As multimorbidity is one of the most important and challenging aspects in public health, monitoring this phenomenon in the general population is important. Unfortunately, few population-based data sources exist that provide information on the occurrence (prevalence) of multimorbidity. However, based on data from the national health interview survey, Sciensano measures an indicator on multimorbidity in the Belgian population since 1997.
Patients with multimorbidity suffer from two or more (concurring) diseases. These diseases have to be chronic, meaning that they are prolonged in duration, do not resolve spontaneously, and are rarely cured completely. Multimorbidity increases with age. Compared to people with one or no chronic diseases, people with multimorbidity face a higher risk of functional decline, poorer quality of life, greater health care use and increased mortality.
How common is multimorbidity?
The number of people with multimorbidity is high and increases with age, affecting more than 60% of people aged 65+ in Belgium. Multimorbidity is associated with numerous negative consequences, including mortality, disability and poor quality of life. It has also a major impact on health care use and the associated costs. Multimorbidity occurs more often among socially disadvantaged population groups, and thus failure to provide appropriate care for multimorbid patients is likely to also have a negative effect on equity in health care.
Why is multimorbidity a cause of concern?
Although multimorbid patients have complex health needs, the current focus is still too much on traditional disease-oriented approaches. Consequently, multimorbid patients often receive fragmented care, leading to inefficient, ineffective, and possibly harmful clinical interventions. They often receive complex drug regimens, which increase the risk of inappropriate prescription, drug-drug interactions, adverse drug reactions and poor adherence to medications. In addition, compared to persons with one chronic disease, multimorbid patients more often have problems related to mobility, self-care, day-to-day functioning, quality of life, and they also have more pain and cognitive problems, which makes care and treatment challenging.
How should patients with multimorbity be managed?
Multimorbidity challenges the “single-disease” viewpoint currently assumed in health care, prescription behaviour, medical research and medical education. Models of care for patients with multimorbidity will have to focus on the idea of ‘treating people, not disease’. This will require a more coordinated approach between different health professionals, also taking into account social needs.