Management Of Multimorbidity Research Articles

Multimorbidity and COPD Medication Receipt Among Medicaid Beneficiaries With Newly Diagnosed COPD.

Multimorbidity is highly prevalent among patients with COPD. The association between multimorbidity and COPD medication management is not well researched. The aim of this study was to examine the association between multimorbidity and COPD medication receipt among Medicaid beneficiaries with newly diagnosed COPD. A retrospective longitudinal dynamic cohort design was used, and data were extracted from Medicaid Analytic eXtract files from 2005 to 2008. Medicaid beneficiaries with newly diagnosed COPD (N = 19,060) were identified using the International Classification of Diseases, 9th Revision, Clinical Modification, for COPD. This code (for commonly co-occurring conditions with COPD) was used to create a multimorbidity variable. These conditions included anxiety, arthritis, bipolar disorder, cardiovascular diseases, depression, diabetes, hypertension, hyperlipidemia osteoporosis, and schizophrenia. Medicaid beneficiaries with newly diagnosed COPD were categorized as: (1) physical multimorbidity only, (2) psychiatric multimorbidity only, (3) both physical and psychiatric multimorbidity, and (4) no multimorbidity. Receipt of COPD medications (short- or long-acting bronchodilators, inhaled corticosteroids) was identified using National Drug Codes. Bivariate relationships between multimorbidity and COPD medication receipt were tested using the chi-square test of independence. The associations between multimorbidity and COPD medication receipt were analyzed with logistic and multinomial logistic regression analyses. Among Medicaid beneficiaries with newly diagnosed COPD, 81.9% had at least one co-occurring chronic condition. After controlling for subject characteristics, adults with multimorbidity were less likely to receive COPD medications compared with those without any inflammation-related multimorbidity. For example, those with physical multimorbidity were less likely to receive short-acting bronchodilators (adjusted odds ratio [OR] 0.76, 95% CI 0.69-0.83), long-acting bronchodilators (adjusted OR 0.84, 95% CI 0.76-0.92), and inhaled corticosteroids (adjusted OR 0.75, 95% CI 0.68-0.82) compared with those with no inflammation-related multimorbidity. The prevalence of multimorbidity is very high among Medicaid beneficiaries with newly diagnosed COPD. Our findings indicate poor COPD medication management among those with multimorbidity.

Multimorbidity patterns in a primary care population aged 55 years and over

Background.To support the management of multimorbid patients in primary care, evidence is needed on prevalent multimorbidity patterns.Objective.To identify the common and distinctive multimorbidity patterns.Methods.Clinical data of 120480 patients (≥55 years) were extracted from 158 general practices in 2002–11. Prevalence rates of multimorbidity were analyzed (overall, and for 24 chronic diseases), adjusted for practice, number of diseases and patients’ registration period; differentiated between patients 55–69 and ≥70 years. To investigate multimorbidity patterns, prevalence ratios (prevalence rate index-disease group divided by that in the non-index-disease group) were calculated for patients with heart failure, diabetes mellitus, migraine or dementia.Results.Multiple membership multilevel models showed that the overall adjusted multimorbidity rate was 86% in patients with ≥1 chronic condition, varying from 70% (migraine) to 98% (heart failure), 38% had ≥4 chronic diseases. In patients 55–69 years, 83% had multimorbidity. Numerous significant prevalence ratios were found for disease patterns in heart failure patients, ranging from 1.2 to 7.7, highest ratio for chronic obstructive pulmonary disease-cardiac dysrhythmia. For diabetes mellitus, dementia or migraine patients highest ratios were for heart failure-visual disorder (2.1), heart failure-depression (3.9) and depression-back/neck disorder (2.1), respectively (all P-values <0.001).Conclusions.Multimorbidity management in general practice can be reinforced by knowledge on the clinical implications of the presence of the comprehensive disease patterns among the elderly patients, and those between 55 and 69 years. Guideline developers should be aware of the complexity of multimorbidity. As a consequence of this complexity, it is even more important to focus on what matters to a patient with multimorbidity in general practice.

Cross-Cultural Validation of the Definition of Multimorbidity in the Bulgarian Language.

