media Among Adolescents: Umbrella Review (Preprint). Abstract.

Allan L, Corbett A, Valderas Martinez J (In Press). Social prescribing programmes to prevent or delay frailty in community-dwelling older adults. Geriatrics Full text.

Fellenor J, Britten N, Courtenay M, Payne RA, Valderas J, Denholm R, Duncan P, McCahon D, Tatnell L, Fitzgerald R, et al (2021). A multi-stakeholder approach to the co-production of the research agenda for medicines optimisation. BMC Health Services Research, 21(1). Abstract. Full text.

Ricci-Cabello I, Yañez-Juan AM, Fiol-deRoque MA, Leiva A, Llobera Canaves J, Parmentier FBR, Valderas JM (2021). Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data. Journal of Clinical Medicine, 10(8), 1782-1782. Abstract. Full text.

Arias de la Torre J, Ronaldson A, Valderas JM, Vilagut G, Serrano-Blanco A, Hatch SL, Alonso J, Hotopf M, Dregan A (2021). Diagnostic promiscuity: the use of real-world data to study multimorbidity in mental health. Br J Psychiatry, 1-3. Abstract. Author URL. Full text.

Ferguson R, Prieto-Alhambra D, Peat G, Delmestri A, Jordan KP, Strauss VY, Valderas JM, Walker C, Yu D, Glyn-Jones S, et al (2021). Does pre-existing morbidity influences risks and benefits of total hip replacement for osteoarthritis: a prospective study of 6682 patients from linked national datasets in England. BMJ Open, 11(9), e046712-e046712.

Total hip arthroplasty (THA) surgery for elderly people with multimorbidity increases the risk of serious health hazards including mortality. Whether such background morbidity reduces the clinical benefit is less clear.ObjectiveTo evaluate how pre-existing health status, using multiple approaches, influences risks of, and quality of life benefits from, THA.SettingLongitudinal record linkage study of a UK sample linking their primary care to their secondary care records.ParticipantsA total of 6682 patients were included, based on the recording of the diagnosis of hip osteoarthritis in a national primary care register and the recording of the receipt of THA in a national secondary care register.Data were extracted from the primary care register on background health and morbidity status using five different constructs: Charlson Comorbidity Index, Electronic Frailty Index (eFI) and counts of comorbidity disorders (from list of 17), prescribed medications and number of primary care visits prior to recording of THA.Outcome measures(1) Postoperative complications and mortality; (2) postoperative hip pain and function using the Oxford Hip Score (OHS) and health-related quality of life using the EuroQoL (EQ)-5D score.ResultsPerioperative complication rate was 3.2% and mortality was 0.9%, both increased with worse preoperative health status although this relationship varied depending on the morbidity construct: the eFI showing the strongest relationship but number of visits having no predictive value. By contrast, the benefits were not reduced in those with worse preoperative health, and improvement in both OHS and EQ-5D was observed in all the morbidity categories.ConclusionsIndependent of preoperative morbidity, THA leads to similar substantial improvements in quality of life. These are offset by an increase in medical complications in some subgroups of patients with high morbidity, depending on the definition used. For most elderly people, their other health disorders should not be a barrier for THA.

Abstract.

Clarke L, Anderson M, Anderson R, Klausen MB, Forman R, Kerns J, Rabe A, Kristensen SR, Theodorakis P, Valderas J, et al (2021). Economic Aspects of Delivering Primary Care Services: an Evidence Synthesis to Inform Policy and Research Priorities. Milbank Q

