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Monthly Archives: March 2012

Multimorbidity measures

By Alyson Huntley

In the Academic Unit of Primary Health Care at the University of Bristol, one of our key research themes is organisation and delivery of care led by Professor Chris Salisbury.  This theme relates to providing evidence about the impact of changes in how primary health care is organised and delivered. Our research often combines quantitative, qualitative and economic methods. We have conducted a number of large scale multi-centre evaluations of important initiatives. We are particularly interested in the impact of these new models of care on core values of primary care such as access to care, generalism, co-ordination and continuity of care.

An important part of this research is the study of multimorbidity. We have several projects running in this area at the moment including:

  • The impact of multimorbidity on the use of resources in primary care
  • Complex consultations. The impact of multimorbidity on consultations.
  • A systematic review of measures of multimorbidity.

We have recently published the systematic review on multimorbidity measures in the Annals of Family Medicine (Huntley AL, Johnson R, Purdy S, Valderas JM, Salisbury C. Measures of multimorbidity and morbidity burden for use in primary care and community settings: a systematic review and guide. Ann Fam Med. 2012;10(2):134-41).

The aims of this review were to identify measures of multimorbidity and morbidity burden suitable for use in research in primary care and community populations, and to investigate their validity in relation to anticipated associations with patient characteristics, process measures, and health outcomes.

We found that the measures most commonly used in primary care and community settings are disease counts, Charlson index, ACG System, CIRS, CDS, and DUSOI. Different measures are most appropriate according to the outcome of interest. Choice of measure will also depend on the type of data available. More research is needed to directly compare performance of different measures.

The prevalence of multimorbidity

By Martin Fortin


Multimorbidity is associated with negative outcomes and increased resource use. Both create a burden on the health-care system.

 Concerned healthcare professionals and decision-makers aware of this information may wonder: 

  • What is the magnitude of this problem in our region?
  • What is the prevalence of multimorbidity in our population?

 Some researchers have attempted to answer these questions with studies involving either nation-wide populations or smaller groups. However, studies in different populations have yielded results with differences in prevalence estimates as important as 95% for a given age. Is this information reliable? Can it be used to determine the allocation of resources to deal with the problem of multimorbidity? Differences of this magnitude are unlikely to reflect real differences between populations and more likely due to methods biases.

 In a systematic review recently published in the Annals of Family Medicine  we identified and compared studies reporting the prevalence of multimorbidity in primary care settings and in the general population. Apart from differences in location, we identified differences in recruitment method and sample size, data collection, and in the operational definition of multimorbidity including the number of conditions and the conditions selected. All of these factors may affect prevalence estimates.

 In this review we discussed differences among studies and possible explanations for variations in the results of prevalence estimates. We also promoted the adoption of a more uniform methodology in this type of research by suggesting methodological aspects to be considered in the conduct of such studies.

 Availability of strong epidemiological data for multimorbidity would benefit both the research and care of this problem.