University of DundeeSchool of Medicine Multimorbidity (and resource allocation) Bruce Guthrie Professor of Primary Care Medicine University of Dundee

Summary Multimorbidity in Scotland Multimorbidity and acute hospital admission in Scotland Additional data you could potentially use Basing resource allocation on current use – a cautionary tale from Scottish general practice

Payne et al. CMAJ 2013; 185: E221-E228

Measuring multimorbidity Charlson Score or similar based on SMR01 Can’t currently access GP morbidity data (and big coding issues) Can access patient level prescribing data which partly explains primary care consultation – Demographics + practice explain 22% of variation – Adding no. of drugs increases to 42% (compared to 37% for ACG, 36% for EDC, 35% for RUB, 30% for QOF Disease Count and 26% for Charlson). Brilleman et al. Family Practice Brilleman et al. Univ of York Centre for Health Economics Research Paper 72 (2012).

Cautionary tale Unpublished and therefore confidential data courtesy of Graham Watt and Stewart Mercer Routine data – NHS income for all practices – Consultation rates estimated from PTI – Multimorbidity estimated from our MM data – Standardised mortality <75 for all practices

Summary Multimorbidity – Common and socially patterned Multimorbidity and acute hospital admission – Strongly associated (sicker people are sicker…) Additional data you could potentially use – New PIS patient level prescribing data Basing resource allocation on current use – Risk of circularity

Acknowledgements CSO funding for ARPG 07/01 Stewart Mercer, Graham Watt (University of Glasgow), Karen Barnett (University of Edinburgh), other members of the Living Well Programme team. Primary Care Clincial Information Unit, University of Aberdeen.