Policy Points the 2018 Declaration of Astana reemphasized the importance of primary health care and its role in achieving universal health coverage. While there is a large amount of literature on the economic aspects of delivering primary care services, there is a need for more comprehensive overviews of this evidence. In this article, we offer such an overview. Evidence suggests that there are several strategies involving coverage, financing, service delivery, and governance arrangements which can, if implemented, have positive economic impacts on the delivery of primary care services. These include arrangements such as worker task-shifting and telemedicine. The implementation of any such arrangements, based on positive economic evidence, should carefully account for potential impacts on overall health care access and quality. There are many opportunities for further research, with notable gaps in evidence on the impacts of increasing primary care funding or the overall supply of primary care services. CONTEXT: the 2018 Declaration of Astana reemphasized the importance of primary health care and its role in achieving universal health coverage. To strengthen primary health care, policymakers need guidance on how to allocate resources in a manner that maximizes its economic benefits. METHODS: We collated and synthesized published systematic reviews of evidence on the economic aspects of different models of delivering primary care services. Building on previous efforts, we adapted existing taxonomies of primary care components to classify our results according to four categories: coverage, financing, service delivery, and governance. FINDINGS: We identified and classified 109 reviews that met our inclusion criteria according to our taxonomy of primary care components: coverage, financing, service delivery, and governance arrangements. A significant body of evidence suggests that several specific primary care arrangements, such as health workers' task shifting and telemedicine, can have positive economic impacts (such as lower overall health care costs). Notably absent were reviews on the impact of increasing primary care funding or the overall supply of primary care services. CONCLUSIONS: There is a great opportunity for further research to systematically examine the broader economic impacts of investing in primary care services. Despite progress over the last decade, significant evidence gaps on the economic implications of different models of primary care services remain, which could help inform the basis of future research efforts.

Abstract. Author URL.

Coste J, Valderas JM, Carcaillon-Bentata L (2021). Estimating and characterizing the burden of multimorbidity in the community: a comprehensive multistep analysis of two large nationwide representative surveys in France. PLoS Med, 18(4).

BACKGROUND: Given the increasing burden of chronic conditions, multimorbidity is now a priority for healthcare and public health systems worldwide. Appropriate methodological approaches for assessing the phenomenon have not yet been established, resulting in inconsistent and incomplete descriptions. We aimed to estimate and characterize the burden of multimorbidity in the adult population in France in terms of number and type of conditions, type of underlying mechanisms, and analysis of the joint effects for identifying combinations with the most deleterious interaction effects on health status. METHODS AND FINDINGS: We used a multistep approach to analyze cross-sectional and longitudinal data from 2 large nationwide representative surveys: 2010/2014 waves of the Health, Health Care, and Insurance Survey (ESPS 2010-2014) and Disability Healthcare Household Survey 2008 (HSM 2008), that collected similar data on 61 chronic or recurrent conditions. Adults aged ≥25 years in either ESPS 2010 (14,875) or HSM 2008 (23,348) were considered (participation rates were 65% and 62%, respectively). Longitudinal analyses included 7,438 participants of ESPS 2010 with follow-up for mortality (97%) of whom 3,798 were reinterviewed in 2014 (52%). Mortality, activity limitation, self-reported health, difficulties in activities/instrumental activities of daily living, and Medical Outcomes Study Short-Form 12-Item Health Survey were the health status measures. Multiple regression models were used to estimate the impact of chronic or recurrent conditions and multimorbid associations (dyads, triads, and tetrads) on health status. Etiological pathways explaining associations were investigated, and joint effects and interactions between conditions on health status measures were evaluated using both additive and multiplicative scales. Forty-eight chronic or recurrent conditions had an independent impact on mortality, activity limitations, or perceived heath. Multimorbidity prevalence varied between 30% (1-year time frame) and 39% (lifetime frame), and more markedly according to sex (higher in women), age (with greatest increases in middle-aged), and socioeconomic status (higher in less educated and low-income individuals and manual workers). We identified various multimorbid combinations, mostly involving vasculometabolic and musculoskeletal conditions and mental disorders, which could be explained by direct causation, shared or associated risk factors, or less frequently, confounding or chance. Combinations with the highest health impacts included diseases with complications but also associations of conditions affecting systems involved in locomotion and sensorial functions (impact on activity limitations), and associations including mental disorders (impact on perceived health). The interaction effects of the associated conditions varied on a continuum from subadditive and additive (associations involving cardiometabolic conditions, low back pain, osteoporosis, injury sequelae, depression, and anxiety) to multiplicative and supermultiplicative (associations involving obesity, chronic obstructive pulmonary disease, migraine, and certain osteoarticular pathologies). Study limitations included self-reported information on chronic conditions and the insufficient power of some analyses. CONCLUSIONS: Multimorbidity assessments should move beyond simply counting conditions and take into account the variable impacts on health status, etiological pathways, and joint effects of associated conditions. In particular, the multimorbid combinations with substantial health impacts or shared risk factors deserve closer attention. Our findings also suggest that multimorbidity assessment and management may be beneficial already in midlife and probably earlier in disadvantaged groups.

