Multimorbidity: A key influencer of complexity and care integration within primary care

Hughes, Llloyd David

Abstract

This paper represents a connective narrative towards the award of a PhD by Published Works by Edinburgh Napier University. The papers represent a body of literature that investigate responses to demands on primary care in Scotland in the context of an increasing prevalence of multimorbidity. This is a key area for health policy given population trends. Multimorbidity is challenging given the attendant complexity resulting from interactions between conditions as well as treatments. Papers have thus investigated implications for prescribing, clinical guidelines and hospital readmission. These are issues for which policy urgently needs evidence if it is to provide health and social care provision that is sustainable for the future.
The narrative provides an overview of the six papers that form the body of literature and how they relate to the three requirements of a PhD by publication specifically, independence, originality, and significance. It then considers them within the framework of the Ariadne Principles highlighting the importance of evidence in enabling informed decision making by patients supported by their general practitioners. This demonstrates how clinicians can involve patients in care decisions that addresses their primary concerns, such as issues to prioritise symptom control, whilst still being realistic and involving judicious prescribing.
It then moves on to consider the future of the field arguing that there needs to be nuance and pragmatism within a strong primary care system. Wider changes will be needed to address the challenges of increasing prevalence of people who have multimorbidity, but change is also required at the consultation level.
Understanding of multimorbidity is constantly evolving. However, the issues of appropriate prescribing, guidelines that go beyond simplistic single condition advice, and avoidance of unnecessary hospitalisations will continue to be fundamental issues for which ongoing research will be crucial to health and social care sustainability.

Citation

Hughes, L. D. Multimorbidity: A key influencer of complexity and care integration within primary care. (Thesis by Publication). Edinburgh Napier University

• Thesis Type: Thesis by Publication
• Deposit Date: Sep 3, 2024
• Publicly Available Date: Sep 9, 2024
• DOI: https://doi.org/10.17869/enu.2024.3789777
• Award Date: Jul 5, 2024