The Challenge of Multimorbidity in Scotland

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Presentation transcript:

The Challenge of Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme Programme lead: Professor Stewart Mercer

Living well with multimorbidity Stewart Mercer Bruce Guthrie Elizabeth Fenwick Alex McConnachie Graham Watt Sally Wyke NHS and Deep End General Practices June 2009-May 2013

Living well with Multimorbidity: research programme 2009-2013 310 general practices -1,754,133 patients Qualitative interviews - 19 HPs and 14 patients Economic analysis: Scottish Health Survey The extent of the problem First draft – 6 Focus Groups Second draft – Scoping Study in 2 practices Developing and optimising the intervention 8 general practices: GPs and practice nurses 152 patients Economic analysis: in-trial and modelling A feasibility randomised controlled trial

Multimorbidity is common The majority of over-65s have 2 or more conditions, and the majority of over-75s have 3 or more conditions More people have 2 or more conditions than only have 1

Most people with any long term condition have multiple conditions

Most people with any long term condition have multiple conditions Guidelines and organisation of care do not reflect this reality Guthrie B et al, BMJ 2012;345:e6341; Hughes L et al, Age and Ageing 2013;42:62-69

Multimorbidity is socially patterned

Mental health problems are strongly associated with the number of physical conditions that people have, particularly in deprived areas

CARE PLUS: a whole-system approach Time, continuity, person centredness and self-management support System Professional Patient Longer consultation time with continuity System Support meetings and structure for long person-centred consultations Practitioner Patient CD and written guide on mindfulness Plus CBT guide Community activities recommended

Summary and conclusions Multimorbidity is now the norm rather than the exception in Scotland It is socially patterned, being more common and occuring at a younger age as deprivation increases Whole-system interventions are required to improve the care and outcomes of care for patients with mutimorbidity

References Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet 2012;380:37-43. Mercer S, Guthrie B, Furler J, Watt G, Hart JT. Multimorbidity and the inverse care law in primary care. BMJ 2012;344:e4152 Mercer SW, Gunn J, Bower P, Wyke S, Guthrie B. Managing patients with mental and physical multimorbidity. BMJ 2012;345. Guthrie B, Payne K, Alderson P, McMurdo MET, Mercer SW. Adapting clinical guidelines to take account of multimorbidity. BMJ 2012;345:e6341. Hughes L, McMurdo MET, Guthrie B. "Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity." Age and Ageing 2013;42:62-69. Payne R, Abel G, Guthrie B, Mercer SW. The impact of physical multimorbidity, mental health conditions and socioeconomic deprivation on unplanned admissions to hospital: a retrospective cohort study. CMAJ 185 (e-publication ahead of print): E221-E228, 2013, doi:10.1503/cmaj.121349 Mercer SW, Watt GCM. "The Inverse Care Law: Clinical Primary Care Encounters in Deprived and Affluent Areas of Scotland." Ann Fam Med 2007;5:503-510. O'Brien R, Wyke S, Guthrie B, Watt G, Mercer S. An ‘endless struggle’: a qualitative study of general practitioners’ and practice nurses’ experiences of managing multimorbidity in socio-economically deprived areas of Scotland. Chronic Illness 2011;7(1):45-59.