Abstract. Author URL.

Ricci-Cabello I, Gangannagaripalli J, Mounce LTA, Valderas JM (2021). Identifying Factors Leading to Harm in English General Practices: a Mixed-Methods Study Based on Patient Experiences Integrating Structural Equation Modeling and Qualitative Content Analysis. Journal of Patient Safety, 17(1), e20-e27. Full text.

Arias de la Torre J, Ronaldson A, Vilagut G, Serrano-Blanco A, Molina AJ, Martín V, Valderas JM, Dutta R, Dregan A, Alonso J, et al (2021). Improving suicide surveillance systems through the use of the Patient Health Questionnaire-9. J Affect Disord, 293, 71-72. Abstract. Author URL.

Ferguson R, Prieto-Alhambra D, Peat G, Delmestri A, Jordan KP, Strauss VY, Valderas JM, Walker C, Yu D, Glyn-Jones S, et al (2021). Influence of pre-existing multimorbidity on receiving a hip arthroplasty: cohort study of 28 025 elderly subjects from UK primary care. BMJ Open, 11(9), e046713-e046713. Abstract.

Arias de la Torre J, Vilagut G, Ronaldson A, Dregan A, Ricci-Cabello I, Hatch SL, Serrano-Blanco A, Valderas JM, Hotopf M, Alonso J, et al (2021). Prevalence and age patterns of depression in the United Kingdom. A population-based study. Journal of Affective Disorders, 279, 164-172. Full text.

Arias-de la Torre J, Vilagut G, Ronaldson A, Serrano-Blanco A, Martín V, Peters M, Valderas JM, Dregan A, Alonso J (2021). Prevalence and variability of current depressive disorder in 27 European countries: a population-based study. Lancet Public Health, 6(10), e729-e738.

BACKGROUND: We aimed to estimate the prevalence of current depressive disorder in 27 European countries, and to explore differences in prevalence between European countries and by gender. METHODS: in this population-based study, we analysed data from respondents living in 27 European countries who were included in the second wave of the European Health Interview Survey, collected between 2013 and 2015. We assessed the prevalence of current depressive disorder using the eight-item Patient Health Questionnaire (PHQ-8), with depressive disorder defined as a PHQ-8 score of 10 or higher. Prevalence estimates and 95% CIs were calculated for all 27 countries overall and for each country individually. We assessed variation in prevalence (country vs the rest of Europe) using crude and adjusted prevalence ratios obtained from negative binomial regression models. We did all analyses for the total sample and stratified by gender. FINDINGS: Our analysis sample comprised 258 888 individuals, of whom 117 310 (weighted proportion 47·8%) were men and 141 578 (52·2%) were women. The overall prevalence of current depressive disorder was 6·38% (95% CI 6·24-6·52) with important variation across countries, ranging from 2·58% (2·14-3·02) in the Czech Republic to 10·33% (9·33-11·32) in Iceland. Prevalence was higher in women (7·74% [7·53-7·95]) than in men (4·89% [4·71-5·08]), with clear gender differences for all countries except Finland and Croatia. Compared with the other European countries in our sample, those with the highest adjusted prevalence ratios were Germany (1·80 [1·71-1·89]) and Luxembourg (1·50 [1·35-1·66]), and those with the lowest adjusted prevalence ratios were Slovakia (0·28 [0·24-0·33]) and the Czech Republic (0·32 [0·27-0·38]). INTERPRETATION: Depressive disorders, although common across Europe, vary substantially in prevalence between countries. These results could be a baseline for monitoring the prevalence of current depressive disorder both at a country level in Europe and for planning health-care resources and services. FUNDING: UK Medical Research Council and CIBER Epidemiology and Public Health (CIBERESP).

Abstract. Author URL.

Arias-de la Torre J, Eiroa-Orosa FJ, Molina AJ, Colell E, Dávila-Batista V, Moreno-Montero F, Robles N, Valderas JM, Martín V (2021). Relación del consumo problemático de cannabis en la población joven de España con el riesgo percibido, los factores ambientales y los factores sociodemográficos. Adicciones, 33(1), 63-63.

