Clinical Review

Managing patients with multimorbidity in primary care

BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h176 (Published 20 January 2015) Cite this as: BMJ 2015;350:h176
  1. Emma Wallace, general practice lecturer1,
  2. Chris Salisbury, professor in primary health care2,
  3. Bruce Guthrie, professor of primary care medicine3,
  4. Cliona Lewis, general practice lecturer1,
  5. Tom Fahey, professor of general practice1,
  6. Susan M Smith, associate professor of general practice1
  1. 1HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland Medical School, Dublin 2, Ireland
  2. 2Centre for Academic Primary Care, University of Bristol, Bristol, UK
  3. 3Quality, Safety and Informatics Research Group, University of Dundee, Dundee, UK
  1. Correspondence to: E Wallace emmawallace{at}rcsi.ie

The bottom line

  • Multimorbidity is commonly defined as the presence of two or more chronic medical conditions in an individual and it can present several challenges in care particularly with higher numbers of coexisting conditions and related polypharmacy

  • Practices should actively identify patients with complex multimorbidity and adopt a policy of continuity of care for these patients by assigning them a named doctor

  • The adoption of a policy for routine extended consultations should be considered for particularly complex patients or the introduction of occasional “specific extended consultations.” allowing protected time to deal with problems encountered in the management of chronic diseases

Multimorbidity, commonly defined as the presence of two or more chronic medical conditions in an individual,1 is associated with decreased quality of life, functional decline, and increased healthcare utilisation, including emergency admissions, particularly with higher numbers of coexisting conditions.2 3 4 5 6 The management of multimorbidity with drugs is often complex, resulting in polypharmacy with its attendant risks.7 8 9 Patients with multimorbidity have a high treatment burden in terms of understanding and self managing the conditions, attending multiple appointments, and managing complex drug regimens.10 Qualitative research highlights the “endless struggle” patients experience in trying to manage their conditions well.11 Psychological distress is common: in an Australian survey of 7620 patients in primary care, 23% of those with one chronic condition reported depression compared with 40% of those with five or more conditions.12

Sources and selection criteria

We based this article on the authors’ experience and information from published literature. We carried out searches of PubMed and the Cochrane library using the search terms “co-morbidity” or “comorbidity” or “multimorbid” or “multimorbidity” or “multi-morbidity”. No MeSH term exists for multimorbidity. The searches were supplemented by a review of authors’ personal archives as well as relevant articles from the International Research …

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