Multimorbidity is a health issue with growing importance. During the last few decades the populations of most countries in the world have been ageing rapidly. Bulgaria is affected by the issue because of the high prevalence of ageing population in the country with multiple chronic conditions. The AIM of the present study was to validate the translated definition of multimorbidity from English into the Bulgarian language. The present study is part of an international project involving 8 national groups. We performed a forward and backward translation of the original English definition of multimorbidity using a Delphi consensus procedure. The physicians involved accepted the definition with a high percentage of agreement in the first round. The backward translation was accepted by the scientific committee using the Nominal group technique. Some of the GPs provided comments on the linguistic expressions which arose in order to improve understanding in Bulgarian. The remarks were not relevant to the content. The conclusion of the discussion, using a meta-ethnographic approach, was that the differences were acceptable and no further changes were required. A native version of the published English multimorbidity definition has been finalized. This definition is a prerequisite for better management of multimorbidity by clinicians, researchers and policy makers.

PRS4 - Multimorbidity and Copd Medication Receipt Among Medicaid Beneficiaries With Newly-Diagnosed Copd

Multimorbidity is highly prevalent among individuals with Chronic Obstructive Pulmonary Disease (COPD). The association between multimorbidity and COPD medication management is not well researched. This study sought to examine the association between multimorbidity and receipt of COPD medications among Medicaid beneficiaries with newly diagnosed COPD. Retrospective longitudinal dynamic cohort design was used and data were extracted from multiple years (2005-2008) of Medicaid Analytic eXtract (MAX) files. Medicaid beneficiaries with newly diagnosed COPD (N = 19,060) were identified using International Classification of Diseases Codes (ICD-9-CM) codes for COPD. ICD-9-CM codes for commonly co-occurring conditions with COPD were used to create multimorbidity variable. These conditions included arthritis, cardiovascular diseases (CVD), depression, diabetes, hypertension, hyperlipidemia and osteoporosis. Medicaid beneficiaries with newly diagnosed COPD were categorized into following multimorbidity categories: 1) physical multimorbidity only; 2) mental multimorbidity only; 3) both physical and mental multimorbidity and 4) no multimorbidity. Receipt of COPD medications (short-acting, long-acting bronchodilators and inhaled corticosteroids) was identified using National Drug Codes. Bivariate relationships between multimorbidity and COPD medication receipt were tested using chi-square test of independence. The associations between multimorbidity and COPD medication receipt were analyzed with logistic and multinomial logistic regressions. Among Medicaid beneficiaries with newly diagnosed COPD, 74.9% had at least one co-occurring chronic condition. After controlling for patient characteristics, adults with multimorbidity were less likely to receive COPD medications compared to those without any multimorbidity. For example those with physical multimorbidity were less likely to receive short-acting bronchodilators (AOR: 0.82; 95% CI: 0.75, 0.89), long-acting bronchodilators (AOR: 0.86; 95% CI: 0.79, 0.93) and inhaled corticosteroids (AOR: 0.81; 95% CI: 0.75, 0.88) compared to those with no inflammation-related multimorbidity. Prevalence of multimorbidity is very high among Medicaid beneficiaries with newly diagnosed COPD. Our study findings suggest poor COPD medication management among those with multimorbidity.

The relationship between activities of daily living and multimorbidity. A view from telecare

