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Monthly Archives: May 2013

Comparisons of multi-morbidity in family practice – issues and biases

By Moira Stewart, Martin Fortin, Helena Britt, Christopher Harrison, and Heather Maddocks

A recent study published in Family Practice “Comparisons of multi-morbidity in family practice – issues and biases” [1] compared the methods and results of three separate prevalence studies of multi-morbidity from; i) the Saguenay region of Quebec [2]; ii) a sub-study of the Bettering Evaluation and Care of Health (BEACH) program in Australia [3,4]; and iii) the Deliver Primary Health Care Information (DELPHI) project in South-western Ontario [5,6].

A re-estimate of the prevalence rates using identical age-sex groups found multi-morbidity prevalence to vary by as much as 61%, where reported prevalence was 95% among females aged 45–64 in the Saguenay study, 46% in the BEACH sub-study and 34% in the DELPHI study.

Several aspects of the methods and study designs were identified as differing among the studies, including the sampling of frequent attenders, sampling period, source of data, and both the definition and count of chronic conditions.

The paper offers a guide for authors reporting the methods used in multi-morbidity prevalence research, recommending detailed descriptions of the type of sampling, completeness and accuracy of the source of data, and the definition of chronic conditions.

Further comparisons among multi-morbidity data using agreed upon standards for the definition of chronic conditions and the way to count multi-morbidity are recommended to assess the impact of these methodological variations.


1 Stewart M, Fortin M, Britt H, Harrison C, Maddocks H.  Comparisons of multi-morbidity in family practice – issues and biases.  Family Practice. May 2013.  doi: 10.1093/fampra/cmt012.

2 Fortin M, Bravo G, Hudon C, Vanasse A, Lapointe L. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med 2005; 3: 223–8.

3 Britt HC, Harrison CM, Miller GC, Knox SA. Prevalence and patterns of multimorbidity in Australia. Med J Aust 2008; 189: 72–7.

4 Knox SA, Harrison CM, Britt HC, Henderson JV. Estimating prevalence of common chronic morbidities in Australia. Med J Aust 2008; 189: 66–70.

5 Stewart M, Thind A, Terry AL, et al. Multimorbidity in primary care: a study using electronic medical record (EMR) data. In: Thirty-Seventh Annual Meeting of North American Primary Care Research Group, Quebec, Canada, 14–18 November, 2009.

6 Stewart M, Thind A, Terry A, Chevendra V, Marshall JN. Implementing and maintaining a researchable database from electronic medical records—a perspective from an academic family medicine department. Healthc Policy 2009; 5: 26–39.

An International Perspective on Designing Interventions for Multimorbidity in Primary Care

By Martin Fortin, Elizabeth A. Bayliss, Susan M. Smith, Stewart W. Mercer, Mogens Vestergaard, Chris Salisbury

Under the sponsorship of the Agency for Healthcare Research and Quality Multiple Chronic Conditions (AHRQ MCC) Research Network, a panel of six members of the International Research Community on Multimorbidity (CIRMo) presented a webinar on interventions for patients with multimorbidity: “An International Perspective on Designing Interventions for Multimorbidity in Primary Care”. The webinar included three parts:

Context and background for interventions: Dr. Chris Salisbury, University of Bristol, UK, discussed the eligibility criteria in intervention studies for multimorbidity (Who should we include in studies of interventions for multimorbidity?). Dr. Elizabeth A. Bayliss, Kaiser Permanente Colorado, University of Colorado School of Medicine, USA, who acted as the moderator of the webinar, presented “Outcomes for Multimorbidity Interventions” followed by Dr. Susan M. Smith, HRB Centre for Primary Care Research, RCSI Medical School, Dublin, Ireland, who presented a brief summary of a systematic review: “Interventions for improving outcomes in patients with multimorbidity in primary care and community settings”.

Reports on specific research and operational interventions: Senior investigators described three intervention initiatives in three different contexts. Dr. Stewart W. Mercer from the Institute of Health & Wellbeing, University of Glasgow, Scotland, presented “Preliminary findings of an exploratory cluster RCT of a primary care-based complex intervention for multimorbid patients living in deprived areas”. Dr. Martin Fortin, Université de Sherbrooke, Québec, Canada, presented results of an ongoing pragmatic randomized controlled trial: “PR1MaC: Evaluating the integration of chronic disease prevention and management services into primary healthcare” and Dr. Mogens Vestergaard, Aarhus University, Denmark, described a very interesting Danish experience in managing patients with multimorbidity: “The multimorbidity clinic at silkeborg hospital”.

Questions & answers period: At the end of the presentation was a very interesting period of interactions between participants of the webinar and the panel of researchers.

The Webinar was coordinated by James R. Fraser and hosted by Jared Lyle from the AHRQ MCC Research Network.

You can access the webinar presentations and recording through the AHRQ MCC Research Network website:


Look for the last item under “Webinars & Workshops” entitled “An International Perspective on Designing Interventions for Multimorbidity in Primary Care.”