Multimorbidity is the coexistence of multiple chronic diseases and medical conditions in one individual. Multimorbidity occurs disproportionately within socio-economically disadvantaged populations, the elderly, and particularly in populations that are both. The prevalence of multimorbidity in Ireland, whilst not yet clearly established, is expected to rise. In 2006 11% of the population were >65 years, this is expected to increase to 25% in 2026.
In Ireland, the Department of Health and Children’s (DoHC) policy documents ‘Tackling chronic disease’ and the National Health Strategy ‘Quality and Fairness’ recognise that with an aging population will come a significant increase in chronic diseases, and emphases the need for its prevention and management, for which primary care has a central role. The Health Service Executive’s (HSE) ‘Transformation programme’ acknowledges and prioritises the need to address the inadequate and fragmented services for chronic diseases. They recognise the need to implement a model for the prevention and management of chronic diseases and multimorbidity, to achieve high quality care through comprehensive and integrated programmes in the community. Primary, Community and Continuing Care (PCCC) services are identified as the path to optimal care and cost effectiveness and is therefore is ideally placed to meet the challenges of caring for patients with multimorbidity.
Some countries have developed models of care to manage patients with multimorbidity who are at a high risk of hospitalisation. These models incorporate a case management approach. There is no such model in Ireland for this cohort of patients.
Over the next few weeks we’ll be looking at some examples of disease and case management models of care.