Arias-de la Torre J, Jose Eiroa-Orosa F, Molina AJ, Colell E, Davila-Batista V, Moreno-Montero F, Robles N, Valderas JM, Vicente-Martin (2021). Relationship of problematic cannabis use among youth in Spain with perceived risk, environmental factors and sociodemographic factors. ADICCIONES, 33(1), 63-69. Author URL.

Gibbons C, Porter I, Gonçalves-Bradley DC, Stoilov S, Ricci-Cabello I, Tsangaris E, Gangannagaripalli J, Davey A, Gibbons EJ, Kotzeva A, et al (2021). Routine provision of feedback from patient-reported outcome measurements to healthcare providers and patients in clinical practice. Cochrane Database Syst Rev, 10

BACKGROUND: Patient-reported outcomes measures (PROMs) assess a patient's subjective appraisal of health outcomes from their own perspective. Despite hypothesised benefits that feedback on PROMs can support decision-making in clinical practice and improve outcomes, there is uncertainty surrounding the effectiveness of PROMs feedback. OBJECTIVES: to assess the effects of PROMs feedback to patients, or healthcare workers, or both on patient-reported health outcomes and processes of care. SEARCH METHODS: We searched MEDLINE, Embase, CENTRAL, two other databases and two clinical trial registries on 5 October 2020. We searched grey literature and consulted experts in the field. SELECTION CRITERIA: Two review authors independently screened and selected studies for inclusion. We included randomised trials directly comparing the effects on outcomes and processes of care of PROMs feedback to healthcare professionals and patients, or both with the impact of not providing such information. DATA COLLECTION AND ANALYSIS: Two groups of two authors independently extracted data from the included studies and evaluated study quality. We followed standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the evidence. We conducted meta-analyses of the results where possible. MAIN RESULTS: We identified 116 randomised trials which assessed the effectiveness of PROMs feedback in improving processes or outcomes of care, or both in a broad range of disciplines including psychiatry, primary care, and oncology. Studies were conducted across diverse ambulatory primary and secondary care settings in North America, Europe and Australasia. A total of 49,785 patients were included across all the studies. The certainty of the evidence varied between very low and moderate. Many of the studies included in the review were at risk of performance and detection bias. The evidence suggests moderate certainty that PROMs feedback probably improves quality of life (standardised mean difference (SMD) 0.15, 95% confidence interval (CI) 0.05 to 0.26; 11 studies; 2687 participants), and leads to an increase in patient-physician communication (SMD 0.36, 95% CI 0.21 to 0.52; 5 studies; 658 participants), diagnosis and notation (risk ratio (RR) 1.73, 95% CI 1.44 to 2.08; 21 studies; 7223 participants), and disease control (RR 1.25, 95% CI 1.10 to 1.41; 14 studies; 2806 participants). The intervention probably makes little or no difference for general health perceptions (SMD 0.04, 95% CI -0.17 to 0.24; 2 studies, 552 participants; low-certainty evidence), social functioning (SMD 0.02, 95% CI -0.06 to 0.09; 15 studies; 2632 participants; moderate-certainty evidence), and pain (SMD 0.00, 95% CI -0.09 to 0.08; 9 studies; 2386 participants; moderate-certainty evidence). We are uncertain about the effect of PROMs feedback on physical functioning (14 studies; 2788 participants) and mental functioning (34 studies; 7782 participants), as well as fatigue (4 studies; 741 participants), as the certainty of the evidence was very low. We did not find studies reporting on adverse effects defined as distress following or related to PROM completion. AUTHORS' CONCLUSIONS: PROM feedback probably produces moderate improvements in communication between healthcare professionals and patients as well as in diagnosis and notation, and disease control, and small improvements to quality of life. Our confidence in the effects is limited by the risk of bias, heterogeneity and small number of trials conducted to assess outcomes of interest. It is unclear whether many of these improvements are clinically meaningful or sustainable in the long term. There is a need for more high-quality studies in this area, particularly studies which employ cluster designs and utilise techniques to maintain allocation concealment.

