International multimorbidity

At a recent event in Dublin, four doctoral fellows from the Irish HRB Collaborative Doctoral Award in Multimorbidity – Bridget Kiely, James Larkin, Louise Foley, and Aisling Croke – presented the findings of their completed doctoral studies. As fellows within the Scottish doctoral training programme inspired by the Irish CDA, ten of us travelled across to learn about and be inspired by the work they have done, and to identify challenges and opportunities for our own research in multimorbidity.

 

However, the day prior to the formal event, the two cohorts – Irish and Scottish – sat down together for a chance to discuss our own work-in-progress, and to tackle some of the recurrent debates that we have each encountered as we set out on a journey for which the four HRB fellows had already forged a path.

 

We opened with a format suggested by Dhan Senaratne, current fellow at the University of Dundee: a ‘data blitz’, whereby each of us presented our projects to date within a strictly-enforced (thanks to Chris Grant’s meticulous time-keeping!) two minutes, followed by an all-too-short two minutes for questions. While inevitably we all had questions that would have gone well beyond the time limit, this served as an excellent refresher of each of our diverse projects, and provided stimulating inspiration for the ‘peer discussion’ that followed, drawing on the experience and expertise of the Irish cohort.

 

Here, we discussed the perennial challenge of defining multimorbidity, particularly in the context of search terms for systematic reviews, which the Irish cohort had all completed and many of our cohort are currently undertaking. Prof Susan Smith, director of the HRB CDA Multimorbidity award, shared her own experience of carrying out a Cochrane review on primary care interventions for multimorbidity, and the challenge of including studies focused on ‘comorbidity’, whereby any intervention may be primarily focussed on an index condition, rather than on the overall complexity of ‘multimorbidity’ as a concept in its own right. She also warned about the dangers of studies which have started with an index condition and then screened for others, such as depression – where many participants may have been labelled with a condition that they do not really have. While ‘multimorbidity’ has only been a ‘MeSH’ term since around 2018, fortunately the growing interest in the topic and ballooning body of literature may mean that studies prior to the widespread use of the concept may not be as necessary to incorporate into future reviews, and perhaps this issue will diminish with time.

 

The trials and tribulations of accessing data also featured. We learnt how fortunate we are in Scotland in the quality and range of large-scale health databases available when compared to Ireland, although as many of our cohort were able to share, these are not always the most easily accessible, and we discussed creating a central list of databases suitable for multimorbidity research, both within the UK and internationally. Sharing these kind of experiences – the ground-work of discovering which resources to use, and how to use them – was a recurrent theme, and both Irish and Scottish cohorts echoed the benefits of being within a programme where learning could be shared across projects.

 

The Irish fellows also shared their experiences of publishing their research, including which journals they had found most appropriate. Familiar to all of us was the Journal of Multimorbidity and Comorbidity, on the editorial board of which serve both Prof Smith and Prof Frances Mair, the director of our Scottish programme, and in which all four Irish fellows had published. We discussed the role of publishing systematic review protocols, emphasising the accountability this provides in allowing the subsequent review to be compared to the original protocol, and where best to submit these – including funders’ own journals such as Wellcome Open Research for our programme, and the equivalent HRB Open Research for the Irish programme.

 

Ultimately, with so much experience to draw on from the four HRB CDA fellows and with so many different projects within our own cohort, the time was sadly too short to cover all that we would have liked. The next day we were incredibly fortunate to hear in much more detail from them again about their own projects, and from patients with lived experience of multiple long term conditions, providing a powerful reminder of the ultimate purpose of any of our research, and a future blog will cover the dissemination meeting. But for myself, perhaps the most valuable aspect of the day was meeting and forming valuable connections with fellow researchers in the same field, seeing how the research process develops over time and ultimately can culminate in impressive outputs despite the challenges we all shared, and in the collegiate and supportive community of which we are all so fortunate to be a part.

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First published: 15 March 2024