Intended for healthcare professionals


Beyond diagnosis: rising to the multimorbidity challenge

BMJ 2012; 344 doi: (Published 13 June 2012) Cite this as: BMJ 2012;344:e3526
  1. Dee Mangin, associate professor, director primary care research unit1,
  2. Iona Heath, president2,
  3. Marc Jamoulle, general practitioner, researcher in primary care3
  1. 1Christchurch School of Medicine and Health Sciences, Department of Public Health and General Practice, Christchurch 8140, New Zealand
  2. 2Royal College of General Practitioners, London, UK
  3. 3University of Louvain, Institute of Health and Society, Brussels, Belgium
  1. dee.mangin{at}

Urgently needs radical shifts in research, evidence based guidance, and healthcare

In January 2012 the Institute of Medicine in the United States published the report of a consensus study on living well with chronic illness. The report made 17 recommendations for public health approaches to chronic disease prevention, surveillance, data gathering, and chronic disease management programmes that would help improve quality of life and functioning and reduce disability.1 Although the report makes some interesting recommendations (box 1), particularly about research in chronic disease, and displays a welcome shift in emphasis to “living well” rather than reducing mortality, it falls short of making the necessary paradigm shift from a disease based model to one that focuses on care for patients. This shift in thinking is urgently needed to provide good care for patients with multiple comorbidities.

Box 1 Summary of the Institute of Medicine report, Living Well with Chronic Illness1

This detailed literature review uses exemplar conditions including arthritis, survivorship after cancer, chronic pain, dementia, depression, type 2 diabetes, post-traumatic disabling conditions, schizophrenia, and vision and hearing loss to give broad recommendations. Its main recommendations are:

  • Resources should be used wisely in the current financially difficult environment. The Centers for Disease Control and Prevention should focus on a select range of diseases

  • Research and programme evaluation should provide better scientific and economic evidence on the effectiveness of chronic disease programmes and models of care

  • Focus on quality of life outcome measures for research and programme evaluation and on interventions that reduce the disparity in healthcare that leads to inequity in outcomes

  • Take a more coordinated approach to meeting both health and social needs that facilitates collaboration between population health, clinical, and non-health services, employers, and community organisations

  • Collect better data for surveillance of chronic illnesses as well as the effect of interventions and models of care on patient reported quality of life outcomes. The …

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