Glossaire

A health problem requiring ongoing management over a period of years or decades (e.g., asthma, cancer, depression, diabetes and heart disease).

According to the World Health Organization, multimorbidity is a medical condition that requires support over a period of several months, or even decades. The co-occurrence of several chronic medical conditions (two or more) in a same individual is the most widely accepted definition.

The definition of multimorbidity adopted by PACE in MM is a count of three or more chronic diseases, which identifies in many cases a more vulnerable population (within the chronic disease spectrum) with higher needs (lower income or poverty, poorer outcomes and challenging processes of care). 

Patient-Centred partnerships in care include: exploring the patients' diseases and the illness experience; understanding the whole person in context; finding common ground; and enhancing the patient provider relationship.

The Patient-Centred approach adopted by PACE in MM has two main facets or components: Patient-Centred Partnerships between Patients and Providers, and Coordination/Integration/Transitions.

"We had recourse to various definitions to describe the front-line services. But above all, it comes to top-level universally accessible services that serve to promote health, to prevent disease and provide diagnostic, curative, rehabilitative, and palliative support" (Lamarche 2003, p. 2).

This definition is broader than that proposed by Health Canada (2001), which defines primary health care as "the first point of contact for Canadians with the health care system, usually through a family doctor" (Health Canada, 2001). However, all these two definitions and many others "are written in a language which ignores the different needs in primary health care of the men and women" (Donner and Pederson, 2003 p. 4). PACE in MM pays particular attention to the gender dimension in its analyses.

Realistic synthesis first proposes to make explicit the underlying mechanisms of the functioning of an intervention in a given context, and then, based on these mechanisms, and their interactions with the context, reports on observed results (expected or unexpected) to go beyond the statement of an effect of an intervention (Pawson, 2013; Wong, Westhorp, Pawson et Greenhalgh, 2013; Pawson et al., 2004; Pawson et Tilley, 1997). The realistic approach also advocated the use of the relevant quantitative and qualitative data (Pollitt, 2013, Pawson et Tilley, 1997).