Review
The European General Practice Research Network Presents a Comprehensive Definition of Multimorbidity in Family Medicine and Long Term Care, Following a Systematic Review of Relevant Literature

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Abstract

Background

Multimorbidity is a new concept encompassing all the medical conditions of an individual patient. The concept links into the European definition of family medicine and its core competencies. However, the definition of multimorbidity and its subsequent operationalization are still unclear. The European General Practice Research Network wanted to produce a comprehensive definition of multimorbidity.

Method

Systematic review of literature involving eight European General Practice Research Network national teams. The databases searched were PubMed, Embase, and Cochrane (1990–2010). Only articles containing descriptions of multimorbidity criteria were selected for inclusion. The multinational team undertook a methodic data extraction, according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

Results

The team identified 416 documents, selected 68 abstracts, included 54 articles, and found 132 definitions with 1631 different criteria. These criteria were aggregated into 11 themes that led to the following definition: Multimorbidity is defined as any combination of chronic disease with at least one other disease (acute or chronic) or biopsychosocial factor (associated or not) or somatic risk factor. Any biopsychosocial factor, any risk factor, the social network, the burden of diseases, the health care consumption, and the patient’s coping strategies may function as modifiers (of the effects of multimorbidity). Multimorbidity may modify the health outcomes and lead to an increased disability or a decreased quality of life or frailty.

Conclusion

This study has produced a comprehensive definition of multimorbidity. The resulting improvements in the management of multimorbidity, and its usefulness in long term care and in family medicine, will have to be assessed in future studies.

Section snippets

Method

The method adopted was a systematic literature review with a multilingual team representing eight different nationalities (Belgian, French, German, Greek, Italian, Dutch, Polish, and Spanish). The collective linguistic ability of the team enabled the inclusion and interpretation of articles in various languages. The entire process was undertaken by groups of four different researchers, drawn from at least two different national teams. The review protocol, following the Preferred Reporting Items

Results

Identification, screening, eligibility, and inclusion processes are shown in Figure 1. Eligible articles are shown in Table 1 with their study type.

One article was not found, despite the help of three different university libraries. Of the 13 other excluded articles, four were editorials with no exclusion/inclusion criteria, seven were using multimorbidity without a clear description, and two were excluded on the basis of poor quality (ie, the average score awarded by the four researchers was

Discussion

This study was undertaken to provide a comprehensive definition of multimorbidity that would be understandable and usable for further collaborative research. The research team selected a systematic review methodology. Data extraction and analysis were based on a phenomenological perspective, using a grounded theory framework. The multilingual team successfully classified the extracted criteria and arrived at a definition using a thematic classification.

There are several important issues to note

Conclusion

This definition is intended to help researchers who are studying the inclusion/exclusion process in the detection of multimorbid patients. This definition is also intended to help FPs to identify multimorbid patients. The effect modifiers direct FPs, or other long term care physicians, toward the tools to help these patients. It provides new opportunities, where medical management is optimal, to lower the burden of multimorbidity. This definition brings into focus the possible outcomes of

Acknowledgments

With special thanks to Christophe Berkhout from France for his clear and specific advice throughout the research process, and to Claire Collins (and her team from the Irish College of General Practice) from Ireland and Jan Karl Soler from Malta for their checking of the English phrasing of the definition.

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    The authors have declared no conflicts of interest.

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