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

2. 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

3. 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

4. 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

5. Most people with any long term condition have multiple conditions

6. 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

7. Multimorbidity is socially patterned

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

9. 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

10. 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

11. 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: /cmaj
Mercer SW, Watt GCM. "The Inverse Care Law: Clinical Primary Care Encounters in Deprived and Affluent Areas of Scotland." Ann Fam Med 2007;5:
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.