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‘Addressing the global challenge of multimorbidity’: Call for written evidence

October 3, 2016 – 8:42 am


The Academy of Medical Sciences has recently launched a new working group project on ‘Addressing the global challenge of multimorbidity’ and is seeking your views on multimorbidity as an international health challenge.

Throughout the world, as life expectancy increases, the population incidence of non-communicable diseases is also increasing. Further, communicable diseases, with both their short and long term sequelae, continue to affect millions of people every year. Together, all of these factors mean that multimorbidity has become, and will increasingly be, an international health challenge.

However, currently there is no commonly used framework for defining or more widely understanding multimorbidity. Further, most health related research is currently focused on the prevention and management of disorders in isolation. Consequently, it is difficult to compile a coherent body of research in this area or develop evidence-based strategies for use in healthcare systems. In order to address the challenge of multimorbidity, we must understand the problem better.

The questions outlined in the call for written evidence have therefore been developed to gather information on the definition(s) of multimorbidity, better understand the current knowledge base on multimorbidity as an international health challenge, and to gather opinions about future priorities and opportunities.

This call is part of our process of gathering external input into the project, and we would welcome responses from external stakeholders, including researchers, healthcare professionals, research institutions, funders, industry, patients and members of the public.

The deadline for submission is 30 November 2016.

For more information about the project and to submit a response, please visit the Academy’s website. If you have any questions, please contact Dr Rachel Brown (rachel.brown@acmedsci.ac.uk).

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Publications on multimorbidity February – June 2016

August 17, 2016 – 12:32 pm

By Martin Fortin
Our search for papers on multimorbidity that were published during the period February – June 2016 has been completed. As in previous searches, we found many new papers and the list is too long for this venue. Therefore, we have prepared a PDF file that can be accessed following this link.
Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expression “multiple chronic diseases”, but we are sure that most publications on the subject are included in the list.
All references are also included in our library. Feel free to share with anyone interested in multimorbidity.
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Updated Cochrane Review: Interventions for improving outcomes in patients with multimorbidity in primary care and community settings

March 24, 2016 – 9:48 am


By Susan M Smith, Emma Wallace, Tom O’Dowd, Martin Fortin
This Cochrane systematic review aimed to identify and summarise the existing evidence on the effectiveness of interventions to improve clinical and mental health outcomes and patient-reported outcomes including health-related quality of life for people with multimorbidity in primary care and community settings.
The Cochrane library have just published an update of the original 2012 review and for this update the literature was searched up to September 2015. In total, we identified 18 generally well-designed randomised controlled trials meeting the eligibility criteria, 8 of which were identified in the updated searches. Nine of the 18 studies focused on specific combinations of health conditions (comorbidity studies), for example diabetes and heart disease. The other nine studies included people with a broad range of conditions (multimorbidity studies) although they tended to focus on elderly people. The majority of studies examined interventions that involved changes to the organisation of care delivery although some studies had more patient-focused interventions.
Key results
Overall the results regarding the effectiveness of interventions were mixed. There were no clear positive improvements in clinical outcomes, health service use, medication adherence, patient-related health behaviours, health professional behaviours or costs. There were modest improvements in mental health outcomes from seven studies that targeted people with depression, and in functional outcomes from two studies targeting functional difficulties in participants. Overall the results indicate that it is difficult to improve outcomes for people with multiple conditions. The review suggests that interventions that are designed to target specific risk factors (for example treatment for depression) or interventions that focus on difficulties that people experience with daily functioning (for example, physiotherapy treatment to improve capacity for physical activity) may be more effective.
Authors’ conclusions:
This review identifies the emerging evidence to support policy for the management of people with multimorbidity and common comorbidities in primary care and community settings. There are remaining uncertainties about the effectiveness of interventions for people with multimorbidity in general due to the relatively small number of RCTs conducted in this area to date, with mixed findings overall. However, several large ongoing studies were identified that will add to the slowly emerging evidence base. The current evidence from this review suggest an improvement in health outcomes if interventions can be targeted at risk factors such as depression, or specific functional difficulties in people with multimorbidity.
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Citation: Smith SM, Wallace E, O’Dowd T, Fortin M. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD006560. DOI: 10.1002/14651858.CD006560.pub3.
Available from: http://www.cochrane.org/CD006560/EPOC_improving-outcomes-people-multiple-chronic-conditions
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Publications on multimorbidity September 2015 – January 2016

March 1, 2016 – 10:34 am


By Martin Fortin
Our search for papers on multimorbidity that were published during the period September 2015 – January 2016 has been completed. As in previous searches, we found many new papers and the list is too long for this venue. Therefore, we have prepared a PDF file that can be accessed following this link.
Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expression “multiple chronic diseases”, but we are sure that most publications on the subject are included in the list.
All references are also included in our library. Feel free to share with anyone interested in multimorbidity.
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What is the future of general practice academics interested in research on multimorbidity?

