Solutions focused research

Managing multimorbidity

Multimorbidity, the presence of two or more chronic conditions, is a growing global challenge. Our research aims to promote prevention and improve management of this complex health care issue.

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Main contact 

Prof Frances Mair (General Practice and Primary Care)

School of Health and Wellbeing research theme 

Solutions Focused Research

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Precision Medicine and Chronic Diseases

The challenge 

Multimorbidity is a global public health problem of increasing prevalence in high and low and middle income countries, affecting about one-third of the World’s population in their lifetime. It is associated with reduced life expectancy, more complex healthcare needs, higher healthcare utilisation, poorer quality of life and higher mortality. Multimorbidity occurs a decade earlier in more deprived communities. Socioeconomic inequalities are a major factor in development of multimorbidity and contributes to poorer outcomes. Understanding these issues and developing appropriate interventions for prevention and management of multimorbidity is essential. Multimorbidity poses new methodological challenges that traditional research approaches struggle to address.

The research 

Our research has driven the issue of multimorbidity into the mainstream of international debate, increasing recognition of multimorbidity and its implications for patients, carers, healthcare professionals and healthcare systems. Research began by focusing on the link between multimorbidity and treatment burden – the work patients and their supporters must do to manage their condition, ranging from managing medications through to attending clinic appointments, undergoing investigations, dealing with fragmented healthcare and enacting lifestyle changes. This work began in high income countries but has now been extended to low and middle income countries (LMICs) too.

The results 

The programme of work began with a call in the BMJ for Minimally Disruptive Medicine, which was subsequently labelled by the Editor of the BMJ as her first choice of favourite papers published in the BMJ over the preceding 20 years. This was followed by our call for treatment burden to be considered as a barometer of quality of care.

Our work then contributed to the development of conceptual models (Cumulative Complexity Model) and theoretical frameworks (Burden of Treatment Theory) to aid understanding of the workload-capacity.

Interplay experienced by people with multimorbidity and its implications for healthcare delivery. These concepts were developed in high income countries and we have more recently been examining their applicability in the LMIC context. Our work in Malawi, funded by the Medical Research Council, has demonstrated that theoretical frameworks such as Burden of Treatment Theory are useful to aid conceptualisation of treatment burden issues in LMICs. However, we have also shown that "lack" of access to treatments or services is an important additional dimension of treatment burden that influences capacity to self-manage and should be integrated into accounts of treatment burden in LMICs.

The impact 

Our work has led to a cultural shift in the thinking about multimorbidity and the related concept of Treatment Burden, with the latter now becoming a part of routine terminology in healthcare and increasingly in the mainstream of international debate. Our work underpinned recommendations within the NICE Multimorbidity guideline (NG56) that emphasised that reducing treatment burden was a key factor to address when attempting to optimise care for people with multimorbidity.

Our research underpinned a successful bid to Wellcome for a Multimorbidity PhD Programme for Health Professionals which is the largest and most ambitious of its kind globally. 

The team

Related publications 

Related URLs

Exemplar studies led by theme staff include: