Managing patients with multimorbidity

Abstract

Multimorbidity is associated with advancing age and frailty states. Those with multimorbidity are more likely to have increased morbidity and mortality as well as care needs. Polypharmacy can be problematic in this group with attention required to determine what is appropriate and what is problematic. A distinct approach is necessary to manage multi-morbidity, compared with single organ management. Awareness is required of the relative paucity of evidence-based medicine in this area due to the heterogeneity of combinations of conditions and individual circumstances. Decisions should be made in partnership with the patient living with these conditions and include a dialogue regarding likely benefits and risks of existing management strategies alongside their goals. This article suggests a five step approach to this in the clinic setting. 1) Discussing the purpose of taking multimorbidity specific approach, 2) Establishing disease and treatment burdens, 3) Establishing goals, values and priorities, 4) Review of medications and other treatment and finally 5) Agree an individualized management plan.