Evidence on multimorbidity from definition to intervention: An overview of systematic reviews

Abstract

The increasing challenge of multiple chronic diseases (multimorbidity) requires more evidence-based knowledge and effective practice. In order to better understand the existing evidence on multimorbidity, we performed a systematic review of systematic reviews on multimorbidity with pre-established search strategies and exclusion criteria by searching multiple databases and grey literature. Of 8006 articles found, 53 systematic reviews (including meta-analysis and qualitative research synthesis performed in some reviews) that stated multimorbidity as the main focus were included, with 79% published during 2013-2016. Existing evidence on definition, measurement, prevalence, risk factors, health outcomes, clinical practice and medication (polypharmacy), and intervention and management were identified and synthesised. There were three major definitions from three perspectives. Seven studies on prevalence reported a range from 3.5% to 100%. As six studies showed, depression, hypertension, diabetes, arthritis, asthma, and osteoarthritis were prone to be comorbid with other conditions. Four groups of risk factors and eight multimorbidity associated outcomes were explored by five and six studies, respectively. Nine studies evaluated interventions, which could be categorized into either organizational or patient-oriented, the effects of these interventions were varied. Self-management process, priority setting and decision making in multimorbidity were synthesised by evidence from 4 qualitative systematic reviews. We were unable to draw solid conclusions from this overview due to the heterogeneity in methodology and inconsistent findings among included reviews. As suggested by all included studies, there is a need for prospective research, especially longitudinal cohort studies and randomized control trials, to provide more definitive evidence on multimorbidity.

Multimorbidity Frameworks Impact Prevalence and Relationships with Patient‐Important Outcomes

“…23 Several factors influence prevalence estimates among studies of multimorbidity, including differing geographic settings, recruitment methods, and data collection methods, and the operational definition of multimorbidity. 9,18,[24][25][26][27] In this study, we found that including risk factors has the largest impact on prevalence estimates. Compared to most diseases and symptoms, risk factors are generally based on objective, rather than subjective, measures; are easy to quantify; and are often collected as part of routine examinations (eg, blood pressure and BMI).…”

Multimorbidity prevalence in Canada: a comparison of Northern Territories with Provinces, 2013/14

“…Multimorbidity is defined as two or more co-occurring chronic conditions without an index condition [1]. Multimorbidity is common among adults, with a general population prevalence estimated to be between 17.3 5 to 71.8% [2]. Multimorbidity reduces physical and social functioning, increases utilization of healthcare services, and leads to higher personal and social costs [3][4][5][6].…”

Becoming a guest in your own home: Home care in Sweden from the perspective of older people with multimorbidities

“…Many older people receiving home care suffer from multimorbidity and disabilities associated with both normal ageing and illness, which increase as life expectancy increases (Kontis et al., ). Multimorbidity is defined in different ways depending on the context (Xu, Mishra, & Jones, ), but a commonly used definition was formulated by the World Health Organization (WHO, ) as “more than one chronic condition at the same time” (p. 26). These are often long‐term health conditions that require complex and ongoing care.…”