Profile

Professor Jose Valderas

Professor of Health Services and Policy Research

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Journal articles

Abstract:Health Data Processes: a Framework for Analyzing and Discussing Efficient Use and Reuse of Health Data with a Focus on Patient-Reported Outcome Measures (Preprint)

Abstract:Patient-Reported Measures for Person-Centered Coordinated Care: a Comparative Domain Map and Web-Based Compendium for Supporting Policy Development and Implementation (Preprint)

Abstract:Piloting the SinergyAPS theory-based online intervention centred around the systematic patient feedback for improving patient safety in Primary Care: a mixed-methods feasibility study (Preprint)

Abstract:Relationship Between Depression and the Use of Mobile Technologies and Social Media Among Adolescents: Umbrella Review (Preprint)

Abstract:A multi-stakeholder approach to the co-production of the research agenda for medicines optimisation

Abstract:Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data

Abstract:Diagnostic promiscuity: the use of real-world data to study multimorbidity in mental health.

Abstract:Does pre-existing morbidity influences risks and benefits of total hip replacement for osteoarthritis: a prospective study of 6682 patients from linked national datasets in England

Abstract:Economic Aspects of Delivering Primary Care Services: an Evidence Synthesis to Inform Policy and Research Priorities.

Abstract:Estimating and characterizing the burden of multimorbidity in the community: a comprehensive multistep analysis of two large nationwide representative surveys in France.

Abstract:Improving suicide surveillance systems through the use of the Patient Health Questionnaire-9.

Abstract:Influence of pre-existing multimorbidity on receiving a hip arthroplasty: cohort study of 28 025 elderly subjects from UK primary care

Abstract:Prevalence and variability of current depressive disorder in 27 European countries: a population-based study.

Abstract:Routine provision of feedback from patient-reported outcome measurements to healthcare providers and patients in clinical practice.

Abstract:The Norwegian PROMIS-29: psychometric validation in the general population for Norway

Abstract:Accuracy of self-reported items for the screening of depression in the general population

Abstract:Development and internal validation of prognostic models to predict negative health outcomes in older patients with multimorbidity and polypharmacy in general practice

Abstract:Differences in Results and Related Factors Between Hospital-at-Home Modalities in Catalonia: a Cross-Sectional Study.

Abstract:Five-year trajectories of multimorbidity patterns in an elderly Mediterranean population using Hidden Markov Models

Abstract:Identifying high-need patients with multimorbidity from their illness perceptions and personal resources to manage their health and care: a longitudinal study.

Abstract:Impact of comorbidity on the short- and medium-term risk of revision in total hip and knee arthroplasty

Abstract:Patient-Reported Morbidity Instruments: a Systematic Review

Abstract:Predicting EQ-5D-5L crosswalk from the PROMIS-29 profile for the United Kingdom, France, and Germany

Abstract:Predicting incident delirium diagnoses using data from primary-care electronic health records.

Abstract:Relationship Between Depression and the Use of Mobile Technologies and Social Media Among Adolescents: Umbrella Review

Abstract:The Characteristics of Patients with Possible Transient Ischemic Attack and Minor Stroke in the Hunter and Manning Valley Regions, Australia (the INSIST Study)

Abstract:Assessing Patient-Centred Outcomes in Lateral Elbow Tendinopathy: a Systematic Review and Standardised Comparison of English Language Clinical Rating Systems

Abstract:Availability of specific tools to assess patient reported outcomes in hip arthroplasty in Spain. Identifying the best candidates to incorporate in an arthroplasty register. A systematic review and standardized assessment.

Abstract:Being tested but not educated - a qualitative focus group study exploring patients' perceptions of diabetic dietary advice.

Abstract:Development and evaluation of an intervention based on the provision of patient feedback to improve patient safety in Spanish primary healthcare centres: study protocol.

Abstract:Differences in Risk of Revision and Mortality Between Total and Unicompartmental Knee Arthroplasty. The Influence of Hospital Volume.

Abstract:Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus.

Abstract:Influence of Hospital Volume of Procedures by Year on the Risk of Revision of Total Hip and Knee Arthroplasties: a Propensity Score-Matched Cohort Study.

Abstract:Safety and Effectiveness of Shoulder Arthroplasties in Spain: a Systematic Review.

