title: The challenges of multimorbidity from the patient perspective.
abstract: BACKGROUND
  Although multiple co-occurring chronic illnesses within the same individual are increasingly common, few studies have examined the challenges of multimorbidity from the patient perspective.
  
  
  OBJECTIVE
  The aim of this study is to examine the self-management learning needs and willingness to see non-physician providers of patients with multimorbidity compared to patients with single chronic illnesses.
  
  
  METHODS
  This research is designed as a cross-sectional survey.
  
  
  METHODS
  Based upon ICD-9 codes, patients from a single VHA healthcare system were stratified into multimorbidity clusters or groups with a single chronic illness from the corresponding cluster. Nonproportional sampling was used to randomly select 720 patients.
  
  
  METHODS
  Demographic characteristics, functional status, number of contacts with healthcare providers, components of primary care, self-management learning needs, and willingness to see nonphysician providers.
  
  
  RESULTS
  Four hundred twenty-two patients returned surveys. A higher percentage of multimorbidity patients compared to single morbidity patients were "definitely" willing to learn all 22 self-management skills, of these only 2 were not significant. Compared to patients with single morbidity, a significantly higher percentage of patients with multimorbidity also reported that they were "definitely" willing to see 6 of 11 non-physician healthcare providers.
  
  
  CONCLUSIONS
  Self-management learning needs of multimorbidity patients are extensive, and their preferences are consistent with team-based primary care. Alternative methods of providing support and chronic illness care may be needed to meet the needs of these complex patients.
authors.affiliation: VERDICT/South Texas Veterans Healthcare System, 7400 Merton Minter Blvd, San Antonio, TX, USA. noelp@uthscsa.edu
authors.forename: Polly Hitchcock
authors.initials: PH
authors.lastname: Noël
authors.forename: Michael L
authors.initials: ML
authors.lastname: Parchman
authors.forename: John W
authors.initials: JW
authors.lastname: Williams
authors.forename: John E
authors.initials: JE
authors.lastname: Cornell
authors.forename: Lee
authors.initials: L
authors.lastname: Shuko
authors.forename: John E
authors.initials: JE
authors.lastname: Zeber
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Kazis
authors.forename: Austin F S
authors.initials: AF
authors.lastname: Lee
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Pugh
mesh_terms: D002908:Chronic Disease / Q000523:psychology* / Q000628:therapy; D015897:Comorbidity; D005260:Female; D015438:Health Behavior; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000706:statistics & numerical data; D012648:Self Care / Q000523:psychology; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*