Introduction: The Public Telecare Service of the Basque Government (betiON) provides home care for dependent and older people through a technological device that guarantees a permanent connection with an interdisciplinary team of professionals who are trained in remote socio-health care. In 2013, the 77.57% of the telecare population were aged above 80 years, 80.69% of users were female and 65% lived alone. Most of the population of betiON lived in the most economically depressed areas. One of the main objectives of betiON is to promote the permanence of their users in their usual social environment. Moreover, this connection with health care devices allows implementing shared information systems with health and social data, which enable a characterization of the attended population and the development of integrated models for health and social provision. The users of telecare service have at least one of the following characteristics: People over 75 who live alone People over 65 who are in a situation of acknowledged dependency or in situation of vulnerability recognized by social services International Journal of Integrated Care – Volume 14, 01 November – URN:NBN:NL:UI:10-1-116558– http://www.ijic.org/ International Digital Health and Care Congress, The King’s Fund, London, September 10-12 2014. People with intellectual, physical or sensory disability and recognized dependency at any degree People who have a diagnosed mental illness and present a situation of recognized dependency or risk of social exclusion. It is well known that multimorbidity, coexistence of two or more diseases, is very common in the older population and it negatively affects the quality of life related to health. Objectives: The purpose of this study is to describe the quality of life of telecare service users collected by EQ-3D questionnaire and to establish its relationship with multimorbidity. Methods: It will be extracted information from the stratification database of the Basque Country (PREST) of more than 30,000 users of betiON. PREST has been created to classify all Basque citizens based on their future health care needs in a hundred mutually exclusive groups, Adjusted Clinical Groups (ACG), provided by the case-mix developed at Johns Hopkins University (Baltimore). This database contains demographic, socioeconomic (deprivation index of the residence area) and clinical variables, from data registered in the MBDS and annotations in electronic health records of specialist care and primary care. To detect chronic disease, it will be used information about diagnoses and prescriptions. For quality of life related to health, it is using the EQ-3D questionnaire by telephone between the users of betiON . Also it will be collect social variables (family unit, heating system, use of social services...) Multiple regression analysis on EQ-3D index will be conducted to determine the simultaneous effect with chronic diseases, social and demographic variables on quality of life related to health in our study population. Results and Conclusions: The results will be presented at the Congress, as well as, future findings. Applications: This study will have applications in the development of specific interventions in subgroups with similar characteristics to improve the quality of life and for management of multimorbidity.

"Where Do We Go from Here?" Health System Frustrations Expressed by Patients with Multimorbidity, Their Caregivers and Family Physicians

This study explored the care challenges experienced by older patients with multimorbidity, their informal caregivers and family physicians. Semi-structured interviews were conducted with 27 patients, their informal caregivers and family physicians. Qualitative description was used to identify key themes in the interview transcripts. Participants experienced many common challenges when managing multimorbidity, including a lack of decision-making support, poor communication and uncoordinated health services. Within these themes, unique perspectives specific to the role of being a patient, caregiver or family physician emerged. The study adds to a limited evidence base on the experience of patients with multimorbidity. By including the perspectives of their family caregivers and physicians, we provide important insight into the management of multimorbidity and recommend the uptake of specific strategies to address them.

Management of multimorbidity in the ederly

As the population ages, more people are living with multiple medical conditions, and patients are suffering from functional decline or disabilities as part of multimorbidity. Multiple chronic diseases are the greatest challenge facing health-care systems, but we are still focused on individual disorders rather than multimorbidity. A new care model for these patients is required. First, we have to know that most clinical guidelines were developed in relation to single conditions, so following the guidelines without regard to a patient’s multimorbidity should be avoided. Physicians should be encouraged to consider their patients as a whole person rather than focusing on the disease itself. Second, it is necessary to identify and listen to patients’ priorities. Focusing on outcomes that come from a singlecondition approach is the most important barrier to goal-oriented care. Third, comprehensive geriatric assessment and care can improve the functional outcome of older patients with multimorbidity. It is important to order the chaos of multiple chronic conditions and share the same therapeutic plan among doctors. Lastly, doctors must review patients’ medication lists systematically before adding a new medication. Clearly, we should avoid prescription of potentially inappropriate medications and polypharmacy.

The 'everyday work' of living with multimorbidity in socioeconomically deprived areas of Scotland.

BackgroundMultimorbidity is common in patients living in areas of high socioeconomic deprivation and is associated with poor quality of life, but the reasons behind this are not clear. Exploring the ‘everyday life work’ of patients may reveal important barriers to self-management and wellbeing.ObjectiveTo investigate the relationship between the management of multimorbidity and ‘everyday life work’ in patients living in areas of high socioeconomic deprivation in Scotland, as part of a programme of work on multimorbidity and deprivation.DesignQualitative study: individual semi-structured interviews of 14 patients (8 women and 6 men) living in deprived areas with multimorbidity, exploring how they manage. Analysis was continuous and iterative. We report the findings in relation to everyday life work.ResultsThe in-depth analysis revealed four key themes: (i) the symbolic significance of everyday life work to evidence the work of being ‘normal’; (ii) the usefulness of everyday life work in managing symptoms; (iii) the impact that mental health problems had on everyday life work; and (iv) issues around accepting help for everyday life tasks. Overall, most struggled with the amount of work required to establish a sense of normalcy in their everyday lives, especially in those with mental–physical multimorbidity.ConclusionsEveryday life work is an important component of self-management in patients with multimorbidity in deprived areas, and is commonly impaired, especially in those with mental health problems. Interventions to improve self-management support for patients living with multimorbidity may benefit from an understanding of the role of everyday life work.Journal of Comorbidity 2014;4:1–10

GPs’ perspectives on the management of patients with multimorbidity: systematic review and synthesis of qualitative research

ObjectiveTo synthesise the existing published literature on the perceptions of general practitioners (GPs) or their equivalent on the clinical management of multimorbidity and determine targets for future research that aims...

