Multimorbidity and the Primary Healthcare Perspective

Abstract

affected; this prevalence is in line with those reported in more recent studies from other countries [8-12]. Family physicians (FPs) can be regarded as experts in dealing with both comorbidity and multimorbidity in primary care; parallel to the expertise of geriatri-cians in secondary care. It is a logical assumption that empiricism and experience will yield original and innovative approaches to inform patient care. For this reason, we performed a series of studies to evaluate primary healthcare data and the experiences of FPs in managing comorbidity and multimorbidity [13-18]. The following is a summary of some of our findings and experiences where our use of the term comorbidity was aligned with the recent definition provided by Ramond-Roquin and Fortin: "comorbidity refers to an additional condition(s) in an individual who has a given index disease…" [3]. Patterns of comorbidity: a case study of diabetes mellitus The high prevalence of multimorbidity in the population can often mean that patient-group-or disease-specific patterns are concealed. We analysed the prevalence and incidence density of chronic comorbid diseases in a representative primary healthcare cohort of patients with recently diagnosed type 2 diabetes mellitus [13]. As expected, a high proportion of this cohort had chronic health problems other than diabetes: hyperten-sion (38%) and chronic venous insufficiency (21%) were highly prevalent, as were chronic functional somatic symptoms (19%), hearing loss (14%), urinary incontinence (13%), angina pectoris (12%), osteoarthritis of the knee (12%), chronic obstructive pulmonary disease The ageing population is marked by an increase in chronic health problems, raising concerns over the feasibility of healthcare systems and their financial capabilities [1,2]. A central point here is the growing rate of multimorbidity, i.e. the coexistence of multiple chronic conditions in a given individual [3]. The concept of multimorbidity conflicts with the 'single-disease model', around which healthcare, medicine and health research are traditionally organized. This model has dominated healthcare, research and education for so long that it is only recently that multimorbidity is being presented as a demographic feature. Multimorbidity requires a paradigm shift away from this single-disease model of patient management; a shift that is now increasingly recognized and adopted, albeit at a slow pace. However, the reality in primary health-care is already somewhat different. Primary healthcare, in its comprehensive approach to all health problems in all individuals at all disease stages and phases of life, has a long experience in dealing with individuals experiencing a range of health problems [4], including chronic health problems as reported in the literature [5-7]. These reports indicate that multimorbidity is substantial, with about a third of the (primary healthcare) population Journal of Comorbidity 2016;6(2):46-49