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Multimorbidity: redesigning health care for people who use it

Salisbury, Chris·2012·The Lancet

DOI 10.1016/s0140-6736(12)60482-6

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“The widespread prevalence of multimorbidity is primarily due to the growing incidence of chronic diseases in an increasingly aging population (1), and it is currently one of the most significant challenges faced by health care providers worldwide (2, 3).”
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“Background Multimorbidity is one of the largest challenges facing health systems worldwide [1, 2].”
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“Background Multimorbidity is now considered the norm, rather than the exception, in primary care settings [1,2].”
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Background
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Background
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Disease-specific clinical pathways – are they feasible in primary care? A mixed-methods study
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Is telephone health coaching a useful population health strategy for supporting older people with multimorbidity? An evaluation of reach, effectiveness and cost-effectiveness using a ‘trial within a cohort’
Panagioti, M., Reeves, D., Meacock, R., Parkinson, B., Lovell, K., Hann, M., Howells, K., Blakemore, A., Riste, L., Coventry, P. A., et al. (2018) · BMC Medicine · doi:10.1186/s12916-018-1051-5 · Cited by 53
“Multimorbidity, defined as ‘the co-existence of two or more chronic conditions, where one is not necessarily more central than the others’ [1], is highly prevalent [2].”
Background
A Multicenter Study of Multimorbidity in Older Adult Inpatients in China
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Multimorbidity: Implications and directions for health psychology and behavioral medicine.
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“The current absence of multiple-condition guidelines means that most patients with co-occurring conditions are shuttled from one specialty to the next, which often leads to fragmented, inefficient, and high-cost care (e.g., Salisbury, 2012).”
Background
Healthcare for Older Adults with Multimorbidity: A Scoping Review of Reviews
Wu, J., Zhang, H., Shao, J., Chen, D., Xue, E., Huang, S., Fu, Y., Tang, L., & Ye, Z. (2023) · Clinical Interventions in Aging · doi:10.2147/cia.s425576 · Cited by 55
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Pedersen, A. F., Nørøxe, K. B., & Vedsted, P. (2020) · British Journal of General Practice · doi:10.3399/bjgp20x707837 · Cited by 49
“24 Second, most guidelines are developed from research in selected patients without comorbidities 25 and good evidence for best care of every possible combination of conditions will never be obtained, 26 making it challenging to balance competing medical priorities when managing patients with…”
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“1,4,5 In addition, in order for medical interventions to work, they generally require that patients take action – at a minimum, following the ordinations but more often, much more than this.”
Background
Handgrip strength, chronic physical conditions and physical multimorbidity in middle-aged and older adults in six low- and middle income countries
Vancampfort, D., Stubbs, B., Firth, J., & Koyanagi, A. (2018) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2018.11.007 · Cited by 50
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Mino‐León, D., Reyes‐Morales, H., Doubova, S. V., Pérez‐Cuevas, R., Giraldo‐Rodríguez, L., & Agudelo‐Botero, M. (2017) · Archives of Medical Research · doi:10.1016/j.arcmed.2017.03.001 · Cited by 46
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Nunes, B. P., Camargo‐Figuera, F. A., Guttier, M. C., de Oliveira, P. D., Munhoz, T. N., Matijasevich, A., Bertoldi, A. D., Wehrmeister, F. C., Silveira, M. P. T., Thumé, E., et al. (2016) · International Journal of Public Health · doi:10.1007/s00038-016-0819-7 · Cited by 46
“Nowadays, the majority of clinical guidelines are targeted at specific problems, which increase the risk of iatrogenic events (Guthrie et al. 2012; Moraes 2012; Salisbury 2012).”
Background
The Foundations Framework for Developing and Reporting New Models of Care for Multimorbidity
Stokes, J., Man, M., Guthrie, B., Mercer, S. W., Salisbury, C., & Bower, P. (2017) · The Annals of Family Medicine · doi:10.1370/afm.2150 · Cited by 47
Multimorbidade, depressão e qualidade de vida em idosos atendidos pela Estratégia de Saúde da Família em Senador Guiomard, Acre, Brasil
Amaral, T. L. M., Amaral, C. D. A., de Lima, N. S., Herculano, P. V., do Prado, P. R., & Monteiro, G. T. R. (2018) · Ciência & Saúde Coletiva · doi:10.1590/1413-81232018239.22532016 · Cited by 44
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“28,29 Multimorbid conditions affect each other, and are closely associated with mortality, severe disability, care variations, increased health resource use and costs.”
