Redesigning the general practice consultation to improve care for patients with multimorbidity

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6202 (Published 17 September 2012)
Cite this as: BMJ 2012;345:e6202

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  1. Umesh Kadam, senior lecturer in general practice and epidemiology
  1. 1Arthritis Research UK National Primary Care Centre, Keele University, Keele ST5 5BG, UK
  1. u.kadam{at}cphc.keele.ac.uk

More time and provision of innovative tools to coordinate care may help

Patients with multimorbidity often need more frequent general practice consultations, and more complex and structured care, than those with a single condition. Their care is often shared and needs to be coordinated with specialist community and hospital teams. A recent article in this series drew attention to the importance of having one main coordinator of care for patients with multimorbidity,1 and Starfield and colleagues highlighted, almost a decade ago,2 the challenge that primary care practitioners face in managing patients with multimorbidity more effectively. The standard primary care consultation for patients with multiple conditions needs to change, but how?

Multimorbidity influences the general practice consultation in three main ways. Firstly, the amount of clinical information that must be collected for an individual patient with many different conditions can be extensive, especially when conditions and their stability change over time.3 Secondly, as conditions progress over time, management priorities and consequently information gathering, plans, and coordination of care must change.4 Thirdly, communication with other services involved in …

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