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More evidence needed to help provide effective healthcare for
people with multimorbidity
10 September 2012 Royal College of Surgeons in Ireland (RCSI)
A research review carried out by the HRB Centre for Primary Care Research,
based in the Royal College of Surgeons in Ireland (RCSI) and published in
this month’s edition of the British Medical Journal (BMJ) has focused on how
we can improve care and outcomes for patients with multimorbidity (coexistence of two or more long-terms health conditions in an individual).
Multimorbidity is the norm, rather than the exception in primary care patients.
Despite the increasing numbers of patients with two or more chronic
conditions, the delivery of care to patients is usually built around single
diseases and there is a limited level of care available to patients with
multimorbidity.
Prof Susan Smith, Associate Professor of General Practice, RCSI said
“Multimorbidity is a challenging factor facing practitioners and patients;
however it has attracted surprisingly little research interest. Our research
focused on how we can improve care and outcomes for these patients and
found that a need exists to clearly identify patients with multimorbidity in order
to develop cost effective and specifically targeted interventions that can
improve health outcomes for patients.”
The research indicated that interventions targeted either at specific
combinations of common conditions or at specific problems for patients with
multiple conditions may be the most effective method to managing patients
with multimorbidity.
Prof Smith continued “We found that the methods used had mixed effects, but
they were more likely to be effective if they were targeted at specific risk
factors for people with common combinations of conditions such as diabetes
and depression or focused on areas where patients have difficulties, such as
with activities of daily living or the management of multiple medications. The
least effective approach was patient orientated interventions which dealt with
patient related behaviour only but did not link this with healthcare.”
“We know from previous research studies that patients with multimorbidity are
more likely to die prematurely, be admitted to hospital and have longer
hospital stays than patients with single conditions. Additionally, patients with
multimorbidity have a poorer quality of life, experience a loss of physical
functioning and are more likely to experience depression”, Prof Smith
continued.
The review identified ten studies examining interventions in 3407 patients with
multimorbidity. It highlighted the scarcity of research in to interventions to
improve outcomes for patients with multimorbidity. It indicated that
interventions targeted either at specific combinations of common conditions or
at specific problems for patients with multiple conditions may be the most
effective method.
A copy of the research can be viewed at the link below and a podcast
summarising the review findings can be found at
http://www.cochrane.org/podcasts/issue-4-april-2012/interventions-improveoutcomes-patients-multimorbidity-primary-care-andhttp://www.bmj.com/content/345/bmj.e5205

Full bibliographic informationSusan M Smith et al, Managing
patients with multimorbidity: systematic review of interventions in
primary care and community settings, British Medical Journal (BMJ),
doi: 10.1136/bmj.e5205 (Published 3 September 2012), BMJ
2012;345:e5205, http://www.bmj.com/content/345/bmj.e5205.