Clinicians and researchers from all over the world have been interested in the phenomenon of multimorbidity for more than 30 years. Interest in this topic has probably arisen because of a growing tension between two opposing developments. On the one hand, medicine is becoming ever more specialized. Attempts to improve the quality of care have led to a focus on managing care of individual long-term conditions in a very structured and standardized way. On the other hand, there is an increasing awareness that this trend may not be appropriate for people who have multimorbidity. These people are frequent users of health care, and they therefore account for a high proportion of health service contacts in both primary and secondary care. There is an increasing dissonance between the way that health services are designed and the needs of the patients that they serve.
In this book, we seek to explore some of these issues, which provide a fundamental challenge to almost every aspect of medicine from national policy about how health care should be provided to the conduct of each individual consultation between a patient and their doctor. We will discuss research on the prevalence of multimorbidity and factors associated with this. Subsequent chapters consider how multimorbidity has an impact on patients, the relationship between physical and mental health problems and how managing multiple health problems concurrently can create a heavy burden of treatment for patients. At a general practice level, we will discuss the implications of an awareness of multimorbidity for the ways in which consultations are managed, how practices are organized, the design of medical records systems and how to ensure high-quality care. At a health care system or policy level, we will provide evidence about the relationship between multimorbidity and the costs of providing care and consider the implications of multimorbidity for health policy and how health systems should be designed. Finally, we look into the future and think about how we can best improve health care in order to achieve the best possible outcomes for patients.
At the heart of this book is the authors' shared conviction that health care should be person-centred. That is, it should be designed as far as possible to understand and respond to the needs of each unique individual patient to treat people rather than diseases. This approach means that we cannot understand and manage long-term conditions in isolation. We have to understand the wider context, particularly recognizing that many patients with long-term conditions have other conditions as well and these may have important implications for management and prognosis.
Due to space limitations each chapter does not cite all references behind the chapter, but that the lead author of each chapter is happy to provide a full list of references on request.
The photographs in this book are from a public exhibition of photographs illustrating the day to day work of general practitioners in a variety of communities in Ireland. Professor Tom O'Dowd commissioned the photographer Fionn McCann to carry out the photography. We thank Trinity College Dublin for permission to use the photographs. Stewart Mercer;Chris Salisbury;Martin Fortin

Contributors, vii Preface, ix Foreword, xi

1 Introducing Multimorbidity, 1 Martin Fortin, Stewart W. Mercer, and Chris Salisbury

2 How Common Is Multimorbidity?, 5 Marjan van den Akker and Christians Muth

3 How Does Multimorbidity Affect Patients?, 8 Elizabeth A. Bayliss

4 Effects of Multimorbidity on Healthcare Resource Use, 12 Efrat Shadmi, Karen Kinder, and Jonathan P. Weiner

5 Multimorbidity and the Primary Care Clinic, 17 Stewart W. Mercer and Chris Salisbury

6 Multimorbidity and Patient-Centred Care, 22 Moira Stewart and Martin Fortin

7 Multimorbidity and the Healthcare Electronic Medical Record, 26 Amanda L. Terry and Sonny Cejic

8 Treatment Burden and Multimorbidity, 30 Katie I. Gallacher, Victor M. Montori, Carl R. May, and Frances S. Mair

9 Multimorbidity and Mental Health, 34 Peter Bower, Peter Coventry, Linda Gask, and Jane Gunn

10 The Impact of Multimorbidity on Quality and Safety of Health Care, 38 Jose M. Valderas, Ignacio Ricci-Cabello, and Concepcion Violan

11 Implications of Multimorbidity for Health Policy, 41 Chris Salisbury and Martin Roland

12 Optimizing Outcomes in Multimorbidity, 46 Stewart W. Mercer, Martin Fortin, and Chris Salisbury

Index, 49

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