A research review carried out by the HRB Centre for Primary Care Research, based in RCSI and published in this month's edition of the British Medical Journal (BMJ) has focused on how we can improve care and outcomes for patients with multi-morbidity (co-existence of two or more long-terms health conditions in an individual).

Multi-morbidity is the norm, rather than the exception in primary care patients. Despite the increasing numbers of patients with two or more chronic conditions, the delivery of care to patients is usually built around single diseases and there is a limited level of care available to patients with multi-morbidity.

Prof. Susan Smith, Associate Professor of General Practice, RCSI said: "Multi-morbidity is a challenging factor facing practitioners and patients; however it has attracted surprisingly little research interest. Our research focused on how we can improve care and outcomes for these patients and found that a need exists to clearly identify patients with multi-morbidity in order to develop cost effective and specifically targeted interventions that can improve health outcomes for patients."

The research indicated that interventions targeted either at specific combinations of common conditions or at specific problems for patients with multiple conditions may be the most effective method to managing patients with multi-morbidity.

Prof Smith continued "We found that the methods used had mixed effects, but they were more likely to be effective if they were targeted at specific risk factors for people with common combinations of conditions such as diabetes and depression or focused on areas where patients have difficulties, such as with activities of daily living or the management of multiple medications. The least effective approach was patient orientated interventions which dealt with patient related behaviour only but did not link this with healthcare."

"We know from previous research studies that patients with multi-morbidity are more likely to die prematurely, be admitted to hospital and have longer hospital stays than patients with single conditions. Additionally, patients with multi-morbidity have a poorer quality of life, experience a loss of physical functioning and are more likely to experience depression," Prof. Smith continued.

The review identified ten studies examining interventions in 3,407 patients with multi-morbidity. It highlighted the scarcity of research in to interventions to improve outcomes for patients with multi-morbidity. It indicated that interventions targeted either at specific combinations of common conditions or at specific problems for patients with multiple conditions may be the most effective method.

A copy of the research can be viewed at http://www.bmj.com/content/345/bmj.e5205 and a podcast summarising the review findings can be found at http://www.cochrane.org/podcasts/issue-4-april-2012/interventions-improve-outcomes-patients-multimorbidity-primary-care-and-