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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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Epidemiology of multimorbidity and implications for health care, research, and medical education: A cross-sectional study
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Self-citation
Health Outcome Prioritization as a Tool for Decision Making Among Older Persons With Multiple Chronic Conditions
Fried, T. R. (2011) · Archives of Internal Medicine · doi:10.1001/archinternmed.2011.424 · Cited by 436
Randomized Controlled Trials: Do They Have External Validity for Patients With Multiple Comorbidities?
Fortin, M. (2006) · The Annals of Family Medicine · doi:10.1370/afm.516 · Cited by 341
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The Challenge of Multiple Comorbidity for the US Health Care System
Parekh, A. K. (2010) · JAMA · doi:10.1001/jama.2010.381 · Cited by 247

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“Patients with long term conditions are frequently managed by specialist nurses working to protocols driven by national guidelines (Salisbury, 2012).”
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“and improving outcomes for patients with these conditions [5, 6].”
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“It has been previously argued that these complex needs may not be covered well enough by a system of healthcare delivery that is designed for patients with a single condition [30].”
Background
Caring for people with chronic disease: is ‘muddling through’ the best way to handle the multiple complexities?
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Subjunctive medicine: Enacting efficacy in general practice
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“Multimorbidity, which is defined as the co-occurrence of two or more chronic conditions in individuals [1], is a major public health challenge worldwide, especially in countries with aging populations [2].”
Chronic Diseases and Multimorbidity in Iran: A Study Protocol for the Use of Iranian Health Insurance Organization’s Claims Database to Understand Epidemiology, Health Service Utilization, and Patient Costs
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“Managements of NCDs can be even more challenging by multimorbidity, the simultaneous occurrence of more than one chronic disease within a single patient (Salisbury 2012).”
Background
Meeting the Needs of a Complex Population: A Functional Health- and Patient-Centered Approach to Managing Multimorbidity
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Development of an international comorbidity education framework
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“There is a clear evidence gap for education and training on how quality and standards of care for each of the single conditions can be integrated to form the optimal chronic disease and other conditions management to improve the overall care of the patient (Salisbury, 2012; Anderson, 2011).”
Background
My Wellbeing Journal: Development of a communication and goal‐setting tool to improve care for older adults with chronic conditions and multimorbidity
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“3 While several definitions exist, multimor-bidity is typically characterised by the presence of two or more chronic conditions, and research indicates that multimorbidity affects over 50% of older individuals.”
Background
Immediate versus delayed short-term integrated palliative care for advanced long-term neurological conditions: the OPTCARE Neuro RCT
Hepgul, N., Wilson, R. J., Yi, D., Evans, C., Bajwah, S., Crosby, V., Wilcock, A., Lindsay, F., Byrne, A., Young, C. A., et al. (2020) · Health Services and Delivery Research · doi:10.3310/hsdr08360 · Cited by 9
“These may be brought together more formally through different kinds of vertical integration, in which agencies involved at different stages of the care pathway form part of a single organisation or function, as well as horizontal integration of community-based services in examples such as health and social care teams…”
Background
Improving the experiences and health of people with multimorbidity: exploratory research with policymakers and information providers on comorbid arthritis
Ryan, R. E., & Hill, S. (2013) · Australian Journal of Primary Health · doi:10.1071/py12083 · Cited by 9
Associations of multimorbidity with breast, cervical, and colorectal cancer screening delivery: a cross-sectional study of a nationally representative Japanese sample
Yamashita, H., Takahashi, Y., Ishizaki, T., Imura, H., & Nakayama, T. (2020) · Cancer Epidemiology · doi:10.1016/j.canep.2020.101798 · Cited by 8
To what extent are comorbidity profiles associated with referral and uptake to cardiac rehabilitation
Tang, L. H., Harrison, A. S., Skou, S. T., & Doherty, P. (2021) · International Journal of Cardiology · doi:10.1016/j.ijcard.2021.09.016 · Cited by 9
Optimising function and well-being in older adults: protocol for an integrated research programme in Aotearoa/New Zealand
Lord, S., Teh, R., Gibson, R., Smith, M., Wrapson, W., Thomson, W. M., Rolleston, A. K., Neville, S. J., McBain, L., Din, S. D., et al. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-02845-7 · Cited by 10
“Guidelines call for individualised treatment, but empirical evidence identifies a lack of understanding of what constitutes individualised care [28].”
