Developing a list of chronic conditions using a Delphi method to study multimorbidity in primary care

To develop a French-language list of chronic conditions to enable more detailed analyses of multimorbid patients in primary care in subsequent studies.

Delphi study followed by a multicentre cross-sectional study in French general practices.

The list development required a three-step procedure: 1) The development of a preliminary version of the list based on the International Classification of Primary Care-2 (ICPC-2): an expert panel of general practitioners participated in two Delphi rounds to assess the relevance of the items as "chronic conditions". 2) Testing the list with outpatients consecutively included in general practices. 3) A final Delphi round accounting for the results of the outpatient list experimentation.

From the 726 items of the ICPC-2, 383 items were submitted to 12 experts. In the first Delphi round, 126 items were accepted and 81 excluded. During the second, 2 additional items were retained and 86 excluded. Then, the experts selected 22 supplementary items from the 88 remaining, and a preliminary list of 124 items has been established after grouping similar items. During the test phase, 16 physicians and 306 patients rated 98 items as "already listed", 58 as "unlisted" and 19 as "unsuitable". During the final Delphi round, the experts selected 11 more items among the unlisted and finalized the list at 135 items.

This list of 135 chronic conditions has been developed with a valid methodology. It is useable by physicians and will allow a more accurate study of multimorbidity in primary care.