gms | German Medical Science

Forum Medizin 21, 45. Kongress für Allgemeinmedizin und Familienmedizin

Paracelsus Medizinische Privatuniversität in Zusammenarbeit mit der Deutschen, Österreichischen und Südtiroler Gesellschaft für Allgemein- und Familienmedizin

22.09. - 24.09.2011, Salzburg, Österreich

Multimorbidity and polypharmacy: concepts, challenges in health care and the primary care research agenda

Meeting Abstract

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  • André Knottnerus - University of Maastricht, The Netherlands

45. Kongress für Allgemeinmedizin und Familienmedizin, Forum Medizin 21. Salzburg, 22.-24.09.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11fom211

DOI: 10.3205/11fom211, URN: urn:nbn:de:0183-11fom2115

Veröffentlicht: 14. September 2011

© 2011 Knottnerus.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

The prevalence of chronic multimorbidity is increasing and will continue to do so over the coming decades, as a result of ageing and of longer survival with chronic disorders than in the past.

This phenomenon, that has important implications for healthcare, can defined in various ways, according to the conceptual model that is chosen, and depending of study objective.

For example, if one is interested in describing the burden of illness and the complex challenges for healthcare, every co-occurrence of various chronic morbidities should be defined as multimorbidity. If the focus is on a possible common etiological ground of co-occurring morbidities, a more frequent occurrence than expected by chance should observed, generally after adjustment for obvious determinants such as age. If, in the latter case, one would also be interested in a possible common pathogenetic basis, not only epidemiological and clinical investigations but also social scientific and biomedical research on susceptibility and frailty and, e.g., on molecular genetic mechanisms, would be required.

For primary care research, usually a practical focus is chosen, in relation to improving prevention and care. For that purpose, every co-occurrence of various morbidities may be important in terms of complex health care implications related to the application of various mono-nosological clinical guidelines and to a higher risk of polypharmacy and drug interactions. Although polypharmacy as such is not specifically related to multimorbidity (as we know this phenomenon also from complex mono-nosological cases of chronic illness), in situations of multimorbidity the polypharmacy implications can be much more challenging in case of conflicting recommendations and untested combinations.

In the primary care research agenda a key priority is strengthening the evidence-base for optimal prevention and patient care. This implies much attention for the epidemiological, clinical and quality of care aspects of multimorbidity. In this context also the specific methodological challenges to study these issues need to be addressed, covering a range of relevant approaches such as: development, validation and improvement of appropriate instruments, panel studies to evaluate complexities of combining various guidelines, multi-nosological guideline development for frequently co-occurring disorders, observational studies on determinants of occurrence and prognosis, and evaluating interventions to improve the quality of care (including prescription management) and to improve health outcome. Furthermore, research in primary care settings can also make contributions to multidisciplinary basic research in studying risk factors and mechanisms of multimorbidity, including frailty and susceptibility.