Background
Multimorbidity and Health Care Service Utilization in the Australian Workforce
Wang, L., Palmer, A. J., Otáhal, P., Cocker, F., & Sanderson, K. A. (2017) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000001089 · Cited by 9
A medical student in private practice for a 1-month clerkship: a qualitative exploration of the challenges for primary care clinical teachers
Muller-Juge, V., Miozzari, A. C. P., Rieder, A., Hasselgård-Rowe, J., Sommer, J., & Audétat, M. (2017) · Advances in Medical Education and Practice · doi:10.2147/amep.s145449 · Cited by 10
Association of Lifestyle Factors with Multimorbidity Risk in China: A National Representative Study
Zou, X., Zou, S., Zhang, R., Xue, K., Guo, Y., Min, H., Wu, Y., & Sun, X. (2024) · Applied Research in Quality of Life · doi:10.1007/s11482-024-10291-3 · Cited by 6
“Multimorbidity, when at least two chronic conditions are simultaneously present in an individual, is a major challenge for global public health (Salisbury, 2012).”
The diabetes mellitus multimorbidity network in hospitalized patients over 50 years of age in China: data mining of medical records
Chen, C., Zheng, X., Liao, S., Chen, S., Liang, M., Tang, K., Yin, M., Liu, H., & Ni, J. (2024) · BMC Public Health · doi:10.1186/s12889-024-18887-y · Cited by 8
“Multimorbidity was defined as concurrently suffering from two or more NCDs [13].”
Background
Validation of the Italian version of the Patient Reported Experience Measures for intermediate care services
Cinocca, S., Rucci, P., Randazzo, C., Teale, E. A., Pianori, D., Ciotti, E., & Fantini, M. P. (2017) · Patient Preference and Adherence · doi:10.2147/ppa.s140041 · Cited by 8
Understanding the clinical reasoning processes involved in the management of multimorbidity in an ambulatory setting: study protocol of a stimulated recall research
Audétat, M., Notari, S. C., Sader, J., Ritz, C., Fassier, T., Sommer, J., NENDAZ, M. R., & Fon, N. C. (2021) · BMC Medical Education · doi:10.1186/s12909-020-02459-w · Cited by 8
Associations between multimorbidity burden and Alzheimer’s pathology in older adults without dementia: the CABLE study
Aerqin, Q., Chen, X., Ou, Y., Ma, Y., Zhang, Y.-R., Hu, H., Tan, L., & Yu, J. (2023) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2023.09.014 · Cited by 8
Historical thinking in clinical medicine: lessons from R . G . C ollingwood's philosophy of history
Chin-Yee, B. H., & Upshur, R. E. G. (2015) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.12344 · Cited by 8
“By design, clinical guidelines simplify complex situations and are poorly suited to handle cases of multimorbidity, which are increasingly common and pose a significant challenge to health services [29,39–41].”
Background
Violence against women and girls 2 The health-systems response to violence against women
García‐Moreno, C., Hegarty, K. L., Flávia, A., Koziol‐McLain, J., Colombini, M., & Feder, G. S. (2014) · Cited by 8
Early life stress in relation with risk of overweight, depression, and their comorbidity across adulthood: findings from a British birth cohort.
Pérez, A. U., Berger, E., Kelly-Irving, M., Delpierre, C., Capuron, L., & Castagné, R. (2024) · Psychological Medicine · doi:10.1017/s0033291723003823 · Cited by 5
“Deepening our understanding of types of multimorbidity and their implication on individuals ’ lives is important to improve patient-centered treatment recommendations, reduce the burden on health and health systems, and propose relevant preventive strategies (Bayliss et al., 2014; Salisbury, 2012).”
