Multimorbidity has become “a Thing”

Why has multimorbidity become a “thing”

– a generally known phenomenon?  This is probably because it is being referenced more and more in policy (and funding related) documents and this is because multimorbidity is identified as a cause of increased health care costs.

A few decades ago, chronic diseases began to assume importance as they became relatively more common when compared to acute illnesses and as infectious diseases have become more treatable.  Co-morbidities then began to be mentioned in specialist clinics where it was noted that, for instance, patients with COPD might also have cardiac or peripheral vascular disease – and that these co-morbidities and their treatments might impact on the disease under care.

Specialist vs generalist

This was a rather specialist view. In the Geriatric literature there had always been a focus on multiple medications (Polypharmacy) and interest began to increase in the complexity of management of (often older) patients with multiple conditions (multimorbidity).  Over the last three decades the number of articles exploring multimorbidity has increased exponentially.  There are various issues regarding definition (how many conditions, how specific, how chronic).  In Australia it is likely that some measure of multimorbidity will be included in stratifying patients for funding in Health Care Homes.

In General Practice

In patient-centred General Practice it is the patient with multiple conditions who is recognised as the reality and seen as the focus of concern (rather than the disease).  This is particularly relevant in a context of increasing sub-specialisation. Managing the associated interactions and integrating available guidelines are challenges.  A very useful patient-centred concept that has emerged for such complex patients is that of Minimally Disruptive Medicine which recognises that health professionals often increase a patient’s burden and make “compliance” problematic.  Managing all of this appropriately is beneficial for the patient and the health system, in both the long and short term and is a relevant goal in the GP context.

Some useful references

The American Geriatric Society has produced a handy Pocketcard summary of their guidelines.

In the UK,  Multimorbidity guidelines have been produced

Minimally Disruptive Medicine: Is healthcare careful? Is it kind?

MedEdPurls has three posts on Teaching Multimorbidity:

http://mededpurls.com/blog/index.php/2016/10/31/teaching-multimorbidity-part-one/

http://mededpurls.com/blog/index.php/2016/11/05/teaching-multimorbidity-part-two/

http://mededpurls.com/blog/index.php/2016/11/13/teaching-multimorbidity-part-three/