Abstract:The International comparison of Systems of care and patient outcomes in minor Stroke and Tia (InSIST) study: a community-based cohort study

Abstract:Validation of hip osteoarthritis diagnosis recording in the UK Clinical Practice Research Datalink.

Abstract:Antibiotic prescribing for acute respiratory tract infections in primary care: an updated and expanded meta-ethnography

Abstract:Clinical rating systems in elbow research—a systematic review exploring trends and distributions of use

Abstract:Comparative analysis of methods for identifying multimorbidity patterns: a study of 'real-world' data.

Abstract:Effectiveness of a complex intervention on Prioritising Multimedication in Multimorbidity (PRIMUM) in primary care: results of a pragmatic cluster randomised controlled trial.

Abstract:From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

Abstract:How do aggregated patient-reported outcome measures data stimulate health care improvement? a realist synthesis.

Abstract:How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? a realist synthesis.

Abstract:Identifying Primary Care Pathways from Quality of Care to Outcomes and Satisfaction Using Structural Equation Modeling

Abstract:Measurement invariance and general population reference values of the PROMIS Profile 29 in the UK, France, and Germany.

Abstract:Multimorbidity patterns with K-means nonhierarchical cluster analysis.

Abstract:Patient-Reported Measures for Person-Centered Coordinated Care: a Comparative Domain Map and Web-Based Compendium for Supporting Policy Development and Implementation.

Abstract:Predicting Incident Multimorbidity.

Abstract:Quality of diabetes care in breast, colorectal, and prostate cancer.

Abstract:The French PROMIS-29. Psychometric validation and population reference values

Abstract:The National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS): a view from the UK.

Abstract:Anorexia nervosa and cancer: a protocol for a systematic review and meta-analysis of observational studies.

Abstract:Can agent-based simulation be used as a tool to support polypharmacy prescribing practice?

Abstract:Cancer and central nervous system disorders: protocol for an umbrella review of systematic reviews and updated meta-analyses of observational studies.

Abstract:Collaborative action for person-centred coordinated care (P3C): an approach to support the development of a comprehensive system-wide solution to fragmented care.

Abstract:Comorbid conditions delay diagnosis of colorectal cancer: a cohort study using electronic primary care records.

Abstract:Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy: study protocol of a cluster randomized clinical trial (Multi-PAP project).

Abstract:Identifying patient and practice characteristics associated with patient-reported experiences of safety problems and harm: a cross-sectional study using a multilevel modelling approach.

Abstract:Identifying patient-centred recommendations for improving patient safety in General Practices in England: a qualitative content analysis of free-text responses using the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire.

Abstract:Outcomes of preexisting diabetes mellitus in breast, colorectal, and prostate cancer

Abstract:Patients' evaluations of patient safety in English general practices: a cross-sectional study.

Abstract:Pharmacological control of diabetes and hypertension comorbidity in the elderly: a study of "real world" data.

Abstract:Associations between exemption and survival outcomes in the UK's primary care pay-for-performance programme: a retrospective cohort study.

Abstract:Framework and guidance for implementing patient-reported outcomes in clinical practice: evidence, challenges and opportunities.

Abstract:Measuring Patient Safety in Primary Care: the Development and Validation of the "Patient Reported Experiences and Outcomes of Safety in Primary Care" (PREOS-PC).

Abstract:Patient-reported outcomes: pathways to better health, better services, and better societies.

Abstract:
Health Data Processes: a Framework for Analyzing and Discussing Efficient Use and Reuse of Health Data with a Focus on Patient-Reported Outcome Measures (Preprint)

Abstract:
Patient-Reported Measures for Person-Centered Coordinated Care: a Comparative Domain Map and Web-Based Compendium for Supporting Policy Development and Implementation (Preprint)

Abstract:
Piloting the SinergyAPS theory-based online intervention centred around the systematic patient feedback for improving patient safety in Primary Care: a mixed-methods feasibility study (Preprint)

Abstract:
Relationship Between Depression and the Use of Mobile Technologies and Social Media Among Adolescents: Umbrella Review (Preprint)

Abstract:
A multi-stakeholder approach to the co-production of the research agenda for medicines optimisation

Abstract:
Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data

Abstract:
Diagnostic promiscuity: the use of real-world data to study multimorbidity in mental health.

