Programme no. 326-OP
Professional Development
The relevance of multimorbidity for patients and general practictioners - the role of diagnoses, risk factors and symptoms in the definition. Results from a systematic review.
Tora Grauers Willadsen*1, Rasmus Køster-Rasmussen2, Dorte Ejg Jarbøl3, Anna Bebe4, Ann Dorrit Guassora5, Frans Boch Waldorff6, Susanne Reventlow7, Niels de Fine Olivarius8
1The Research Unit for General Practice,University of Copenhagen, Department of Public Health,Copenhagen,Denmark, 2The Research Unit for General Practice,University of Copenhagen, Department of Public Health,Copenhagen,Denmark, 3The Research Unit for General Practice,University of Southern Denmark,Odense,Denmark, 4The Research Unit for General Practice,University of Copenhagen, Department of Public Health,Copenhagen,Denmark, 5The Research Unit for General Practice,University of Copenhagen, Department of Public Health,Copenhagen,Denmark, 6The Research Unit for General Practice,University of Copenhagen, Department of Public Health,Copenhagen,Denmark;The Research Unit for General Practice,University of Southern Denmark,Odense,Denmark, 7The Research Unit for General Practice,University of Copenhagen, Department of Public Health,Copenhagen,Denmark, 8The Research Unit for General Practice,University of Copenhagen, Department of Public Health,Copenhagen,Denmark
* = Presenting author
Objectives: This presentation presents the results of a systematic literature review on the definitions of multimorbidity with focus on the role of diagnoses, risk factors and symptoms in the definition.
Background: The number of people living with several coexisting conditions, multimorbidity, is rising. Multimorbidity has major implications for the individual with increased mortality and low quality of life. In primary care the majority of consultations include patients having multimorbidity. Multimorbidity, however, is not well defined and we do not know if those patients with the heaviest illness burden are captured by the definition. Symptoms are often the reason for patients consulting their doctor and can be viewed as an aspect of the burden they experience. Risk factors, on the other hand, are an awareness of a future, rather than a present, burden.
Results: Overall, the definitions fall in two categories; 1) Distinct definitions (n=115), where cut-offs of 2, 3, 4 or more conditions selected from diagnoses or symptoms need to be present, or 2) Index definitions (n=27), where the degree of multimorbidity is graded with a scoring system. Diabetes, stroke and cancer were the most prevalent diagnoses in the existing distinct definitions. Risk factors were included in 85% of the definitions with hypertension, osteoporosis and hypercholesterolemia as the most prevalent. Symptoms were less frequently included with a great diversity in included symptoms occurring in 62% of the definitions. Back pain, visual impairment and urinary incontinence were the most prevalent symptoms.
Material/Methods: The databases PubMed, Embase and Cochrane were searched for multimorbidity with different linguistic variations, limited to original articles, English language and research in humans. 943 titles and abstracts were screened and 163 articles were included in the study. Among other variables information on diagnoses, symptoms and risk factors were collected. The review was conducted according to PRISMA guidelines.
Conclusion: The concept of multimorbidity mainly includes diagnoses. Risk factors have an important role in the definition but symptoms are less frequently included. Based on the results it is unlikely that these definitions of multimorbidity entirely reflect the burden of living with several chronic conditions. It is important to consider definitions more meaningful to the patient and for general practice.
Points for discussion: How can multimorbidity be more patient-oriented and less diagnose-focused?

Is it meaningful to include risk factors in the definition of multimorbidity?