multimorbidity in scotland the scottish school of primary care’s multimorbidity research programme
TRANSCRIPT
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
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
– 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
Most people with any long term condition have multiple conditions in Scotland
23
13
7
5
48
31
23
22
18
14
13
9
7
6
3
22
21
17
13
20
23
21
24
19
20
21
16
13
14
9
18
21
20
18
12
16
17
19
17
19
21
19
16
18
14
36
46
56
64
21
29
39
35
47
47
46
56
65
62
74
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
Most people with any long term condition have multiple conditions in Scotland
There are more people in Scotland with multimorbidity below 65 years than above
People living in more deprived areas in Scotland develop multimorbidity 10 years
before those living in the most affluent areas
Mental health problems are strongly associated with the number of physical conditions that people have,
particularly in deprived areas in Scotland
International evidence shows that people with multimorbidity experience more problems with
the coordination of their care
International evidence shows that people with multimorbidity experience more medical errors
People with multimorbidity in Scotland are much more likely to have emergency and potentially
preventable admissions
3 59 14 21
3447
6485
100
151
20
3151
74
115
151
200
242
318
342
479
0
100
200
300
400
500
600
0 1 2 3 4 5 6 7 8 9 10+
Ann
ual a
dmis
sion
rate
per
100
0 pa
tien
ts
No of conditions
Potentially preventable admission
Other emergency admissions
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
“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 “
“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
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
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
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
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]
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