Our search for papers on multimorbidity that were published during the period September-December 2020 has been completed. As in previous searches, 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” in PubMed (https://www.ncbi.nlm.nih.gov/pubmed), 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.
The Patient-Centered Innovations for Persons with Multimorbidity research program, funded by the Canadian Institutes of Health Research, had an overall goal to build on existing structures and initiatives to evaluate patient-centered innovations relevant to multimorbidity in primary care. As part of this program, trials were conducted in 2 Canadian provinces, Quebec and Ontario. We reported the Quebec trial where the research team collaborated with a regional health care organization to implement an integrated chronic disease prevention and management program into family medicine groups (FMG), the most prevalent type of primary care practice in Quebec [1].
We conducted a concurrent triangulation mixed methods study, with convergent quantitative and qualitative components. The first component was a pragmatic randomized controlled trial with a delayed intervention in the control group to evaluate the effect of the intervention on patient’s self-management and self-efficacy for managing chronic diseases. The second concurrent component used a descriptive qualitative approach.
Primary outcomes were the Health Education Impact Questionnaire (heiQ) and Self-Efficacy for Managing Chronic Diseases. Secondary outcomes included health status measured by the Veterans RAND 12 Item Health Survey (VR-12), quality of life measured with the EuroQol 5-dimensions questionnaire, psychological distress, measured with the Kessler 6-item Psychological Distress Scale Questionnaire (K6), and health behaviors (tobacco smoking, physical activity, healthy eating, and high risk alcohol consumption) assessed with specific questions from the Enquête de santé du Saguenay–Lac-Saint Jean 2007 and the Behavioral Risk Factor Surveillance System.
The trial randomized 284 patients (144 in intervention group, 140 in control group). After 4 months, the intervention showed a neutral effect for the primary outcomes, but there was significant improvement in 2 health behaviors (healthy eating, and physical activity).
The descriptive qualitative evaluation revealed that the patients reinforced their self-efficacy and improved their self-management which was divergent from the quantitative results. Qualitatively, the intervention was evaluated as positive.
The combination of qualitative and quantitative designs proved to be a good design for evaluating this complex intervention.
Formerly, we could find in the description of the Journal of Comorbidity that it published “original clinical and experimental research articles on the pathophysiology, diagnosis, prevention and management of patients with comorbidity/multimorbidity.” Now, in the description of the Journal of Multimorbidity and Comorbidity, one reads that it publishes the same type of articles on “comorbidity and multimorbidity.”
The change in the name of the journal and the change in the description from “comorbidity/multimorbidity” to “comorbidity and multimorbidity” may seem natural for those working on multimorbidity or those who are familiar with its meaning. However, for many who still consider both words as interchangeable, writing “comorbidity/multimorbidity” could have been seen as normal and the separation in “comorbidity and multimorbidity” could be seen as redundant.
In 1996, van den Akker and colleagues [1] pointed out the prevailing ambiguity around the use of both terms at that time, and suggested distinct definitions for them. Since then, there has been an increasing awareness about the difference between both terms and the importance of using them correctly. A benefit in using both terms adequately is that publications are then correctly classified, leading to an improvement in the quality of search queries and ultimately to better research.
However, although the first alert on the ambiguity in the use of the terms was published 25 years ago, it has taken a long time for the recognition of the difference between both terms and its effect in slowing down the advance of our knowledge on the subject. For example, in the National Library of Medicine of the National Institutes of Health (NIH), the term “multimorbidity” was a subheading under the Medical Subject Heading (MeSH) “comorbidity” until 2017. It was only in 2018 that the term “multimorbidity” appeared with the hierarchy of a MeSH.
In the editorial of the Journal of Multimorbidity and Comorbidity explaining the change in the name of the journal [2], it is well explained that multimorbidity and comorbidity are distinct concepts in research design, intervention development and healthcare delivery. However, there is not a universal recognition of this distinction yet.
We welcome the change in the name of the journal as another step in clarifying the use of the terms, hoping that it will contribute to our main goal which is to improve the health outcomes of our patients.
van den Akker M, Buntinx F and Knottnerus JA. Comorbidity or multimorbidity: what’s in a name? A review of literature. Eur J Gen Pract 1996; 2: 65-70.
Harrison C, Fortin M, van den Akker M, et al. Comorbidity versus multimorbidity: Why it matters. Journal of Multimorbidity and Comorbidity 2021; 11. Article first published online: March 2, 2021. DOI: https://doi.org/10.1177/2633556521993993.
