Multimorbidity: a current research priority in the UK
Dear Editor,
We welcome the editorial by Fortin et al[1], on the challenges on
comorbidity and multimorbidity. In their call for international
collaborative efforts, they identify 3 unique major research areas for
investigation. Four additional aspects of multimorbidity are also
relevant: 1) Acute conditions also contribute to comorbidity and there is
no reason for their exclusion; 2) Comorbidity is of particular relevance
to primary care, which is person-focused and not disease-focused[2,3]; 3)
Research on the mechanisms through which co-morbid conditions interact is
important for understanding its genesis as well as its management; and 4)
the implications of co-morbidity for the assessment of quality of primary
care and its financial retribution. The current financial incentives for
GPs to provide high quality care currently focus almost exclusively on
single conditions[4], increasingly the likelihood of fragmented care[5].
Nevertheless, other research from the US suggests that when patients have
multiple co-morbid conditions, the care for each may be better than when
they have single conditions[6]. More research in this area is clearly
needed.
The measurement of comorbidity by means of the Adjusted Clinical
Group can help with all of these issues[7]. This tool, originally
conceived for research in the primary care ambulatory setting but now
broadened for all care, includes all conditions and is therefore highly
suitable to the study of interactions among conditions and to studies of
the nature of influences (including those of the health system) on
patterns of illness.
In the UK there are currently specific collaborative research
initiatives focusing on multimorbidity in primary care, including the NIHR
School for Primary Care Research, founded in October 2006 as a partnership
between the leading academic centres for primary care research in England
(http://www.nspcr.ac.uk/). The School’s main aim is to increase the
evidence base for primary care practice, and one of its five core research
programmes focuses specifically on comorbidity research.
1. Fortin M, Soubhi, Hudon C, Bayliss EA, van den Akker M.
Multimorbidity's many challenges. BMJ 2007;334;1016-1017
2. Starfield B. Threads and yarns: weaving the tapestry of
comorbidity. Ann Fam Med. 2006 Mar-Apr;4(2):101-3.
3. van den Akker M, Buntinx F, Metsemakers JF, Roos S, Knottnerus JA.
Multimorbidity in general practice: prevalence, incidence, and
determinants of co-occurring chronic and recurrent diseases. J Clin
Epidemiol. 1998 May;51(5):367-75.
4 Roland M. Linking physician pay to quality of care: a major
experiment in the UK. New England Journal of Medicine 2004; 351: 1448-54.
5 Roland M, Campbell S, Bailey N, Whalley D, Sibbald B. Financial
incentives to improve the quality of primary care in the UK: predicting
the consequences of change Primary Health Care Research and Development
2006; 7: 18–26
6. Higashi T, Wenger N, Adams J, Fung C, Roland M, McGlynn E, Reeves
D, Asch S, Kerr A, Shekelle P. Patients with More Medical Conditions
Receive Better Quality Care: Analysis of quality data from three large
surveys. New England Journal of Medicine (in press).
7. Weiner J, Abrams C eds. The Johns Hopkins ACG Case-Mix System,
September 2006. Available at http://acg.jhsph.edu.edu. Accessed April 10,
2007.
Competing interests:
None declared
Competing interests:
No competing interests
21 May 2007
Jose M Valderas
Clinical Lecturer
Barbara Starfield, Martin Roland
National Primary Care Research and Development Center, University of Manchester, M13 9PL, UK
Rapid Response:
Multimorbidity: a current research priority in the UK
Dear Editor,
We welcome the editorial by Fortin et al[1], on the challenges on
comorbidity and multimorbidity. In their call for international
collaborative efforts, they identify 3 unique major research areas for
investigation. Four additional aspects of multimorbidity are also
relevant: 1) Acute conditions also contribute to comorbidity and there is
no reason for their exclusion; 2) Comorbidity is of particular relevance
to primary care, which is person-focused and not disease-focused[2,3]; 3)
Research on the mechanisms through which co-morbid conditions interact is
important for understanding its genesis as well as its management; and 4)
the implications of co-morbidity for the assessment of quality of primary
care and its financial retribution. The current financial incentives for
GPs to provide high quality care currently focus almost exclusively on
single conditions[4], increasingly the likelihood of fragmented care[5].
Nevertheless, other research from the US suggests that when patients have
multiple co-morbid conditions, the care for each may be better than when
they have single conditions[6]. More research in this area is clearly
needed.
The measurement of comorbidity by means of the Adjusted Clinical
Group can help with all of these issues[7]. This tool, originally
conceived for research in the primary care ambulatory setting but now
broadened for all care, includes all conditions and is therefore highly
suitable to the study of interactions among conditions and to studies of
the nature of influences (including those of the health system) on
patterns of illness.
In the UK there are currently specific collaborative research
initiatives focusing on multimorbidity in primary care, including the NIHR
School for Primary Care Research, founded in October 2006 as a partnership
between the leading academic centres for primary care research in England
(http://www.nspcr.ac.uk/). The School’s main aim is to increase the
evidence base for primary care practice, and one of its five core research
programmes focuses specifically on comorbidity research.
1. Fortin M, Soubhi, Hudon C, Bayliss EA, van den Akker M.
Multimorbidity's many challenges. BMJ 2007;334;1016-1017
2. Starfield B. Threads and yarns: weaving the tapestry of
comorbidity. Ann Fam Med. 2006 Mar-Apr;4(2):101-3.
3. van den Akker M, Buntinx F, Metsemakers JF, Roos S, Knottnerus JA.
Multimorbidity in general practice: prevalence, incidence, and
determinants of co-occurring chronic and recurrent diseases. J Clin
Epidemiol. 1998 May;51(5):367-75.
4 Roland M. Linking physician pay to quality of care: a major
experiment in the UK. New England Journal of Medicine 2004; 351: 1448-54.
5 Roland M, Campbell S, Bailey N, Whalley D, Sibbald B. Financial
incentives to improve the quality of primary care in the UK: predicting
the consequences of change Primary Health Care Research and Development
2006; 7: 18–26
6. Higashi T, Wenger N, Adams J, Fung C, Roland M, McGlynn E, Reeves
D, Asch S, Kerr A, Shekelle P. Patients with More Medical Conditions
Receive Better Quality Care: Analysis of quality data from three large
surveys. New England Journal of Medicine (in press).
7. Weiner J, Abrams C eds. The Johns Hopkins ACG Case-Mix System,
September 2006. Available at http://acg.jhsph.edu.edu. Accessed April 10,
2007.
Competing interests:
None declared
Competing interests: No competing interests