Multi-Morbidity and Complexity in the GP

Question 1

What is a complex patient

Answer 1

Individuals who have either multiple complex medical conditions, multiple
detrimental social determinants of health, or a combination of both that contribute to preventable
service utilization and poorer overall healthcare management that ultimately negatively impacts the
individual’s overall health status

Question 2

What are the drivers for complexity?

Answer 2

Ageing population-understanding the implications – more chornic disease, more survivors of cancer and the consequences of this

Health resource allocation – if patient is living longer what does this mean from the capacity to deliver care to patients

Frameworks to support clinicians and policy makers in decision making

Question 3

What is the definition of multi morbidity

Answer 3

definition: 2 or more

long-term conditions

Question 4

How much of the population does multi-morbidity effect

Answer 4

Affects 25% of UK population

• effects 2/3 of the population in over 65y

Question 5

What is the commonest pair for multi-morbidity

Answer 5

Cardiometabolic (E.G. diabetes ICH) + joint pain

Question 6

What is the commonest triad for multi-morbidity

Answer 6

cardiometabolic + joint pain + mental health (such as depression and anxiety)

Question 7

Why is the evidence for multi-morbidity lacking

Answer 7

Evidence is Lacking!
- Problematic with terms as no global understanding or agreement in what multi-morbidity means for example people use other terms such as co-morbidity

Question 8

What is an indepndent risk factor for A and E attendance

Answer 8

multi morbidity

Question 9

What factors impact on multi morbidity

Answer 9

• Age

- Socioeconomic status - poorer people get sicker earlier on in life and are sicker for longer

Question 10

What are the NICE guidelines for multi-morbidity

Answer 10

how the person’s health conditions and their treatments interact and how this affects quality of life

the person’s individual needs, preferences for treatments, health priorities, lifestyle and goals

the benefits and risks of following recommendations from guidance on single health conditions

improving quality of life by reducing treatment burden, adverse events, and unplanned care

improving coordination of care across services.

Question 11

What is the transitional model for multi-morbidity verusus the multi-morbidity modem

Answer 11

Traditional model
- this is the idea that there is a single condition focused approach to care, idea that each condition is single and there are multiple treatments for each condition

Multi-morbidity approach to care
- idea that conditions overlap, how the persons health conditions and their treatments interact and affect the quality of life, the persons individual needs and preferences for treatments, benefits and risk of recommendations from the guidance on single health conditions, improve quality of life by reducing treatment burden, adverse events and unplanned care, improving coordination of care across services

Question 12

What is the definition of frailty

Answer 12

Frailty is a distinctive health state related to the ageing process.

Multiple body systems gradually lose their in-built reserves.

Question 13

How many patients over the age of 65 and over the age of 85 have frailty

Answer 13

• around 10 percent of people aged over 65 years have frailty
• rises to between a 1/4 and a 1/2 in those over aged 85

Question 14

Why is frailty important

Answer 14

• nursing home admissions

- A&E admissions – practises get charged for patients going to A and E

Question 15

Name some frailty measuring tools

Answer 15

• Timed get up and go test
• Do they have to stop to talk to walk
• E frailty index (eFI)
• QFrailty
• recognition of a frailty syndrome
• Prisma 7

Question 16

describe timed up and go test

Answer 16

Timed Get Up and Go Test-walk 4m-taking 5 seconds or longer may indicate frailty

Question 17

describe do they have to stop to talk to walk test and what it is a predictor of

Answer 17

• do they have to stop talking to walk

- It is a predictor of frailty and falls

Question 18

Describe the E frailty index

Answer 18

-embedded on common GP computer systems.
- Searches for 36 variables from the last year such as what age they are, admission to hospital, what medication they are on
= Mild - 0.12-0.24
= Moderate = 0.24-0.36
= Severe >0.36

Question 19

What is QFrailty

Answer 19

= QMortality and QAdmissions algorhythms-identify as low/mod/high levels frailty

Question 20

Name factors that can be a predictor of suspicions of frailty

Answer 20

1. Falls (e.g. ‘collapse’, ‘legs gave way’, ‘found lying on floor)’
2. Immobility (e.g. sudden change in mobility, ‘gone off legs’ ‘stuck on toilet’)
3. Delirium (e.g. acute confusion, worsening of pre-existing confusion/short term memory loss)
4. Incontinence (e.g. new onset or worsening of urinary or faecal incontinence)
5. Susceptibility to medication side effects (e.g. confusion with codeine, hypotension with antidepressants).

Question 21

What are the Prisma 7 questions

Answer 21

1] Are you more than 85 years?

2] Male?

3] do you have any health problems that require you to limit your activities

4] Do you need someone to help you on a regular basis?

5] do you have any health problems that require you to stay at home?

6] In case of need can you count on someone close to you?

7] Do you regularly use a stick, walker or wheelchair to get about?

Question 22

What was the aim, funding and criteria for the health 1000 experience for complexity

Answer 22

Funding : Prime Ministers Challenge Fund

Aim: To recruit 1000 complex patient across 3 East London boroughs

Criteria: Need 5 of 8 medical conditions identified to join the Health 1000 GP practice

Question 23

What is the definitions of complexity

Answer 23

Medical complexity

Psychological complexity

Social complexity