Abstract:
Does pre-existing morbidity influences risks and benefits of total hip replacement for osteoarthritis: a prospective study of 6682 patients from linked national datasets in England

Abstract:
Economic Aspects of Delivering Primary Care Services: an Evidence Synthesis to Inform Policy and Research Priorities.

Abstract:
Estimating and characterizing the burden of multimorbidity in the community: a comprehensive multistep analysis of two large nationwide representative surveys in France.

Abstract:
Improving suicide surveillance systems through the use of the Patient Health Questionnaire-9.

Abstract:
Influence of pre-existing multimorbidity on receiving a hip arthroplasty: cohort study of 28 025 elderly subjects from UK primary care

Abstract:
Prevalence and variability of current depressive disorder in 27 European countries: a population-based study.

Abstract:
Routine provision of feedback from patient-reported outcome measurements to healthcare providers and patients in clinical practice.

Abstract:
The Norwegian PROMIS-29: psychometric validation in the general population for Norway

Abstract:
Accuracy of self-reported items for the screening of depression in the general population

Abstract:
Development and internal validation of prognostic models to predict negative health outcomes in older patients with multimorbidity and polypharmacy in general practice

Abstract:
Differences in Results and Related Factors Between Hospital-at-Home Modalities in Catalonia: a Cross-Sectional Study.

Abstract:
Five-year trajectories of multimorbidity patterns in an elderly Mediterranean population using Hidden Markov Models

Abstract:
Identifying high-need patients with multimorbidity from their illness perceptions and personal resources to manage their health and care: a longitudinal study.

Abstract:
Impact of comorbidity on the short- and medium-term risk of revision in total hip and knee arthroplasty

Abstract:
Patient-Reported Morbidity Instruments: a Systematic Review

Abstract:
Predicting EQ-5D-5L crosswalk from the PROMIS-29 profile for the United Kingdom, France, and Germany

Abstract:
Predicting incident delirium diagnoses using data from primary-care electronic health records.

Abstract:
Relationship Between Depression and the Use of Mobile Technologies and Social Media Among Adolescents: Umbrella Review

Abstract:
The Characteristics of Patients with Possible Transient Ischemic Attack and Minor Stroke in the Hunter and Manning Valley Regions, Australia (the INSIST Study)

Abstract:
Assessing Patient-Centred Outcomes in Lateral Elbow Tendinopathy: a Systematic Review and Standardised Comparison of English Language Clinical Rating Systems

Abstract:
Availability of specific tools to assess patient reported outcomes in hip arthroplasty in Spain. Identifying the best candidates to incorporate in an arthroplasty register. A systematic review and standardized assessment.

Abstract:
Being tested but not educated - a qualitative focus group study exploring patients' perceptions of diabetic dietary advice.

Abstract:
Development and evaluation of an intervention based on the provision of patient feedback to improve patient safety in Spanish primary healthcare centres: study protocol.

Abstract:
Differences in Risk of Revision and Mortality Between Total and Unicompartmental Knee Arthroplasty. The Influence of Hospital Volume.

Abstract:
Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus.

Abstract:
Influence of Hospital Volume of Procedures by Year on the Risk of Revision of Total Hip and Knee Arthroplasties: a Propensity Score-Matched Cohort Study.

Abstract:
Safety and Effectiveness of Shoulder Arthroplasties in Spain: a Systematic Review.

Abstract:
The International comparison of Systems of care and patient outcomes in minor Stroke and Tia (InSIST) study: a community-based cohort study

Abstract:
Validation of hip osteoarthritis diagnosis recording in the UK Clinical Practice Research Datalink.

Abstract:
Antibiotic prescribing for acute respiratory tract infections in primary care: an updated and expanded meta-ethnography

Abstract:
Clinical rating systems in elbow research—a systematic review exploring trends and distributions of use

Abstract:
Comparative analysis of methods for identifying multimorbidity patterns: a study of 'real-world' data.

Abstract:
Effectiveness of a complex intervention on Prioritising Multimedication in Multimorbidity (PRIMUM) in primary care: results of a pragmatic cluster randomised controlled trial.

Abstract:
From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

Abstract:
How do aggregated patient-reported outcome measures data stimulate health care improvement? a realist synthesis.

Abstract:
How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? a realist synthesis.