February 22, 2016 – 2:09 pm


By Aline Ramond-Roquin and Martin Fortin
In a recent provocative blogpost [1] hosted by the Canadian Medical Association Journal, the associate editor Domhnall MacAuley initiated an interesting discussion on the challenges general practice research currently faces. We would like to extend the reflection and to discuss some issues relevant for multimorbidity research.
First, we somewhat disagree on the fact that academic general practitioners have “become less and less embedded in daily patient care”. Many of them still deliver “personal, primary and continuing care”. The traditional model of single-handed practitioners offering “twenty four hour access to patients” is quite obsolete, but this reflects the evolution of general practice rather than a specific characteristic of academics.
Indeed, general practitioners can no longer single-handedly fill the increasingly complex needs of their patients. Patients living with multimorbidity, who are now considered the rule in primary care, need interdisciplinary care. The current evolution towards increasing interdisciplinary work has generated specific research questions which require lowering some traditional barriers in the academic setting and developing interdisciplinary research, to appropriately address them. In this regard, having non-doctor primary care researchers in academic departments of general practice should neither be reduced to a question of “cost-effectiveness”, nor be considered as a threat for general practice research, as suggested in the CMAJ blogpost. Rather, collaborations within interdisciplinary teams are definitely an advantage to undertake research in complex fields such as multimorbidity. In these teams, general practitioners with significant clinical activity have a crucial and irreplaceable role.
Finally, meaningful research for people living with multimorbidity is often based on complex designs, such as multi-level epidemiological studies or pragmatic trials. We therefore strongly argue for scientific journals not neglecting research grounded in the real world of practice. They should not only focus on “sample size” and “international generalizability”, but should also be concerned by clinical relevance and potential for implementation and transferability in different contexts. Producing and publishing practice-based evidence is required to practice evidence-based medicine relevant to the context, with the potential to eventually improve the life of our patients.
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[1] http://cmajblogs.com/thinking-the-unthinkable-about-general-practice-research/
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IMPORTANT ANNOUNCEMENT. Indexing in MEDLINE: Journal of Comorbidity needs your help

January 15, 2016 – 10:16 am


By Martin Fortin, Jane Gunn, Stewart W. Mercer, Susan Smith, Marjan van den Akker
At the Journal of Comorbidity, we recognize the importance of publishing high-quality work in a timely manner, and publishing work that can be discovered by the wider community in bibliographic databases. One of the premier databases that many authors and readers turn to is MEDLINE®, the National Library of Medicine’s (NLM) database containing over 20 million citations of biomedical literature. Indexing in MEDLINE is therefore key to helping any journal seeking the widest dissemination of their published content.
Although the Journal of Comorbidity is indexed in many databases, it currently does not meet the minimum requirements for MEDLINE indexing. The journal is therefore increasing its efforts to achieve this as soon as possible – but first, we need your help.
In order to be considered for MEDLINE indexing, we have to meet a set of minimum requirements, particularly with regard to the quantity of published articles. And this is where we ask for your help. We are inviting all researchers, clinicians and other healthcare professionals with an interest in comorbidity/multimorbidity to submit their work to the Journal of Comorbidity. (refer to the online author guidelines for preparing your article: http://www.jcomorbidity.com/index.php/test/about/submissions#authorGuidelines). We are currently seeking publications – original research papers, but also critical reviews and study protocols – to meet our target. We believe that indexing in MEDLINE will help to increase our visibility, increase access to our content, and will encourage more authors at all levels of experience and expertise to publish their work in the journal.
With your help, we can make the Journal of Comorbidity grow, and enhance its impact in this niche field and beyond.
We would like to thank all members of our editorial board, reviewers, readers, and our contributors, who together have shaped the journal into its current form and who have provided articles of great interest.
We look forward to a continued collaboration in further developing this journal into an authoritative resource on comorbidity/multimorbidity.
About the Journal of Comorbidity
The Journal of Comorbidity is an international, open-access, peer-reviewed journal with a focus on comorbidity and multimorbidity – the only journal of its kind. Established in Switzerland in 2011, the journal has attracted important and well-cited research worldwide. The Journal of Comorbidity is overseen by five co-Editors-in-Chief and by over 40 editors from across the globe. The journal publishes original clinical and experimental research articles, guidelines, policies, editorials, commentaries, protocols, and critical review papers. The journal provides a forum for scientists, researchers and healthcare professionals to share their research, experience and insight into diverse aspects of medicine in order to optimize the management of patients with comorbidity/multimorbidity.
Further information can be found online: www.jcomorbidity.com, or contact one of our editors today: editorial@jcomorbidity.com

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Conceptualising multiple conditions in Australia

November 20, 2015 – 8:57 am



By Christine Walker

Since the 1970s greater numbers of people are now living with several serious long term illnesses. These include rarer genetic conditions and ‘lifestyle conditions’ as well as those of an idiopathic nature. A recently published article [1] examines the growing need for new terms and concepts that reflect the changes in the lives of people living with long-term serious illnesses.