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Chronic Obstructive Pulmonary Disease is Just One Component of the Complex Multimorbidities in Patients with COPD
Clini, E. M., Beghé, B., & Fabbri, L. M. (2013) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201302-0230ed · Cited by 40
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Gebregziabher, M., Ward, R. C., Taber, D. J., Walker, R. J., Ozieh, M. N., Dismuke, C. E., Axon, R. N., & Egede, L. E. (2018) · Social Science & Medicine · doi:10.1016/j.socscimed.2018.06.020 · Cited by 42
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The Importance of Taking a Patient-Centered, Community-Based Approach to Preventing and Managing Frailty: A Public Health Perspective
Adja, K. Y. C., Lenzi, J., Sezgin, D., Ó’Caoimh, R., Morini, M., Damiani, G., Buja, A., & Fantini, M. P. (2020) · Frontiers in Public Health · doi:10.3389/fpubh.2020.599170 · Cited by 40
“The reduction in healthy life years is characterized by an increase in frailty, multimorbidity and disability (3), which results in frequent use of healthcare services by older adults (4).”
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Psychopharmacological effects of cannabis.
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Capturing the experiences of patients across multiple complex interventions: a meta-qualitative approach
Webster, F., Christian, J. B., Mansfield, E. D., Bhattacharyya, O. K., HAWKER, G. A., Levinson, W. S., Naglie, G., Pham, T.-N. T., Rose, L., Schull, M. J., et al. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-007664 · Cited by 38
Improving the management of multimorbidity in general practice: protocol of a cluster randomised controlled trial (The 3D Study)
Man, M., Chaplin, K., Mann, C., Bower, P., Brookes, S. T., Fitzpatrick, B., Guthrie, B., Shaw, A. R. G., Hollinghurst, S. P., Mercer, S. W., et al. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-011261 · Cited by 38
Association of physical performance and self-rated health with multimorbidity among older adults: Results from a nationwide survey in Japan
Ishizaki, T., Kobayashi, E., Fukaya, T., Takahashi, Y., Shinkai, S., & Liang, J. (2019) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2019.103904 · Cited by 38
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“Current delivery of health services is often poorly matched to the needs of patients with multimorbidity (6).”
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Association Between Nonspecific Severe Psychological Distress as an Indicator of Serious Mental Illness and Increasing Levels of Medical Multimorbidity
Swartz, J. A., & Jantz, I. (2014) · American Journal of Public Health · doi:10.2105/ajph.2014.302165 · Cited by 36
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Gates, M. L., Hunter, E. G., Dicks, V. G., Jessa, P. N., Walker, V., & Yoo, W. (2018) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2018.03.012 · Cited by 35
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Danish clinical quality databases – an important and untapped resource for clinical research
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Patterns of physical activity and health-related quality of life amongst patients with multimorbidity in a multi-ethnic Asian population
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Interventions for involving older patients with multi-morbidity in decision-making during primary care consultations
Butterworth, J. E., Goulding, R., McDonagh, S. T. J., Richards, S. H., Bower, P., & Campbell, J. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013124.pub2 · Cited by 31
“Why it is important to do this review There are concerns that current delivery of good-quality care is not meeting the needs of older patients, who often experience multi-morbidity (Salisbury 2012; Steel 2014).”
Background
Clinical and operational insights from data-driven care pathway mapping: a systematic review
Manktelow, M., Iftikhar, A., Bucholc, M., McCann, M., & O’Kane, M. (2022) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-022-01756-2 · Cited by 34
“Particularly in patients with multimorbidity the risks and benefits of treatments may differ [6, 7], and the pressure to practice “defensive medicine” in an increasingly litigious environment [8] and a lack of resources to undertake labour-intensive rationalisation of treatment plans [9] compound…”
Background
Association of cardiovascular health using Life's Essential 8 with noncommunicable disease multimorbidity
Zhang, Y., Sun, M., Wang, Y., Xu, T., Ning, N., Tong, L., He, Y., Jin, L., & Ma, Y. (2023) · Preventive Medicine · doi:10.1016/j.ypmed.2023.107607 · Cited by 30
What are the core predictors of ‘hassles’ among patients with multimorbidity in primary care? A cross sectional study
