Unpacking the complexities of multimorbidities management: Identifying priorities for clinicians

Background: Non-communicable diseases presenting in clusters (multi-morbidities) create a more complex set of symptoms for physicians to treat, patients to self-manage and health educators and health strategists to plan for and address. Existing patient treatment and education commonly aim to address individual conditions relying on a single disease paradigm. As chronic conditions do not present in silos a different approach is required.
With this in mind, this current study aimed to: 1. Identify salient issues challenging healthcare provision for patients living with multi-morbidities in Northern Ireland; 2. Co-produce real world research priorities to inform improved wellbeing and outcomes for patients and to shape service delivery and related strategy in NI for those with multi-morbidities.
Methods: A series of workshops were facilitated to co-produce research priorities within an embedded practice framework. The workshops comprised: clinicians drawn from primary and secondary care, academics and researchers, commissioning representatives, senior health trust staff and health policy developers with expertise in chronic health conditions multi-morbidities and integrated care. The workshops provided a forum to explore current best practice, issues impacting services and patient well-being, and what is needed to improve provision and outcomes. Data from the initial workshops was analysed using framework analysis; with findings synthesised to elucidate key themes. Early analytic findings were formally reported back to the group for discussion, feedback and agreement. These findings informed subsequent workshops to co-produce research priorities to improve outcomes for those living with multi-morbidities and those who provide care for these patients.
Results: Findings identified four key research priorities to improve outcomes for those living with multiple, chronic conditions: 1. Single hub or clinic for management of multi-morbidities; 2. Involving patients and families in patient wellbeing; 3. Community and voluntary sector input; and 4. Extending reach of existing provision. Categories were agreed within each priority including: Decreasing treatment burden for patients; Reducing dependence on healthcare professionals; Upstream prevention within family networks; Addressing health inequities. These findings provided as basis for discussion leading to refinement of these priorities, with a focus on feasible and impactful work to bring benefits for patients, healthcare professionals, and healthcare providers in both the short and longer-term. Risk stratification, mapping of patient treatment pathways, scoping work to inform the extent of the difficulties faced, and models of patient-centred, holistic provision were identified as starting points to address the identified research priorities.
Implications: The findings highlighted key research priorities, and a direction of travel, for professionals tasked with improving outcomes for patients with chronic conditions. This study has taken a novel approach to embedded practice with the early involvement of healthcare professionals, senior healthcare staff and policy makers in the research process. The embedded practice approach facilitated co-production of research priorities with potential to address real-world issues facing healthcare and allied professionals as they navigate the complexities of multi-morbidity management. They also provide an important staring point to inform improved wellbeing and outcomes for patients and to shape service delivery and related policy for those with multi-morbidities.