Abstract:
Identifying Primary Care Pathways from Quality of Care to Outcomes and Satisfaction Using Structural Equation Modeling

Abstract:
Measurement invariance and general population reference values of the PROMIS Profile 29 in the UK, France, and Germany.

Abstract:
Multimorbidity patterns with K-means nonhierarchical cluster analysis.

Abstract:
Patient-Reported Measures for Person-Centered Coordinated Care: a Comparative Domain Map and Web-Based Compendium for Supporting Policy Development and Implementation.

Abstract:
Predicting Incident Multimorbidity.

Abstract:
Quality of diabetes care in breast, colorectal, and prostate cancer.

Abstract:
The French PROMIS-29. Psychometric validation and population reference values

Abstract:
The National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS): a view from the UK.

Abstract:
Anorexia nervosa and cancer: a protocol for a systematic review and meta-analysis of observational studies.

Abstract:
Can agent-based simulation be used as a tool to support polypharmacy prescribing practice?

Abstract:
Cancer and central nervous system disorders: protocol for an umbrella review of systematic reviews and updated meta-analyses of observational studies.

Abstract:
Collaborative action for person-centred coordinated care (P3C): an approach to support the development of a comprehensive system-wide solution to fragmented care.

Abstract:
Comorbid conditions delay diagnosis of colorectal cancer: a cohort study using electronic primary care records.

Abstract:
Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy: study protocol of a cluster randomized clinical trial (Multi-PAP project).

Abstract:
Identifying patient and practice characteristics associated with patient-reported experiences of safety problems and harm: a cross-sectional study using a multilevel modelling approach.

Abstract:
Identifying patient-centred recommendations for improving patient safety in General Practices in England: a qualitative content analysis of free-text responses using the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire.

Abstract:
Outcomes of preexisting diabetes mellitus in breast, colorectal, and prostate cancer

Abstract:
Patients' evaluations of patient safety in English general practices: a cross-sectional study.

Abstract:
Pharmacological control of diabetes and hypertension comorbidity in the elderly: a study of "real world" data.

Abstract:
Associations between exemption and survival outcomes in the UK's primary care pay-for-performance programme: a retrospective cohort study.

Abstract:
Framework and guidance for implementing patient-reported outcomes in clinical practice: evidence, challenges and opportunities.

Abstract:
Measuring Patient Safety in Primary Care: the Development and Validation of the "Patient Reported Experiences and Outcomes of Safety in Primary Care" (PREOS-PC).

Abstract:
Patient-reported outcomes: pathways to better health, better services, and better societies.

Abstract:
Patients' perceptions and experiences of patient safety in primary care in England.

Abstract:
Pilot study to test the feasibility of a trial design and complex intervention on PRIoritising MUltimedication in Multimorbidity in general practices (PRIMUMpilot).

Abstract:
[Multimorbidity patterns in young adults in Catalonia: an analysis of clusters].

Abstract:
Any versus long-term prescribing of high risk medications in older people using 2012 Beers Criteria: results from three cross-sectional samples of primary care records for 2003/4, 2007/8 and 2011/12.

Abstract:
Developing a research agenda for patient safety in primary care. Background, aims and output of the LINNEAUS collaboration on patient safety in primary care.

Abstract:
Impact of multi-morbidity on quality of healthcare and its implications for health policy, research and clinical practice. A scoping review.

Abstract:
Impact of the Prevalence of Concordant and Discordant Conditions on the Quality of Diabetes Care in Family Practices in England.

Abstract:
Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care.

Abstract:
Measuring experiences and outcomes of patient safety in primary care: a systematic review of available instruments.

Abstract:
Multimorbidity Patterns in Elderly Primary Health Care Patients in a South Mediterranean European Region: a Cluster Analysis.

Abstract:
Patients' responses to transient ischaemic attack symptoms: a cross-sectional questionnaire study in Australian general practices.

Abstract:
Routine provision of information on patient-reported outcome measures to healthcare providers and patients in clinical practice

Abstract:
Time spent on health-related activities by senior Australians with chronic diseases: what is the role of multimorbidity and comorbidity?

Abstract:
Evaluation of shoulder-specific patient-reported outcome measures: a systematic and standardized comparison of available evidence.