The complexity of food for people with multiple long-term health conditions
Francis, H., Carryer, J., & Wilkinson, J. (2018) · Journal of Primary Health Care · doi:10.1071/hc18020 · Cited by 7
Características de la provisión del servicio de gestión de casos en el entorno comunitario en Andalucía a partir del registro RANGECOM
Morales‐Asencio, J. M., Fernández‐Gallego, M. C., Herrera, J. C. M., Martín‐Santos, F. J., Arranz, A. S., Sicilia, J. P. B., Delgado-Romero, A., Gómez, L. P., López, Á. C., & Kaknani‐Uttumchandani, S. (2019) · Enfermería Clínica · doi:10.1016/j.enfcli.2018.12.009 · Cited by 7
The Friendly Health Issue Network to Support Computer-Assisted Education for Clinical Reasoning in Multimorbidity Patients
Pecoraro, F., Ricci, F. L., Consorti, F., Luzi, D., & Tamburis, O. (2021) · Electronics · doi:10.3390/electronics10172075 · Cited by 7
“For this kind of patient, a shift is requested from the traditional disease-oriented approach to a more functional patient-tailored one [8,9].”
Effect of Family Practice Contract Services on the Perceived Quality of Primary Care among Patients with Multimorbidity: A Cross-Sectional Study in Guangdong, China
Liao, J., Zhou, M., Zhong, C., Liang, C., Hu, N., & Kuang, L. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19010157 · Cited by 8
“These complex patients are rather in need of home service, chronic disease follow-up consultation and other contracted services, compared with those with less complex conditions [57,63].”
Background
Multimorbidity and adverse longitudinal outcomes among patients attending chronic outpatient medical care in Bahir Dar, Northwest Ethiopia
Eyowas, F. A., Schneider, M., Alemu, S., & Ambaw, F. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2023.1085888 · Cited by 7
A Pharmaceutical Dispensing–based Index of Mortality Risk From Long-term Conditions Performed as well as Hospital Record–based Indices
Stanley, J., Doughty, R. N., & Sarfati, D. (2019) · Medical Care · doi:10.1097/mlr.0000000000001217 · Cited by 11
Baseline Prevalence of Polypharmacy in Older Hypertensive Study Subjects with Elevated Dementia Risk: Findings from the Risk Reduction for Alzheimer’s Disease Study (rrAD)
Vidoni, E. D., Kamat, A., Gahan, W. P., Ourso, V., Woodard, K. T., Kerwin, D. R., Binder, E. F., Burns, J. M., Cullum, C. M., Hynan, L. S., et al. (2020) · Journal of Alzheimer s Disease · doi:10.3233/jad-200122 · Cited by 7
Meeting the needs of an aging population in China: Public health and policy implications
Woo, J. (2013) · Journal of Clinical Gerontology and Geriatrics · doi:10.1016/j.jcgg.2013.02.001 · Cited by 7
Development of indicators to assess quality and patient pathways in interdisciplinary care for patients with 14 ambulatory-care-sensitive conditions in Germany
Schüttig, W., Flemming, R., Mosler, C. H., Leve, V., Reddemann, O., Schultz, A., Brua, E., Brittner, M., Meyer, F., Pollmanns, J., et al. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08327-1 · Cited by 6
“Their health care outcomes may not only be dependent on the treatment of one disease, but the interplay of different disciplines [38, 39].”
