Multimorbidity in younger deprived patients: An exploratory study of research and service implications in general practice

Susan M Smith,Atakelet Ferede,Tom O'Dowd

doi:10.1186/1471-2296-9-6

Susan M Smith, Atakelet Ferede + Show 1 more

Open Access

https://doi.org/10.1186/1471-2296-9-6

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Abstract

BackgroundMultimorbidity has been defined as the co-existence of two or more chronic conditions. It has a profound impact on both the individuals affected and on their use of healthcare services. The limited research to date has focused on its epidemiology rather than the development of interventions to improve outcomes in multimorbidity patients, particularly for patients aged less than 65 years. Potential barriers to such research relate to methods of disease recording and coding and examination of the process of care. We aimed to assess the feasibility of identifying younger individuals with multimorbidity at general practice level and to explore the effect of multimorbidity on the type and volume of health care delivered. We also describe the barriers encountered in attempting to carry out this exploratory research.MethodsCross sectional survey of GP records in two large urban general practices in Dublin focusing on poorer individuals with at least three chronic conditions and aged between 45 and 64 years.Results92 patients with multimorbidity were identified. The median number of conditions was 4 per patient. Individuals received a mean number of 7.5 medications and attended a mean number of GP visits of 11.3 in the 12 months preceding the survey. Barriers to research into multimorbidity at practice level were identified including difficulties relating to GP clinical software; variation in disease coding; assessment of specialist sector activity through the GP-specialist communications and assessment of the full scale of primary care activity in relation to other disciplines and other types of GP contacts such as home visits and telephone contacts.ConclusionThis study highlights the importance of multimorbidity in general practice and indicates that it is feasible to identify younger patients with multimorbidity through their GP records. This is a first step towards planning a clinical intervention to improve outcomes for such patients in primary care.

Highlights

Multimorbidity has been defined as the co-existence of two or more chronic conditions
Patients In an effort to identify patients with higher levels of multimorbidity, who present particular management problems for primary care, we focused on younger, more socioeconomically deprived patients with three or more chronic conditions
Setting The survey was conducted in two general practices in Dublin: Inchicore Medical Centre (IMC) and Mary Mercer Health Centre (MMHC), where two of the authors practice as GPs

Summary

Introduction

Multimorbidity has been defined as the co-existence of two or more chronic conditions It has a profound impact on both the individuals affected and on their use of healthcare services. There has been limited research into multimorbidity and most has focused on the exploration of large patient databases in an attempt to understand its full impact [6]. Several barriers to the introduction of an intervention for multimorbidity exist in most healthcare systems These include identifying patients using existing clinical software, which uses single disease coding systems, the estimation of the process of care, and polypharmacy issues, all of which make management of these patients more complex for primary care practitioners

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