The European General Practice Research Network Presents a Comprehensive Definition of Multimorbidity in Family Medicine and Long Term Care, Following a Systematic Review of Relevant Literature

Multimorbidity is a new concept encompassing all the medical conditions of an individual patient. The concept links into the European definition of family medicine and its core competencies. However, the definition of multimorbidity and its subsequent operationalization are still unclear. The European General Practice Research Network wanted to produce a comprehensive definition ofmultimorbidity. Systematic review of literature involving eight European General Practice Research Network national teams. The databases searched were PubMed, Embase, and Cochrane (1990-2010). Only articles containing descriptions of multimorbidity criteria were selected for inclusion. The multinational team undertook a methodic data extraction, according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The team identified 416 documents, selected 68 abstracts, included 54 articles, and found 132 definitions with 1631 different criteria. These criteria were aggregated into 11 themes that led to the following definition: Multimorbidity is defined as any combination of chronic disease with at least one other disease (acute or chronic) or biopsychosocial factor (associated or not) or somatic risk factor. Any biopsychosocial factor, any risk factor, the social network, the burden of diseases, the health care consumption, and the patient's coping strategies may function as modifiers (of the effects of multimorbidity). Multimorbidity may modify the health outcomes and lead to an increased disability or a decreased quality of life or frailty. This study has produced a comprehensive definition of multimorbidity. The resulting improvements in the management of multimorbidity, and its usefulness in long term care and in family medicine, will have to be assessed in future studies.

Dealing with tobacco use and dependence within primary health care: time for action

Main text Primary health care has an operational advantage in overall health promotion, as preventive activities and the management of multimorbidity are placed highly within its agenda. A key component of health promotion is tobacco prevention and smoking cessation, which in the developed world, is the largest preventable cause of death and disability, and estimated to cause 6 million preventable and premature deaths every year [1]. With the above dire number in mind, the World Health Organization has called for smoking cessation to be integrated into primary health care globally [2,3]. Patient centered primary care is seen as the most suitable health system “environment” for providing advice on smoking cessation and general practitioners/family physicians thus have a framework to advocate for smoking cessation within their daily practice [4]. Based on this framework, guidelines have been issued and promoted within primary care practice [4,5]. The first step in handling tobacco control and smoking cessation within daily clinical care is to identify smokers a practice has been shown to increase the likelihood of smokers being provided with help to quit [5], and provide primary care practitioners the chance to refer smokers to a cessation program [6]. Indeed, within the UK, 73% of new patients within primary care were reported to have their smoking status recorded within 90 days of registering an indicator of smoker engagementwith 44% of these entries being recorded on the day of registration [7] The above numbers, although promising, are still far from those that primary care can potentially achieve. Literature frequently reports failure to advise on smoking cessation during clinical visits and this opportunity may be largely missed by clinicians, especially in developing countries or in countries under fiscal constraints [8]. This gap in engagement has been

Multimorbidity Patterns in HIV-Infected Patients

Increases in multimorbidity and obesity have been noted in HIV-infected populations in the current treatment era. Patterns of multimorbid disease clustering and the impact of obesity on multimorbidity are understudied in this population. We examined obesity and multimorbidity patterns among 1844 HIV-infected patients in the UAB 1917 Clinic. Exploratory factor analysis was used to identify the underlying factor structure responsible for clustering. Patterns among the resulting morbidity factors by body mass index (BMI) category were explored. Multivariable logistic regression models were fit to identify predictors of multimorbidity cluster patterns. The prevalence of multimorbidity was 65% (1205/1844). Prevalence increased with progressive BMI categories from underweight (64%) to obese (79%). Three multimorbidity clusters were identified: "metabolic," including hypertension, gout, diabetes mellitus, and chronic kidney disease (range, 0.41-0.84; P < 0.001); "Behavioral," including mood disorders, dyslipidemia, chronic obstructive pulmonary disease, chronic ulcer disease, osteoarthritis, obstructive sleep apnea, and cardiac disorders (range, 0.32-0.57; P < 0.001); "Substance Use," including alcohol abuse, substance abuse, tobacco abuse, and hepatitis C (range, 0.53-0.89; P < 0.001). Obesity was associated with increased odds of multimorbidity (obese vs. normal BMI category: OR = 1.52, 95% CI: 1.15 to 2.00). Three patterns of disease clustering were identified. Obesity was associated with a higher likelihood of multimorbidity. The management of multimorbidity and obesity will need to be addressed in future clinical practice guidelines to enhance long-term outcomes of HIV-infected patients in the current treatment era.

