A new clinical review that provides guidance for doctors on how to best organise and prioritise care for patients who suffer from multiple chronic medical conditions (multimorbidity) has been conducted by researchers from RCSI.

The study was carried out by the Health Research Board (HRB) Centre for Primary Care Research at RCSI's Department of General Practice, RCSI in collaboration with researchers from the University of Bristol and the University of Dundee in the United Kingdom. The study was published in the BMJ (British Medical Journal).

This study recommends providing continuity of care with one named GP where possible, prioritising the aspects of care that matter most to patients (for example, difficulties in physical functioning), and providing regular reviews of prescriptions, which should include ceasing the prescription of medications no longer considered beneficial. With an average GP consultation time of 10-15 minutes it is a real challenge for GPs to achieve all that is required and practices may consider offering specific extended consultations for patients identified as having particularly complex needs.

Multimorbidity is present in a patient when the individual has two or more chronic medical conditions. These patients are more likely to experience decreased quality of life, functional decline and increased need for healthcare. Patients with multimorbidity often need to take several medications (polypharmacy), visit many different healthcare providers, are admitted to hospital more frequently and are more likely to experience mental health difficulties and difficulties with physical functioning. Over 16% of all patients have multimorbidity; with at least 65% of those aged over 65 years suffering from co-existing conditions. Patients with multimorbidity account for one-in-three GP (general practitioner) consultations.

Current clinical guidelines, which recommend best practice for GPs, tend to focus on single conditions which make decision making more challenging for those patients with several co-existing conditions.

Speaking on the publication of this study, lead author, HRB Research Fellow and GP lecturer, Dr Emma Wallace said, “Managing patients with multiple chronic conditions is part of everyday practice for GPs, who take on the role of co-ordinating care for such patients who are often seeing many different specialists. This review highlights the importance of continuity of care, the prioritising of patient physical functioning and mental health, the value of clinical judgement and the need to adopt a multidisciplinary approach to care.”

Commenting on this publication, Graham Love, Chief Executive at the Health Research Board said, “It is very important that care for people with multimorbidity is organised and delivered based on best research evidence in order to improve the outcomes that really matter to patients. This review offers guidance for GPs to help support this process.”

The paper entitled, ‘Managing patients with multimorbidity in primary care' can be viewed online on the BMJ website at http://www.bmj.com/content/350/bmj.h176.