Multimorbidity: time for action rather than words.

Over the past few years there has been an explosion of interest in the concept of multimorbidity, the existence of multiple longterm conditions in one individual. A search of Medline for papers on multimorbidity or the related term comorbidity reveals that the number of publications on this topic has increased more than twenty fold in the past 20 years (Figure 1). Figure 1 Number of publications on multimorbidity or comorbidity by year. This level of interest of multimorbidity reflects a growing tension between two opposing trends. Medicine is increasingly focused on helping people to manage longterm conditions rather than treating acute illness, and many people have multiple longterm conditions, and yet medical services are becoming ever more specialised and fragmented. Attention has been paid to improving vertical integration across primary and secondary care using disease pathways for individual conditions such as diabetes or heart failure, but this can be at the expense of holistic coordinated care for people with multiple conditions. Thanks to all the research over the past two decades we have learnt a great deal about the epidemiology of multimorbidity, the consequences for patients and healthcare professionals of designing systems based on a single disease paradigm, and the adverse impact of multimorbidity on health. We now understand that multimorbidity is extremely common,1 and is particularly prevalent in deprived areas.2 Qualitative studies have shown that providing care for one disease at a time can be inconvenient, inefficient, and unsatisfactory, both for patients with multimorbidity and for healthcare professionals.3,– …