Age- and gender-related prevalence of multimorbidity in primary care: the swiss fire project

BackgroundGeneral practitioners often care for patients with several concurrent chronic medical conditions (multimorbidity). Recent data suggest that multimorbidity might be observed more often than isolated diseases in primary care. We explored the age- and gender-related prevalence of multimorbidity and compared these estimates to the prevalence estimates of other common specific diseases found in Swiss primary care.MethodsWe analyzed data from the Swiss FIRE (Family Medicine ICPC Research using Electronic Medical Record) project database, representing a total of 509,656 primary care encounters in 98,152 adult patients between January 1, 2009 and July 31, 2011. For each encounter, medical problems were encoded using the second version of the International Classification of primary Care (ICPC-2). We defined chronic health conditions using 147 pre-specified ICPC-2 codes and defined multimorbidity as 1) two or more chronic health conditions from different ICPC-2 rubrics, 2) two or more chronic health conditions from different ICPC-2 chapters, and 3) two or more medical specialties involved in patient care. We compared the prevalence estimates of multimorbidity defined by the three methodologies with the prevalence estimates of common diseases encountered in primary care.ResultsOverall, the prevalence estimates of multimorbidity were similar for the three different definitions (15% [95%CI 11-18%], 13% [95%CI 10-16%], and 14% [95%CI 11-17%], respectively), and were higher than the prevalence estimates of any specific chronic health condition (hypertension, uncomplicated 9% [95%CI 7-11%], back syndrome with and without radiating pain 6% [95%CI 5-7%], non-insulin dependent diabetes mellitus 3% [95%CI 3-4%]), and degenerative joint disease 3% [95%CI 2%-4%]). The prevalence estimates of multimorbidity rose more than 20-fold with age, from 2% (95%CI 1-2%) in those aged 20–29 years, to 38% (95%CI 31-44%) in those aged 80 or more years. The prevalence estimates of multimorbidity were similar for men and women (15% vs. 14%, p=0.288).ConclusionsIn primary care, prevalence estimates of multimorbidity are higher than those of isolated diseases. Among the elderly, more than one out of three patients suffer from multimorbidity. Management of multimorbidity is a principal concern in this vulnerable patient population.

GPs' considerations in multimorbidity management: a qualitative study

Scientific evidence on how to manage multimorbidity is limited, but GPs have extensive practical experience with multimorbidity management. To explore GPs' considerations and main objectives in the management of multimorbidity and to explore factors influencing their management of multimorbidity. Focus group study of Dutch GPs; with heterogeneity in characteristics such as sex, age and urbanisation. The moderator used an interview guide in conducting the interviews. Two researchers performed the analysis as an iterative process, based on verbatim transcripts and by applying the technique of constant comparative analysis. Data collection proceeded until saturation was reached. Five focus groups were conducted with 25 participating GPs. The main themes concerning multimorbidity management were individualisation, applying an integrated approach, medical considerations placed in perspective, and sharing decision making and responsibility. A personal patient-doctor relationship was considered a major factor positively influencing the management of multimorbidity. Mental-health problems and interacting conditions were regarded as major barriers in this respect and participants experienced several practical problems. The concept of patient-centredness overarches the participants' main objectives. GPs' main objective in multimorbidity management is applying a patient-centred approach. This approach is welcomed since it counteracts some potential pitfalls of multimorbidity. Further research should include a similar design in a different setting and should aim at developing best practice in multimorbidity management.

Understanding the management of early-stage chronic kidney disease in primary care: a qualitative study.

