title: Multimorbidity in younger deprived patients: an exploratory study of research and service implications in general practice.
abstract: BACKGROUND
  Multimorbidity has been defined as the co-existence of two or more chronic conditions. It has a profound impact on both the individuals affected and on their use of healthcare services. The limited research to date has focused on its epidemiology rather than the development of interventions to improve outcomes in multimorbidity patients, particularly for patients aged less than 65 years. Potential barriers to such research relate to methods of disease recording and coding and examination of the process of care. We aimed to assess the feasibility of identifying younger individuals with multimorbidity at general practice level and to explore the effect of multimorbidity on the type and volume of health care delivered. We also describe the barriers encountered in attempting to carry out this exploratory research.
  
  
  METHODS
  Cross sectional survey of GP records in two large urban general practices in Dublin focusing on poorer individuals with at least three chronic conditions and aged between 45 and 64 years.
  
  
  RESULTS
  92 patients with multimorbidity were identified. The median number of conditions was 4 per patient. Individuals received a mean number of 7.5 medications and attended a mean number of GP visits of 11.3 in the 12 months preceding the survey. Barriers to research into multimorbidity at practice level were identified including difficulties relating to GP clinical software; variation in disease coding; assessment of specialist sector activity through the GP-specialist communications and assessment of the full scale of primary care activity in relation to other disciplines and other types of GP contacts such as home visits and telephone contacts.
  
  
  CONCLUSIONS
  This study highlights the importance of multimorbidity in general practice and indicates that it is feasible to identify younger patients with multimorbidity through their GP records. This is a first step towards planning a clinical intervention to improve outcomes for such patients in primary care.
authors.affiliation: Department of Public Health and Primary Care, Trinity College, Dublin 2, Ireland. susmith@tcd.ie
authors.forename: Susan M
authors.initials: SM
authors.lastname: Smith
authors.forename: Atakelet
authors.initials: A
authors.lastname: Ferede
authors.forename: Tom
authors.initials: T
authors.lastname: O'Dowd
mesh_terms: D002908:Chronic Disease / Q000145:classification / Q000453:epidemiology*; D015897:Comorbidity; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D038801:International Classification of Diseases; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D019037:Urban Health Services