Multimorbidity (lecture) Flashcards
What is multimorbidity?
The presence of two or more long-term health conditions.
What is another term for multimorbidity preferred by patient groups?
Multiple long-term conditions.
List examples of physical long-term conditions.
- Diabetes
- Cardiovascular disease
- Cancer
List examples of mental health conditions.
- Depression
- Schizophrenia
- Dementia
What are chronic infectious diseases that can be included in multimorbidity?
- HIV
- Hepatitis C
What are some other contributors to multimorbidity?
- Learning disabilities
- Symptom complexes (e.g., frailty, chronic pain)
- Sensory impairments (e.g., hearing or sight loss)
- Substance misuse
What is comorbidity?
A secondary condition linked to a primary disease.
How does multimorbidity affect healthcare appointments?
Accounts for 50% of all GP appointments.
What is the risk associated with polypharmacy?
Risks frailty with more than 5 medications.
What challenges does multimorbidity present in medical practice?
Challenges the practice of medicine as it tends to work in specialities.
What are the potential outcomes for patients with multimorbidity?
Poor outcomes and high use of unplanned healthcare.
What is a recommended approach to managing multimorbidity?
More generalism and not specialism in medicine.
Why may guidelines on a single condition not be appropriate for multimorbidity?
Often conflicting treatment guidelines.
What should be considered when treating patients with multimorbidity?
All conditions should be treated simultaneously.
What are some difficulties faced in managing multimorbidity?
- Differentiating polypharmacy side effects from disease processes
- Fragmented care
- Duplication
- Cost
What is a holistic approach to managing multimorbidity?
Thinking holistically and ensuring continuity of care.
Who should be assessed for multimorbidity?
People opportunistically during routine care and yearly reviews.
What are high-risk indicators for adverse drug events?
People on ≥15 regular medicines.
What tools can help identify high-risk patients?
- eFI (electronic Frailty Index)
- PEONY (predicts emergency admissions)
- QAdmissions (for use in GP records)
What should be assessed regarding disease burden in multimorbidity?
- Impact on daily life and wellbeing
- Mental health
- Interactions between conditions
- Effects on quality of life
What aspects should be considered regarding treatment burden?
- Number and types of appointments
- Medicines
- Non-drug treatments
- Harms from treatment
- Impact on mental wellbeing
What are important considerations in patient perspectives?
- Attitudes, beliefs, and understanding of treatments
- Involve patients in decisions
- Follow NICE guidance on medicines adherence
What is the role of a named GP in managing multimorbidity?
An expert generalist is best for holistic care.
What should be discussed with patients to optimize care?
- Effective treatments
- Treatments to stop
- Overburdensome follow-ups
- Possible alternatives
What is the purpose of reviewing treatments regularly?
To assess medications and non-drug therapies and discuss benefits and harms.
What is a specific tool used to identify risky medications?
STOPP/START.
When should treatment with limited benefit be discussed?
When considering continuing or stopping based on likely benefit and patient preferences.
What should an individualised management plan include?
- What’s recorded and actions planned
- Future care planning
- Medicines and treatments to start, stop, or change
- Prioritisation of appointments
What is the goal of a multimorbidity approach?
- Understand how conditions + treatments interact
- Tailor care to the person’s needs, goals, values, and lifestyle
- Improve quality of life
What types of conditions count towards multimorbidity?
Physical (e.g. diabetes, cancer)
Mental (e.g. depression, dementia)
Chronic infections (e.g. HIV)
Other: learning disabilities, frailty, chronic pain, sensory impairment, substance misuse
How is multimorbidity different from comorbidity?
Multimorbidity = multiple unrelated long-term conditions
Comorbidity = one condition exists as a consequence of another (primary disease)
What is a key medication-related risk in multimorbidity?
Polypharmacy (5+ meds) increases the risk of frailty and adverse effects.
What are the key difficulties in managing multimorbidity?
Conflicting guidelines
Side effects vs disease symptoms
Fragmented care
Duplication of effort
Cost and coordination
What are some solutions to managing multimorbidity?
Holistic thinking
Continuity of care
Integrated services
Tackling polypharmacy
When should you assess someone for multimorbidity?
Opportunistically (e.g. during reviews)
Proactively (via records and polypharmacy review)
What are red flags for a multimorbidity approach?
On ≥15 regular meds
On 10–14 meds or high-risk profile
Multiple care services
Physical + mental conditions
Frailty, falls, or emergency care use
What tools can help identify at-risk patients?
eFI (electronic Frailty Index)
PEONY (emergency risk)
QAdmissions
What are the 4 core aspects to assess in multimorbidity?
Disease burden
Treatment burden
Patient perspectives
Social context & coping
What do you ask when assessing disease burden?
Daily impact
Wellbeing and mental health
Condition interaction
Quality of life
What is the ideal approach to managing multimorbidity?
Expert generalist (named GP)
Shared decision-making
Focus on individual needs and priorities
Routine reviews for high medication burden
Comprehensive Geriatric Assessment in hospital
What are the main goals of a multimorbidity approach?
Understand condition/treatment interactions
Personalise care
Improve quality of life
Reduce treatment burden
Minimise adverse events
Coordinate care
How should treatments be reviewed?
Regular reviews of meds and therapies
Use STOPP/START tool
Discuss harms/benefits
Plan follow-ups and changes as needed
