multimorbidity in scotland the scottish school of primary care’s multimorbidity research programme

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Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme.

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Page 1: Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme

Multimorbidity in Scotland

The Scottish School of Primary Care’s Multimorbidity Research Programme.

Page 2: Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme

The Slide Pack The Scottish national data shown uses:

– Clinical data from 310 Scottish general practices for 1,754,133 registered patients, and was provided by the Primary Care Clinical Informatics Unit (“PCCIU data”)

– Or clinical data from 40 Scottish general practices linked to hospital admissions data (“ISD and PCCIU data”)

Data on consultations in general practice from a previous study ofover 3,000 patients living in either high or low deprivation areas ofScotland is also referred to, as are examples of experiences from arecent qualitative interview study with people living in some ofthe most deprived areas in Scotland

Please use data & graphs freely with acknowledgement

Page 3: Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme

Multimorbidity in Scotland• Multimorbidity is the presence of two or more long term

conditions. • The Long Term Conditions Alliance Scotland call it ‘having

multiple conditions’. It matters because: • Living with multiple conditions is the norm rather than the

exception for many people. It is associated with poorer quality of life, more hospital admissions and higher mortality

• Health services are largely organised to provide care for single diseases

Page 4: Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme

– The majority of over-65s have 2 or more conditions, and the majority of over-75s have 3 or more conditions

– More people have 2 or more conditions than only have 1

Multimorbidity is common in Scotland

Page 5: Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme

Most people with any long term condition have multiple conditions in Scotland

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0% 20% 40% 60% 80% 100%

Depression

Schizophrenia/bipolar

Anxiety

Dementia

Asthma

Epilepsy

Cancer

Hypertension

COPD

Diabetes

Painful condition

Coronary heart disease

Atrial fibrillation

Stroke/TIA

Heart failure

Percentage of patients with each condition who have other conditionsThis condition only This condition + 1 other + 2 others + 3 or more others

Page 6: Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme

Most people with any long term condition have multiple conditions in Scotland

Page 7: Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme

There are more people in Scotland with multimorbidity below 65 years than above

Page 8: Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme

People living in more deprived areas in Scotland develop multimorbidity 10 years

before those living in the most affluent areas

Page 9: Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme

Mental health problems are strongly associated with the number of physical conditions that people have,

particularly in deprived areas in Scotland

Page 10: Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme

International evidence shows that people with multimorbidity experience more problems with

the coordination of their care

Page 11: Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme

International evidence shows that people with multimorbidity experience more medical errors

Page 12: Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme

People with multimorbidity in Scotland are much more likely to have emergency and potentially

preventable admissions

3 59 14 21

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No of conditions

Potentially preventable admission

Other emergency admissions

Page 13: Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme

People with multimorbidity in Scotland do not feel enabled by healthcare encounters

In a study of over 3,000 GP consultations, patients withmultimorbidity (compared to those without) had :• More problems to discuss, which were more often

complex (a mix of physical, psychological, and social);Yet• Consultations were not longer for people with multi-

morbidity; and• Patient enablement was lower;• These findings were worse in deprived areas, and

GPs in deprived areas reported more stress in and after the consultations

Page 14: Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme

“I’m just to trying to survive and get

through each day”

Illness work Everyday life work Work to keep a sense of their own identity

People with multiple conditions in Scotland have to ‘work’ hard just to get by.

“My life is painkillers, insulin, making sure I’ve got all my stock for my stoma…. It’s really hard work”

“I don’t ask for help off anybody….I’m not that kind of person. I like to be strong. I’ve always (taken) care of my self. I’ve never asked naebody for help. Ever. … And now I just don’t want to ask (the GP) for help “

Page 15: Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme

“Exhausting”“Demoralising”

“I feel like a wrung-out rag at the end of

consultations”

“If you’re too caring ... you’ll

crack up in a place like this. Our

boundaries lie where they are

because they have to at the moment”

General practitioners and practice nurses in deprived areas struggle to support people with multimorbidity

Page 16: Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme

Implications

• Multimorbidity is the norm for people with long-term conditions in Scotland

• Multimorbidity contributes significantly to health inequalities and the inverse care law

• We need to understand how to better support people with multimorbidity

• Primary care is central to providing this support but practitioners also need support

Page 17: Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme

The Scottish School of Primary Care’s Multimorbidity Research Programme

The broad research objectives are: • To describe the nature, extent and experience

of multiple morbidity in primary care• To describe the impact of multiple morbidity

over time on health outcomes• To develop and evaluate interventions that

help people with multiple morbidities

Page 18: Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme

The Scottish School of Primary Care’s multimorbidity programme – current research

• Living well with multimorbidity: the development of a primary care-based complex intervention for people with multimorbidity in deprived areas of Scotland Funded by CSO NHS Applied Research Programme Grant

• The MALT Study: the development of a cohort study of people with multiple and long-term conditions in Scotland. Funded by a SSPC Visiting Professor Award

Page 19: Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme

Contacts• Stewart Mercer, Professor of Primary Care Research,

University of Glasgow: SSPC National Lead for Multimorbidity Research [email protected]

• Bruce Guthrie, Professor of Primary Care Medicine, University of Dundee: Living Well with Multimorbidity Epidemiology workstream lead

[email protected] • Sally Wyke, Professor of Interdisciplinary Research, University

of Glasgow: Living Well with Multimorbidity Self-Management and Personal Experience [email protected]

Page 20: Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme

Other researchers involved

Researchers involved in the multimorbidity programme whose work has contributed to these slides includes: University of Glasgow: Rosaline O’Brien, Graham Watt. University of Dundee:Karen Barnett