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Multimorbidity: what next?

dianagosalvez Diana Gosálvez Prados last modified 17/07/2017 14:04

The Clinical Intelligence article1 provides a useful overview of the recent National Institute for Health and Care Excellence (NICE) guideline on multimorbidity.2 The guideline itself is important because it confirms the prevalence of multimorbidity, emphasises the need to take a person-centred, holistic approach to patient care, and provides guidance about key principles to consider when managing people with multimorbidity. However, there remain many gaps in the advice contained within the guideline, which reflect the deficiencies in our current understanding of multimorbidity.

Mair FS, Gallacher KI. Multimorbidity: what next?. Gen Pract 2017; 67 (659): 248-249. Available at:http://bjgp.org/content/67/659/248/tab-article-info





We know that multimorbidity is common, and is particularly problematic in those from deprived areas, but we still have no effective means of risk stratification. The current guideline highlights the issue of frailty as an important risk indicator; however, it also highlights that studies which examine frailty in younger populations are lacking. Our knowledge is currently insufficient about the problem of multimorbidity in young or middle-aged people or vulnerable populations, such as those with learning disabilities, serious mental health problems, addiction issues, or migrants. Although there is growing evidence of the adverse effects of multimorbidity on mortality,3 healthcare utilisation,4 and quality of life,5 we still do not fully understand which combinations of chronic disease are associated with the worst outcomes or greatest economic costs, and where best to target limited resources for greatest effect.

Mair FS, Gallacher KI