1. Multimorbidity in Scotland The Scottish School of Primary Care’s Multimorbidity Research Programme.

2. The Slide Pack The Scottish national data shown uses: – Clinical data from 310 Scottish general practices for 1,754,133 registered patients, and was provided by the Primary Care Clinical Informatics Unit (“PCCIU data”) – Or clinical data from 40 Scottish general practices linked to hospital admissions data (“ISD and PCCIU data”) Data on consultations in general practice from a previous study of over 3,000 patients living in either high or low deprivation areas of Scotland is also referred to, as are examples of experiences from a recent qualitative interview study with people living in some of the most deprived areas in Scotland Please use data & graphs freely with acknowledgement

3. Multimorbidity in Scotland Multimorbidity is the presence of two or more long term conditions. The Long Term Conditions Alliance Scotland call it ‘having multiple conditions’. It matters because: Living with multiple conditions is the norm rather than the exception for many people. It is associated with poorer quality of life, more hospital admissions and higher mortality Health services are largely organised to provide care for single diseases

4. – The majority of over-65s have 2 or more conditions, and the majority of over-75s have 3 or more conditions – More people have 2 or more conditions than only have 1 Multimorbidity is common in Scotland

5. Most people with any long term condition have multiple conditions in Scotland

7. There are more people in Scotland with multimorbidity below 65 years than above

8. People living in more deprived areas in Scotland develop multimorbidity 10 years before those living in the most affluent areas

9. Mental health problems are strongly associated with the number of physical conditions that people have, particularly in deprived areas in Scotland

10. International evidence shows that people with multimorbidity experience more problems with the coordination of their care

11. International evidence shows that people with multimorbidity experience more medical errors

12. People with multimorbidity in Scotland are much more likely to have emergency and potentially preventable admissions

13. People with multimorbidity in Scotland do not feel enabled by healthcare encounters In a study of over 3,000 GP consultations, patients with multimorbidity (compared to those without) had : More problems to discuss, which were more often complex (a mix of physical, psychological, and social); Yet Consultations were not longer for people with multi- morbidity; and Patient enablement was lower; These findings were worse in deprived areas, and GPs in deprived areas reported more stress in and after the consultations

14. “I’m just to trying to survive and get through each day” Illness workEveryday life work Work to keep a sense of their own identity People with multiple conditions in Scotland have to ‘work’ hard just to get by. “My life is painkillers, insulin, making sure I’ve got all my stock for my stoma…. It’s really hard work” “I don’t ask for help off anybody….I’m not that kind of person. I like to be strong. I’ve always (taken) care of my self. I’ve never asked naebody for help. Ever. … And now I just don’t want to ask (the GP) for help “

15. “Exhausting” “Demoralising” “I feel like a wrung-out rag at the end of consultations” “If you’re too caring... you’ll crack up in a place like this. Our boundaries lie where they are because they have to at the moment” General practitioners and practice nurses in deprived areas struggle to support people with multimorbidity

16. Implications Multimorbidity is the norm for people with long-term conditions in Scotland Multimorbidity contributes significantly to health inequalities and the inverse care law We need to understand how to better support people with multimorbidity Primary care is central to providing this support but practitioners also need support

17. The Scottish School of Primary Care’s Multimorbidity Research Programme The broad research objectives are: To describe the nature, extent and experience of multiple morbidity in primary care To describe the impact of multiple morbidity over time on health outcomes To develop and evaluate interventions that help people with multiple morbidities

18. The Scottish School of Primary Care’s multimorbidity programme – current research Living well with multimorbidity: the development of a primary care-based complex intervention for people with multimorbidity in deprived areas of Scotland Funded by CSO NHS Applied Research Programme Grant The MALT Study: the development of a cohort study of people with multiple and long-term conditions in Scotland. Funded by a SSPC Visiting Professor Award

19. Contacts Stewart Mercer, Professor of Primary Care Research, University of Glasgow: SSPC National Lead for Multimorbidity Research stewart.mercer@glasgow.ac.ukstewart.mercer@glasgow.ac.uk Bruce Guthrie, Professor of Primary Care Medicine, University of Dundee: Living Well with Multimorbidity Epidemiology workstream lead b.guthrie@dundee.ac.uk Sally Wyke, Professor of Interdisciplinary Research, University of Glasgow: Living Well with Multimorbidity Self-Management and Personal Experience lead sally.wyke@glasgow.ac.uk

20. Other researchers involved Researchers involved in the multimorbidity programme whose work has contributed to these slides includes: University of Glasgow: Rosaline O’Brien, Graham Watt. University of Dundee: Karen Barnett