Primary care is recognised to have an important role in the delivery of care for people with chronic kidney disease (CKD). However, there is evidence that CKD management is currently suboptimal, with a range of practitioner concerns about its management. To explore processes underpinning the implementation of CKD management in primary care. Qualitative study in general practices participating in a chronic kidney disease collaborative undertaken as part of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester. Semi-structured interviews were conducted with GPs and practice nurses (n = 21). Normalisation Process Theory provided a framework for generation and analysis of the data. A predominant theme was anxiety about the disclosure of early-stage CKD with patients. The tensions experienced related to identifying and discussing CKD in older people and patients with stage 3A, embedding early-stage CKD within vascular care, and the distribution of work within the practice team. Participants provided accounts of work undertaken to resolve the difficulties encountered, with efforts having tended to focus on reassuring patients. Analysis also highlighted how anxiety surrounding disclosure influenced, and was shaped by, the organisation of care for people with CKD and associated long-term conditions. Offering reassurance alone may be of limited benefit, and current management of early-stage CKD in primary care may miss opportunities to address susceptibility to kidney injury, improve self-management of vascular conditions, and improve the management of multimorbidity.

“They come with multiple morbidities”: A qualitative assessment of pharmacist prescribing

This paper presents qualitative findings from a larger sequential mixed methods study which sought to provide an in-depth understanding of pharmacist prescribing from the perspective of pharmacist prescribers, medical colleagues and key stakeholders in Northern Ireland. Transcriptions were analyzed using thematic analysis as the interviews progressed and emergent themes were identified and coded (along with supporting quotes) independently and by consensus of the research team. Three major themes emerged in relation to pharmacist prescribing: the effect on patient care; challenges facing pharmacist prescribers and the importance of the interprofessional team (where two or more different professions with varied, yet complementary experience work together with a common purpose). Pharmacist prescribing may have the potential to reduce the medication burden for patients (as reported by pharmacists) as pharmacists tend to provide a more comprehensive medication review than doctors; the additional time for consultations made this possible. Further research is required on how interprofessional team working can be maximized in the context of pharmacist prescribing, particularly in relation to the management of multi-morbidity.

Shifting priorities in multimorbidity: a longitudinal qualitative study of patient’s prioritization of multiple conditions

To examine what influences self-management priorities for individuals with multiple long-term conditions and how this changes over time. A longitudinal qualitative study using semi-structured interviews completed with 21 participants with more than one chronic condition. The study demonstrates the impact of multiple conditions on many aspects of people's illness management. Narratives illuminated how individual's condition priorities changed at pivotal points and altered their engagement with self-management practices. This is influenced by contact with health professionals and how people framed illness and lifestyle changes. Medication management was a central point where individuals took control of their conditions. Additional conditions were more readily accommodated if people established a cognitive link between existing management practices. Thus, multiple conditions were not inevitably experienced as an increasing burden but subject to considerable flux and change. Prioritizing one condition over another at a particular time together with a transfer and amalgamation of practices appears to facilitate accommodation of multiple conditions and ease the burden of everyday management. These findings have implications for how we understand the variable nature of multimorbidity experience and management for patients. Clinicians might usefully engage with patients' understanding to reduce complexity, and enhance engagement of condition management.

GPs' and pharmacists' experiences of managing multimorbidity: a ‘Pandora's box’

Multimorbidity is defined as the occurrence of two or more chronic diseases in one individual. Patients with multimorbidity generally have poorer health and functioning and higher rates of attendance in primary care and specialty settings. To explore the views and attitudes of GPs and pharmacists managing patients with multimorbidity in primary care. Qualitative study using focus groups. Primary care in Ireland. Three focus groups were held in total, involving 13 GPs and seven pharmacists. Focus groups were recorded, transcribed, and analysed using the 'framework' approach. The predominant themes to emerge from the focus groups were: 1) the concept of multimorbidity and the link to polypharmacy and ageing; 2) health systems issues relating to lack to time, inter-professional communication difficulties, and fragmentation of care; 3) individual issues from clinicians relating to professional roles, clinical uncertainty, and avoidance; 4) patient issues; and 5) potential management solutions. This study provides information on the significant impact of multimorbidity from a professional perspective. It highlights potential elements of an intervention that could be designed and tested to achieve improvements in the management of multimorbidity, outcomes for individuals affected, and the experiences of those providing healthcare.