Dr. Martin Fortin, M.D., M.Sc., CMFC (F)

The Situation

Maybe you know, or are, someone like this. “Ms. Jones” is a 55 year-old, divorced, mother of three who suffers from multiple health issues. She suffers from hypertension, type 2 diabetes, asthma, osteoarthritis, colon cancer and, not surprisingly, depression.

Because of her multiple health chronic issues, or ‘multimorbidity’, Ms. Jones’ family doctor is presented with a huge clinical challenge that will require a complex and time-consuming intervention that will prove to be a highly frustrating process for both parties – most family doctors are just not equipped to address the complex intervention and care needed by patients with multimorbidities. Both doctor and patient will most likely be very unsatisfied with the process of giving and receiving care under these conditions.

Is Ms. Jones an unusual case, unrepresentative of most patients that primary health care providers deal with on a day-to-day basis?

“Not in the least,” emphasizes Dr. Martin Fortin, a physician with over 20 years experience in the practice of family medicine in the remote areas of the Saguenay, Quebec. “As the population ages, the number of such patients is increasing and, actually, set to explode.”

The Problem and the Advocate

Conventional medicine does not yet offer any care model tailored to multiple chronic disease patients. Most pharmacological treatments, practice guidelines and educational programs were indeed developed to manage single chronic conditions.

“And that’s the problem,” explains Dr. Fortin. “We just don’t have a strong body of knowledge and guidelines in primary care at our disposal to help us effectively address the needs of patients with multiple chronic conditions.”

Frustrated trying to care for those patients suffering multiple chronic diseases in the absence of an adequate literature and clear guidelines on how to do so, Dr. Fortin decided that something had to be done.

Trained in Family Medicine and holder of a master’s degree in Epidemiology, Dr. Fortin has dedicated his research efforts since 2001 on finding healthcare solutions for people dealing with multiple chronic conditions. His research team has shown that multiple chronic diseases are associated with poorer quality of life, greater psychological distress and additional problems due to medication.

“Studies report clear associations between multiple conditions and mortality, longer hospital stays as well as additional complications and costs for the health system,” says Dr. Fortin. “Chronic diseases are responsible for the biggest part of the healthcare budget and we have to find a way to control these cost by intervening in a better way to optimize the overall quality of primary health care.”

Dr. Fortin believes that his major contribution in this field of research has been to increase the awareness of the research community and the health authority to the fact that a majority of the patients seen in primary care present with many chronic concurring conditions thus questioning the linear single disease paradigm.

“We grew up in a system that was geared toward acute care more than chronic care many years ago,” says Dr. Fortin. “We have since given priority to chronic diseases but this has been done rather in silos, around the major chronic diseases with the highest burden, like cardiovascular diseases, cancer, arthritis, and diabetes.”

“By doing this we have forgotten at some point that many patients have several of those major chronic diseases but also suffer from several other chronic conditions and illnesses at the same time. This complicates their care trajectory and results in significant burdens not only for the individuals, but for the whole care system as well.”

Dr. Fortin has published several works related to the epidemiology of multimorbidity as well as papers discussing the multimorbidity research agenda in primary care. His work is seen as an inspiration for many researchers worldwide sharing the same understanding about what has to be done to enhance the quality of primary care around the growing issue of multimorbidity in primary healthcare.

Research

As the CIHR Applied Research Chair in Health Services and Policy Research on Chronic Diseases in Primary Care (2009 - 2013), Dr. Fortin’s research mission is to develop and disseminate knowledge that will help primary care professionals of all disciplines interact more efficiently with people dealing with multiple chronic diseases. He pays particular attention to clienteles in rural and semi-urban regions and to the evaluation of clinical practices regarding chronic diseases. Dr. Fortin and his team are developing a unique expertise in Canada on disease management.

Dr. Fortin's research program includes three complementary themes. The first conceptual theme proposes a conceptualization of “multimorbidity” that can be adopted by the entire clinical and research community. The second epidemiological theme aims to better understanding of the evolution of multiple chronic conditions over time and which factors are associated with it. The third intervention theme will allow him to develop, implement and evaluate an intervention program involving inter-professional collaborations between physicians, families, primary care professionals and decision-makers, for the management and follow-up in primary care of patients presenting multiple chronic diseases.

“The vision that drives my research is one of collaboration that integrates decision-makers and all disciplines in primary care services, calling upon them in a care model adapted to patients suffering from multiple chronic diseases and involving interventions tailored to their day-to-day reality,” explains Dr. Fortin.

Dr. Fortin inspires confidence. He also receives funding from FRSQ, The Canadian Health Services Research Foundation-CHRSF, Pfizer Canada, The College of Family Physicians of Canada, and has developed graduate programs in Clinical Sciences and Family Medicine in Saguenay in affiliation with his Alma Mater, the Université de Sherbrooke. He has become an international leader in the multimorbidity research and spearheads the International Research Community on Multimorbidity(IRCMo), a virtual international community bringing together researchers and health care professionals that are directing leading contributions to new understandings and approaches to multimorbidity in primary care. The Université de Sherbrooke hosts the IRCMo blog where researchers from all around the world can share ideas and results for dissemination directly to those mostly concerned by the same themes.

Vision

While proud of the work that he and his colleagues in Canada and around the world have accomplished, Dr. Fortin knows that much more needs to be done in the research community to communicate the importance of recognizing and dealing with multimorbidity, what he refers to as the elephant in the room of primary care.

“My research is really about advocating for enhanced care for patients with multimorbidity that deserve more attention that what we have given them so far,” explains Dr. Fortin. “With a mere 15 minute consultation with the family doc in a three to six month period of time, it is very difficult to achieve good quality, and we should never lose any time doing things that are irrelevant for the patient.”

“My work is really all about my commitment towards my patients. That is what drives my research.”

For further information, please contact Dr. Martin Fortin, M.D., M.Sc., CMFC (F) using the Email contact form