88th EGPRN Meeting, Tampere-Finland, 9-12 May 2019
If patients have more than a single chronic diagnosis, they are called multi-morbid. Such patients are, as the nature of the multi-morbidity definition implies, bothered by more and more varied symptoms and complications and are frequent users of the health care system. Also, as treatment quality improves, people stay out of hospitals, live longer and have more time to gather diagnoses without seriously affecting their level of functionality; their diseases have to be managed in primary care. Primary care is anyway the obvious place for the management of the multi-morbid because of its holistic view of health management; the lack of focus on a single diagnosis or organ. Hence, studies that center on multi-morbidity are naturally based in general medicine research groups.
While we can agree that multi-morbidity is a problem – which is getting bigger, and more based in primary care – it is harder to point out what actually the problem is with multi-morbidity and how we can use this concept in practice. There is a trap while performing studies in multi-morbidity. If research questions and analyses are not well thought through, such studies will give obvious and rather useless results: people with multi-morbidity have higher mortality and healthcare use than people with less disease; people with multi-morbidity display a greater variety of problems; etc. If an alarming increase in the incidence of multi-morbidity is observed this could be taken as happy news: these people live longer and have more time to gather the diagnoses necessary. Hence, a more useful focus of studies with multi-morbidity is how such information can be used in the management of the health of these people: de-clutter treatment programmes, streamline logistics, making sure that the treatments for the various diseases do not cause more and other problems, and, eventually, see whether multi-morbidity can be used as a resource.
In the last ten years in the Research Unit for General Practice in Copenhagen we have had a focus on multi-morbidity. While the research we have conducted ranges from complete surveys of the whole of Denmark using the national administrative databases, to the synthesis of the life story of a single patient with multiple diagnoses, we have always tried to put the research in service of clinical practice. In this workshop we will give an overview of the multi-morbidity research that we have been doing, how this research gives us information that can be used in the treatment of our patients, and how this research could have been useless if we would have been too lazy to think of the right research questions. Thereafter the workshop participants will try their hands at formulating their own research projects building on the ideas from the presented projects, and hopefully venture beyond these examples! The facilitators have quite some expertise in various research methods and will help with keeping the projects feasible and will try to keep you from the pitfalls of getting obvious and useless results. At the end of the workshop, we will discuss the projects and investigate whether some of these projects could be turned into reality!
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