Mapping of UK initiatives for the multimorbidity patient
Introduction: The management of patients with multimorbidity is an increasingly common problem faced by health systems worldwide. The prevalence of multimorbidity is substantial and it presents in the majority of GP consultations in the UK, carrying an inevitable healthcare cost burden. Research data shows rates of multimorbidity in the adult population to be 58% in England & 58% in Scotland. Chronic illness care has traditionally been disease orientated, but this is not necessarily an effective model for the multimorbid patient. There have been a number of initiatives within the UK in recent years to attempt to address complex care problems, but limited information regarding their effectiveness is available. Investigation and evaluation of such initiatives is paramount for improving care for this substantial patient group.
Methods: All 211 English Care Commissioning Groups (CCG), 7 Welsh Local Health Boards (LHB), 14 Scottish NHS Boards and 6 Health & Social Care Trusts in Northern Ireland were contacted. In addition; internet searches, review of National projects & discussion with experts in the area of multimorbidity were carried out. Information on each initiative was gathered & 5 reviewers screened for eligibility using a criteria proforma.
Results: Response rate from initial enquiry to CCG/LHB/NHSB/HSC was 40% (95/238). 30 programmes put forward were short listed to 19 (high rate of reviewer agreement for meeting specified criteria). All programmes are currently active.
Programme criteria; At least 1 Medical service involved, cooperation between at least 2 services, formal status, & evaluable.
Target group; includes adult (aged 18+) with more than one medical diagnosis of a chronic or long lasting disease or disorder, of which at least one is (mainly) of a somatic nature.
A Shortlist selection was made by analysing reviewer agreement levels.
Primary outcome: To establish details & locations of UK initiatives with a primary focus on patients with multimorbidity.
Geographical mapping revealed; 3 initiatives at a National level, 2 within the North of England, 5 within the Midlands & East of England, 5 Within London & 4 within the South of England. No initiatives with the specific focus of multimorbidity were reported in Wales, Northern Ireland or Scotland.
14 programmes have started within the last 2 years, 4 within the last 3-4 years & 1 programme commenced 5 years ago.
Discussion: Further comprehensive evaluation of the data gathered will add to findings. Models of care for multimorbidity patients is a developing area, with the aim of improving patient care for this rapidly growing patient population. Improvement in Quality of Life for this patient group and how this can be accurately measured is an important area for investigation. Evaluation of emerging models of care is required in order to inform future decision making and Policy.