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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 (co-existence 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-improve-outcomes-patients-multimorbidity-primary-care-and-

http://www.bmj.com/content/345/bmj.e5205

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