Background
Study protocol for two stepped-wedge interventional trials evaluating the effects of holistic information technology-based patient-oriented management in older multimorbid patients with cancer: The GERONTE trials
Hamaker, M. E., Wildiers, H. P. M. W., Ardito, V., Arsandaux, J., Barthod-Malat, A., Davies, P., Degol, L., Ferrara, L., Fourrier, C., Kenis, C., et al. (2024) · Journal of Geriatric Oncology · doi:10.1016/j.jgo.2024.101761 · Cited by 6
Impact of Patient–Provider Attachment on Hospital Readmissions Among People Living With HIV: A Population-Based Study
Parent, S., Barrios, R., Nosyk, B., Ye, M., Bacani, N., Panagiotoglou, D., Montaner, J. S. G., Ti, L., & on behalf of the STOP HIV/AIDS in BC Study Group (2018) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000001857 · Cited by 6
Characteristics of the provision of case management services in the community setting in Andalusia based on the RANGECOM registry
Morales‐Asencio, J. M., Fernández‐Gallego, M. C., Herrera, J. C. M., Martín‐Santos, F. J., Arranz, A. S., Sicilia, J. P. B., Delgado-Romero, A., Gómez, L. P., López, Á. C., & Kaknani‐Uttumchandani, S. (2019) · Enfermería Clínica (English Edition) · doi:10.1016/j.enfcle.2018.12.002 · Cited by 6
“People with complex chronic disease processes are now the norm and no longer the exception, yet our health services have failed to adapt since their initial conception, which focussed on acute disease.(1) The list of models to tackle this challenge is ever longer, but all studies agree on the development of self-care…”
Background
Multimorbidity in Incident Heart Failure: Characterisation and Impact on 1-Year Outcomes
Gutiérrez, A. G., Juste, A. M., Laguna-Berna, C., Santos-Mejías, A., Poblador‐Plou, B., Miguel, A. G., & Ruiz-Laiglesia, F. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13133979 · Cited by 5
“Multimorbidity is now the norm rather than the exception in clinical practice and requires a paradigm shift from disease-centred to person-centred care that prioritises the integral and holistic view and care of chronic patients [7].”
Background
What can we learn from multimorbidity? A deep dive from its risk patterns to the corresponding patient profiles
Wang, X., Zhang, R., & Zhu, X. (2024) · Decision Support Systems · doi:10.1016/j.dss.2024.114313 · Cited by 6
Multimorbidade em idosos de um município do nordeste brasileiro: prevalência e fatores associados
Santos, L. B., Rocha, S. V., Lessa, R. S., & Vilela, A. B. A. (2019) · Revista de Salud Pública · doi:10.15446/rsap.v21n5.77775 · Cited by 5
Differentials in Health and Wellbeing in Older Adults with Obesity in England: A Cross-Sectional Analysis Using the English Longitudinal Study of Ageing
Ghosh, G., Khan, H. T. A., & Vohra, S. (2022) · Journal of Population Ageing · doi:10.1007/s12062-022-09386-2 · Cited by 5
“The previous studies (Barnett et al., 2012; Salisbury, 2013) suggest that a single disease approach is failed to evaluate the complexity of the problem correctly.”
Association of chronic conditions and physical multimorbidity with new-onset incontinence in a nationwide prospective cohort study of older adults ≥ 50 years in China
Li, H., Zou, X., Zhang, R., Zou, S., Qian, F., Zheng, J., Xiao, A. Y., & Guo, X. (2024) · Age and Ageing · doi:10.1093/ageing/afad258 · Cited by 5
Managing the needs of older patients with multimorbidity - A systematic review of the challenges faced by the healthcare services
Holm, A., Berland, A., & Severinsson, E. (2016) · Open Journal of Nursing · doi:10.4236/ojn.2016.610086 · Cited by 5
“According to Salisbury [9], healthcare professionals should focus more on learning how to promote patient self-management, including how different physical and mental health problems and diseases interact and how to help the patient to make healthcare decisions in the face of competing priorities.”
BackgroundInfluential
Coping with multiple chronic conditions among Chinese older couples: A community of shared destiny
Sun, L., Liu, J., Ji, M., Wang, Y., Chen, S., & Wang, L. (2022) · Geriatric Nursing · doi:10.1016/j.gerinurse.2022.09.019 · Cited by 5
A randomised controlled trial, cost-effectiveness and process evaluation of the implementation of self-management for chronic gastrointestinal disorders in primary care, and linked projects on identification and risk assessment
Thompson, D. G., O’Brien, S. J., Kennedy, A. P., Rogers, A. E., Whorwell, P. J., Lovell, K., Richardson, G., Reeves, D., Bower, P., Chew-Graham, C. A., et al. (2018) · Programme Grants for Applied Research · doi:10.3310/pgfar06010 · Cited by 5

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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