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“Research evidence has shown that many older patients visit primary care with multimorbidity, and has highlighted the requirement to develop ways of improving health care services delivery to be responsive to the needs of these patients [25–28].”
Background
A Research Group from the European General Practice Research Network (EGPRN) Explores the Concept of Multimorbidity for Further Research into Long Term Care
Reste, J. Y. L., Nabbé, P., Lygidakis, C., Doerr, C., Lingner, H., Czachowski, S., Muñoz, M. Á., Argyriadou, S., Clavería, A., Calvez, A., et al. (2012) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2012.07.017 · Cited by 30
Computer technologies to integrate medical treatments to manage multimorbidity
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Shared decision making between older people with multimorbidity and GPs: a qualitative study
Brown, E., Poltawski, L., Pitchforth, E., Richards, S., Campbell, J., & Butterworth, J. (2022) · The British journal of general practice : the journal of the Royal College of General Practitioners · doi:10.3399/bjgp.2021.0529 · Cited by 25
Improving Health Care for Patients with Multimorbidity: A Mixed-Methods Study to Explore the Feasibility and Process of Aligning Scheduled Outpatient Appointments through Collaboration between Medical Specialties
Bell, C., Appel, C., Frølich, A., Prior, A., & Vedsted, P. (2022) · International Journal of Integrated Care · doi:10.5334/ijic.6013 · Cited by 30
Polypharmacy in Older Adults with Alzheimer’s Disease
Esumi, S., Ushio, S., & Zamami, Y. (2022) · Medicina · doi:10.3390/medicina58101445 · Cited by 30
Clinical Outcomes Following Exercise Rehabilitation in People with Multimorbidity: A Systematic Review
Barker, K., Holland, A. E., Skinner, E. H., & Lee, A. L. (2023) · Journal of Rehabilitation Medicine · doi:10.2340/jrm.v55.2551 · Cited by 29
Nursing in an age of multimorbidity
O’Connor, S., Deaton, C., Nolan, F., & Johnston, B. M. (2018) · BMC Nursing · doi:10.1186/s12912-018-0321-z · Cited by 32
“Some additional ways that may counteract the difficulties patients with multiple chronic conditions face include embedding public health and health promotion in all aspects of society and having longer and more comprehensive primary care visits, especially for older adults [49].”
Background
Multimorbidity patterns among COVID-19 deaths: proposal for the construction of etiological models
Fernández-Niño, J. A., Guerra‐Gomez, J. A., & Idrovo, Á. J. (2020) · Revista Panamericana de Salud Pública · doi:10.26633/rpsp.2020.166 · Cited by 29
Personalized Health Care as a Pathway for the Adoption of Genomic Medicine
Burnette, R., Simmons, L. A., & D, R. S. M. (2012) · Journal of Personalized Medicine · doi:10.3390/jpm2040232 · Cited by 29
“In the United States and worldwide, health care systems focus on the reactive treatment of disease events associated with the later stages of chronic, often multi-morbid diseases (the presence of two or more disorders) rendering care inefficient and extremely costly [4–6].”
Background
Lifestyle factors related to prevalent chronic disease multimorbidity: A population-based cross-sectional study
Niebuur, J., Vonk, J. M., Du, Y., de Bock, G. H., Lunter, G. A., Krabbe, P. F. M., Alizadeh, B. Z., Snieder, H., Smidt, N., Boezen, M., et al. (2023) · PLoS ONE · doi:10.1371/journal.pone.0287263 · Cited by 31
“In addition to high mortality rates, disability, functional decline and poor quality of life [1, 3], multimorbidity places a substantial economic burden on society due to exponentially rising healthcare costs [4].”
Background
Managing medical and psychiatric multimorbidity in older patients
Carlson, D. M., & Yarns, B. C. (2023) · Therapeutic Advances in Psychopharmacology · doi:10.1177/20451253231195274 · Cited by 31
“2,15,16,40”
Background

Authors: Salisbury, C.
Affiliations: University of Bristol (GB)
Corresponding author: Salisbury, Chris
ORCID: Salisbury, Chris
Venue: The Lancet
Publisher: Elsevier BV
Published: 2012-07
Volume: 380
Issue: 9836
Pages: 7-9
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(12)60482-6
OpenAlex: W2056096736
Cited by: 326
References: 15
Citations by year: 2026: 10 · 2025: 18 · 2024: 22 · 2023: 26 · 2022: 24 · 2021: 27 · 2020: 31 · 2019: 20 · 2018: 27 · 2017: 28 · 2016: 24 · 2015: 27 · 2014: 19 · 2013: 18 · 2012: 4
FWCI: 16.28
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet (publishedVersion)
PubMed (publishedVersion)
Bristol Research (University of Bristol) (submittedVersion)
Explore Bristol Research (submittedVersion)
Topics: Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords: multimorbidity, chronic disease, primary care, continuity of care, socioeconomic deprivation, age and sex differences, health care redesign, individualized care
MeSH terms: Mental Disorders, Chronic Disease, Female, Humans, Male

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Multimorbidity: redesigning health care for people who use it

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