Journal of Comorbidity

4

Authors: William A. Satariano, Cynthia M. Boyd

“Multiple Chronic Conditions: A Strategic Framework” is a seminal report and the heart of a US strategic initiative, released by the U.S. Department of Health and Human Services (HHS) in December 2010, to focus the attention and resources of the US government on the research, practice, and policy implications of multiple chronic conditions (MCCs) [1]. The specific purpose of the report is “to catalyze change within the context of how chronic illnesses are addressed in the United States – from an approach focused on individual chronic diseases to one that uses a multiple chronic condition approach” [1]. The report observes that this process represents “a culture change, or paradigm shift, and the subsequent implementation of these strategies that will provide a foundation for realizing the vision of optimal health and quality of life for individuals with multiple chronic conditions” [1]. Journal of Comorbidity 2013;3(2)18–21

5

Authors: François G. Schellevis

The epidemiology of multimorbidity, or multiple chronic conditions (MCCs), is one of the research priority areas of the U.S. Department of Health and Human Services (HHS) by its Strategic Framework on MCCs. A conceptual model addressing methodological issues leading to a valid measurement of the prevalence rates of MCCs has been developed and applied in descriptive epidemiological studies. Comparing these results with those from prevalence studies performed earlier and in other countries is hampered by methodological limitations. Therefore, this paper aims to put the size and patterns of MCCs in the USA, as established within the HHS Strategic Framework on MCCs, in perspective of the findings on the prevalence of MCCs in other countries. General common trends can be observed: increasing prevalence rates with increasing age, and multimorbidity being the rule rather than the exception at old age. Most frequent combinations of chronic diseases include the most frequently occurring single chronic diseases. New descriptive epidemiological studies will probably not provide new results; therefore, future descriptive studies should focus on the prevalence rates of MCCs in subpopulations, statistical clustering of chronic conditions, and the development of the prevalence rates of MCCs over time. The finding of common trends also indicates the necessary transition to a next phase of MCC research, addressing the quality of care of patients with MCCs from an organizational perspective and with respect to the content of care. Journal of Comorbidity 2013;3(2)36–40

6

Authors: Martin Fortin, Susan M. Smith

The U.S. Department of Health and Human Services vision and strategic framework on multiple chronic conditions (MCCs) incorporates recommendations designed to facilitate research that will improve our knowledge about interventions and systems that will benefit individuals with MCCs (or multimorbidity). The evidence base supporting the management of patients with MCCs will be built both through intervention trials specifically designed to address multimorbidity and identification of MCCs in participants across the clinical trial range. This article specifically focuses on issues relating to external validity with specific reference to trials involving patients with MCCs. The exclusion of such patients from clinical trials has been well documented. Randomized control trials (RCTs) are considered the “gold standard” of evidence, but may have drawbacks in relation to external validity, particularly in relation to multimorbidity. It may, therefore, be necessary to consider a broader range of research methods that can provide converging evidence on intervention effects to address MCCs. Approaches can also be taken to increase the usefulness of RCTs in general for providing evidence to inform multimorbidity management. Additional improvements to RCTs would include better reporting of inclusion and exclusion criteria and participant characteristics in relation to MCCs. New trials should be considered in terms of how they will add to the existing evidence base and should inform how interventions may work in different settings and patient groups. Research on treatments and interventions for patients with MCCs is badly needed. It is important that this research includes patient-centered measures and that generalizability issues be explicitly addressed. Journal of Comorbidity 2013;3(2)30–35

8

Authors: Susan M. Smith, Elizabeth A. Bayliss, Stewart W. Mercer, Jane Gunn, Mogens Vestergaard, Sally Wyke, Chris Salisbury, Martin Fortin

Multimorbidity is a major challenge for patients and healthcare providers. The limited evidence of the effectiveness of interventions for people with multimorbidity means that there is a need for much more research and trials of potential interventions. Here we present a consensus view from a group of international researchers working to improve care for people with multimorbidity to guide future studies of interventions. We suggest that there is a need for careful consideration of whom to include, how to target interventions that address specific problems and that do not add to treatment burden, and selecting outcomes that matter both to patients and the healthcare system. Innovative design of these interventions will be necessary as many will be introduced in service settings and it will be important to ensure methodological rigour, relevance to service delivery, and generalizability across healthcare systems. Journal of Comorbidity 2013;3(1):10–17