The Chronic Illness Alliance conducted a workshop with its members who had multiple conditions to scope the problems they faced in receiving health care. A literature review using the principles of meta-synthesis which aims to systematise qualitative concepts provided the means to identify whether the concerns raised by consumers were recognised in the literature. The risks identified by consumers were used both as search terms and analytical terms. While the consumer perspective appeared absent in the literature, many authors showed similar concern about the tardiness of health systems to acknowledge the impact of multi-morbidities for consumers and the associated risks. More importantly the literature review demonstrated that problems associated with concepts, definitions and data collection impact on health care and service delivery. This in turn dictates how consumers receive their health care services and ultimately influences the safety and quality of their health care. The article argues that the adoption of better concepts is a first step to achieving systemic change on behalf of people with multiple conditions.

[1] Walker C. Conceptualising multiple conditions in Australia: First steps to systemic change to meet the needs of people with serious long-term illnesses. Patient Experience Journal, Volume 2, Issue 2 -Fall 2015, pp. 69-76.

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Publications on multimorbidity April-August 2015

October 5, 2015 – 1:55 pm



By Martin Fortin

Our search for papers on multimorbidity that were published during the period April-August 2015 has been completed. As in previous searches, we found many new papers and the list is too long for this venue. Therefore, we have prepared a PDF file that can be accessed following this link.
Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expression “multiple chronic diseases”, but we are sure that most publications on the subject are included in the list.
All references are also included in our library. Feel free to share with anyone interested in multimorbidity.

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Stroke Rehabilitation and Multimorbidity: A Scoping Review Protocol

August 28, 2015 – 10:21 am



By Michelle L.A. Nelson

What proportion of the stroke rehabilitation evidence is relevant to patients with multimorbidity?
Current evidence syntheses serving as the foundation for stroke rehabilitation best practice recommendations do not categorize or report data extraction related to multimorbidity. This may be problematic for the design of stroke clinical practice recommendations. Although it may be expected (based on prevalence data) that multimorbid patients were included in reported rehabilitation intervention studies, by not having an explicit understanding of the patients included or excluded in the evidence, we may be faced with a mismatch between the research participants used to generate evidence, the best practice recommendations, and the patient seen in practice.

We are conducting a systematic scoping review of the stroke rehabilitation intervention literature to identify the evidence relevant to patients with multimorbidity.  The study protocol was published in the Journal of Comorbidity [1].  The publication of protocols supports transparency in scoping approaches through the publication of the original proposed study, serving as a baseline from which we can discuss any methodological modifications and subsequently study results.  Additionally, a second contribution of publishing this protocol is providing guidance to other researchers in the key elements of scoping protocols and proposals, a clear gap in the literature we discovered during the development of the funding proposal.

The full article can be accessed at: http://www.jcomorbidity.com/index.php/test/article/view/47

1. Nelson, Michelle LA, et al. Stroke rehabilitation and patients with multimorbidity: a scoping review protocol. J Comorbidity 2015:5(1):1-10. doi: http://dx.doi.org/10.15256/joc.2015.5.47

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Relevant outcomes of patient-centered interventions in multimorbidity: an invitation to the NAPCRG forum and a preliminary survey

August 14, 2015 – 8:19 am



By Martin Fortin, Moira Stewart, Elizabeth Bayliss, Maxime Sasseville, Paul Little, Stewart Mercer, John Furler, Marjan van den Akker, Susan Smith

An activity organized by the PACEinMM international advisory committee

During the 2015 NAPCRG Annual Meeting to be held October 24-28 in Cancun, Mexico, we will be conducting a three hour forum entitled “Think-tank on outcomes for patient-centered interventions for persons with multimorbidity”. The objectives of the forum are to use a group process 1) to identify a set of relevant outcomes for patient-centered interventions for persons with multimorbidity (MM), 2) to share experiences internationally, and 3) to inform the conduct of interventions for persons with multimorbidity in primary care settings.  The Special Interest Group on Comorbidity/multimorbidity endorses the forum and it is open to all.
In order to prepare for the forum, we are conducting a short survey. The questions assess the relevance of types and domains of outcome measures for interventions in multimorbidity.
Please consider completing the survey. Your input is important even if you do not plan to attend the NPCRG conference. If you do plan to attend, we look forward to meeting you at NAPCRG in Cancun, Mexico next October.

Many thanks for your help.

GO TO THE SURVEY

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