Entete 3

Monthly Archives: November 2012

Multimorbidity: a hidden epidemic that challenges European health services

By Christiane Muth, Amaia Calderón-Larrañaga, Marjan van den Akker, Beatriz Poblador-Plou and Alexandra Prados-Torres (from left to right)

A workshop on multimorbidity was held in Malta the 9th November in the context of the 20th Annual European Public Health Conference (EUPHA).

This workshop was organized by researchers of the Aragon Institute of Health Sciences (IACS) in Spain and the CAPHRI School for Public Health and Primary Care in the Netherlands, and supported by the EUPHA Section on Chronic Diseases. The aim was to shed light on future research and action strategies for patients with multiple chronic conditions.

The analysis was performed from three complementary perspectives. During the first part of the workshop, coordinated by Alexandra Prados and Amaia Calderón from the EpiChron Research Group on Chronic Diseases of the IACS, results from epidemiological research were presented regarding the systematic association between diseases or medications into so-called multimorbidity and polypharmacy patterns. The role of adverse drug events on increased morbidity burden was discussed.

The second part, led by Marjan van den Akker from CAPHRI School at Maastricht University, focused on the role to be played by health services in face of this reality, and the need to reorient them to give a global response to patient’s health problems. Specific interventions involving the patient (e.g. shared decision making, patient centred care), but also at the level of the organization of care (e.g. case managers, reorganizing chains of care) were reviewed.

Finally, Christiane Muth from the Institute of General Practice at Frankfurt’s Goethe University suggested a methodological framework to systematically address multimorbidity in clinical practice guidelines. Taking chronic heart failure (CHF) as an example, the importance of identifying relevant interactions between CHF and its common comorbidities, as well as potential drug-disease and drug-drug interactions was highlighted, as a necessary precondition and a first step to optimize health care in patients with multiple conditions.

For further detail on the program and speakers, see:


Evidence-Based Medicine Meets Multimorbidity: A Blind Date?

By Marjan van den Akker and Christiane Muth

On Wednesday, October 17, 2012, an international symposium took place at the ´Deutsche Nationalbibliothek´ in Frankfurt am Main, Germany.

The focus of the symposium was on questions that keep family doctors and general practice researchers busy, such as: What should and can be done when my patient has several illnesses simultaneously? What are the problems of multimorbidity and polypharmacy that confront us today? What clinical decision-support does evidence-based medicine (EbM) currently provide, and how can EbM contribute in the future? Leading researchers representing both disciplines – EbM and multimorbidity research – discussed the dilemmas and challenges that multimorbidity entails, as well as strategies to overcome them.

The symposium garnered attention, both from Germany and abroad. There were over 130 registrations. For further detail on the program and speakers, see [link to the Institute of General Practice, Goethe-University, Frankfurt, Germany:

The Symposium was part of the Friedrich Merz Foundation’s 22nd visiting professorship, to which Professor Marjan van den Akker from Maastricht University was appointed this year.

Subsequent to the symposium a 2-day international workshop on ´How to handle patients with multimorbidity in primary care´ was conducted. Twenty participants from the UK, Canada, Australia, Germany, the Netherlands and Spain exchanged on this subject. Although there is a growing body of knowledge regarding multimorbidity, it seems to mainly focus on observational, epidemiological studies. There remains a lack of research studying and supporting every day clinical practice for patients with multimorbidity.

A collaborative report on the workshop will follow.