Intended for healthcare professionals


Ordering the chaos for patients with multimorbidity

BMJ 2012; 345 doi: (Published 07 September 2012) Cite this as: BMJ 2012;345:e5915
  1. Jeannie L Haggerty, associate professor
  1. 1St Mary’s Hospital Center, QC, Montréal, Canada, H3T 1M5
  1. jeannie.haggerty{at}

Building continuity of care takes work but earns trust

Estimates of the prevalence of multimorbidity vary according to how it is measured, but studies agree that prevalence is rising and that it increases precipitously with age.1 By middle age, multimorbidity is the new normal. The first article in this editorial series on multimorbidity highlighted the difficulty of achieving evidence based targets for multiple diseases in a single patient.2 Treating all of a patient’s diseases optimally represents a considerable management burden for the patient and can result in a chaotic experience of care. Barbara Starfield defined relational continuity in primary care as person focused care over time, and such an approach is needed for patients with multimorbidity, rather than the more traditional one of managing diseases.3 But how can continuity of care be achieved for patients with multimorbidity?

Continuity of care is most commonly defined as a connected and coherent series of healthcare events, or seamless care.4 For the healthcare professional, this means having all the necessary information about the patient at the point of care (informational continuity) and coordinating actions with other providers to deliver services in a complementary and timely manner along a recommended care pathway (management continuity). Connectedness matters for healthcare professionals because it translates into technical quality of …

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