ABC of Multimorbidityis the first title to provide primary care practitioners with a practical approach to the complex issues of treating and managing patients with more than one morbidity.

Ageing populations and earlier diagnosis of chronic conditions mean more people are living longer with multimorbidity. However, treatment guidelines are often designed for treatment in isolation of other morbidities. Multimorbidity management therefore requires a more patient centred approach and greater knowledge and coordination of existing services. Effective multimorbidity management both improves overall patient well-being and reduces the overall demand on health services.

ABC of Multimorbidity examines how multimorbidities can be addressed within primary care, from the GP and family physician consultation through to the effective use of a range of health care services. It addresses complex issues such as polypharmacy, mental health, patient safety, patient involvement in self-management, and the role of the practitioner. It then provides guidance on how multimorbidities can be best treated and managed within primary care through specific interventions to improve outcomes.

From an international, primary care editor and contributor team,ABC of Multimorbidity is a practical resource for general practitioners, family physicians, practice and specialist nurses, and others caring for multimorbid patients. It is also relevant for junior doctors, medical trainees and students.

Stewart Mercer, Professor of Primary Care Research, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, UK and General Practitioner, Penicuik Health Centre, Penicuik, UK

Chris Salisbury, Professor of Primary Health Care, Centre for Academic Primary Care, University of Bristol, UK and General Practitioner, William Budd Health Centre, Bristol, UK

Martin Fortin, Professor of Family Medicine, Department of Family Medicine, Université de Sherbrooke, Canada and Family Physician, Centre de santé et de services sociaux de Chicoutimi, Canada

Contributors vii

Preface ix

Foreword xi

1 Introducing Multimorbidity 1
Martin Fortin StewartW. Mercer and Chris Salisbury

2 How Common Is Multimorbidity? 5
Marjan van den Akker and Christiane Muth

3 How Does Multimorbidity Affect Patients? 8
Elizabeth A. Bayliss

4 Effects of Multimorbidity on Healthcare Resource Use 12
Efrat Shadmi Karen Kinder and Jonathan P.Weiner

5 Multimorbidity and the Primary Care Clinic 17
Stewart W. Mercer and Chris Salisbury

6 Multimorbidity and Patient-Centred Care 22
Moira Stewart and Martin Fortin

7 Multimorbidity and the Healthcare Electronic Medical Record 26
Amanda L. Terry and Sonny Cejic

8 Treatment Burden and Multimorbidity 30
Katie I. Gallacher Victor M. Montori Carl R. May and Frances S. Mair

9 Multimorbidity and Mental Health 34
Peter Bower Peter Coventry Linda Gask and Jane Gunn

10 The Impact of Multimorbidity on Quality and Safety of Health Care 38
Jose M. Valderas Ignacio Ricci-Cabello and Concepción Violán

11 Implications of Multimorbidity for Health Policy 41
Chris Salisbury and Martin Roland

12 Optimizing Outcomes in Multimorbidity 46
Stewart W. Mercer Martin Fortin and Chris Salisbury

Index 49