TY - JOUR T1 - Multimorbidity in primary care: developing the research agenda JF - Fam Pract Y1 - 2009 A1 - Mercer, Stewart W A1 - Smith, SM A1 - Wyke, Sally A1 - O'Dowd, T A1 - Watt, Graham C M KW - Aged KW - Chronic Disease KW - Comorbidity KW - Forecasting KW - Great Britain KW - Health Services Needs and Demand KW - Humans KW - International Cooperation KW - Primary Health Care KW - Quality Assurance, Health Care AB - Multimorbidity - usually defined as the co-existence of two or more long-term conditions in an individual - is the norm rather than the exception in primary care patients1,2 and will become more prevalent as populations age.3,1 Multimorbidity cuts across the vertical paradigms in which most health research and policy is envisaged, supported and carried out, reflecting not only specialist interests in particular problems and diseases, but also the tendency of research to focus on easily defined issues. “Complicated” patients with multimorbidity are usually excluded from such research. Although complexity is under-represented in the research literature, it is common place in general medical practice, where the challenges are “horizontal”, integrating not only at the level of the clinical encounter, but also in the co-ordination of services to support patients with multiple problems. The challenge of carrying out research on multimorbidity is to reflect, investigate, inform and improve these aspects of generalist clinical practice. Given that multimorbidity is a challenge facing practitioners and patients alike it has attracted surprisingly little research interest.4 The research to date has largely focussed on analysis of the impact of multimorbidity on individuals and healthcare systems, with very few studies examining interventions to improve outcomes.5 One of ‘multimorbidity's many challenges’1 includes setting a research agenda to systematically begin to answer important practical issues in supporting people with multimorbidity. Given the scale and complexity of the task, the first difficulty is simply knowing where to start. In order to gather views from the academic primary care community on the research agenda in multimorbidity we held workshops in Ireland (July 2008) and Scotland (January 2009) under the aegis of the Society for Academic Primary Care and the Scottish School of Primary Care respectively. The workshops were attended by approximately 50 delegates, including patient representatives, primary care professionals, and academics; both explored issues of definition, outcome measures, studies and interventions. The common themes that emerged are outlined below. VL - 26 UR - http://fampra.oxfordjournals.org/content/26/2/79.long IS - 2 ER - TY - JOUR T1 - How to design and evaluate interventions to improve outcomes for patients with multimorbidity JF - Journal of Comorbidity Y1 - 2013 A1 - Smith, SM A1 - Bayliss, EA A1 - Mercer, Stewart W A1 - Gunn, J A1 - Vestergaard, M A1 - Wyke, Sally A1 - Salisbury, C A1 - Fortin, M KW - Comorbidity KW - Family Practice KW - interventions KW - multimorbidity AB - Multimorbidity is a major challenge for patients and healthcare providers. The limited evidence of the effectiveness of interventions for people with multimorbidity means that there is a need for much more research and trials of potential interventions. Here we present a consensus view from a group of international researchers working to improve care for people with multimorbidity to guide future studies of interventions. We suggest that there is a need for careful consideration of whom to include, how to target interventions that address specific problems and that do not add to treatment burden, and selecting outcomes that matter both to patients and the healthcare system. Innovative design of these interventions will be necessary as many will be introduced in service settings and it will be important to ensure methodological rigour, relevance to service delivery, and generalizability across healthcare systems VL - 3 UR - http://jcomorbidity.com/index.php/test/article/view/21 IS - 1 ER -