Chronic care and multimorbidities

– Plan of the lecture

1) Definition of comorbidities/multimorbidities
2) What is the impact of multiple morbidities on
mortality, quality of life, health services use
3) Multimorbidities and fragmentation of supply,
the quest for continuity
4) Implications for research, guidelines, primary
care, medical homes, chronic care models
5) Epidemiology of multimorbidities, ageing and
socio-economic status
6) Effectiveness of integrated care models with
moltimorbidities
Health services research – Gianluca Fiorentini
 Multimorbodities – References used

1) Oecd «Meeting the challenge of ageing

and of multiple morbidities», 2011

2) Barnett et al. «Epidemiology of

multimorbidity and implications for
health care, research, and medical
education: a cross-sectional study»,
Lancet 2012

Health services research – Gianluca Fiorentini

 The challenge of multi-morbidity - Oecd 2011

Health services research – Gianluca Fiorentini

 The challenge of multi-morbidity - Oecd 2011

Health services research – Gianluca Fiorentini

 The challenge of multi-morbidity - Oecd 2011

Health services research – Gianluca Fiorentini

 The challenge of multi-morbidity - Oecd 2011

Health services research – Gianluca Fiorentini

 The challenge of multi-morbidity - Oecd 2011

Health services research – Gianluca Fiorentini

 The challenge of multi-morbidity - Oecd 2011

Health services research – Gianluca Fiorentini

 The challenge of multi-morbidity - Oecd 2011

Health services research – Gianluca Fiorentini

 The challenge of multi-morbidity - Oecd 2011

Health services research – Gianluca Fiorentini

 Impact of multi-morbidity on outcomes - Oecd

Health services research – Gianluca Fiorentini

 Multi-morbidity and mortality - Oecd 2011

Health services research – Gianluca Fiorentini

 Multimoridity and socio-economic status Oecd

Health services research – Gianluca Fiorentini

 Multi-morbidity and quality of life - Oecd 2011

Health services research – Gianluca Fiorentini

 Multi-morbidity - burden of disease - Oecd
2011

Health services research – Gianluca Fiorentini

 Multi-morbidity/use of resources - Oecd 2011

Health services research – Gianluca Fiorentini

 Multi-morbidity/use of resources - Oecd 2011

Health services research – Gianluca Fiorentini

 Multi-morbidity/fragmentation - Oecd 2011

Health services research – Gianluca Fiorentini

 Multi-morbidity/fragmentation - Oecd 2011

Health services research – Gianluca Fiorentini

 Multi-morbidity/coordination - Oecd 2011

Health services research – Gianluca Fiorentini

 Multi-morbidity/coordination - Oecd 2011

Health services research – Gianluca Fiorentini

 Multi-morbidity/safety - Oecd 2011

Health services research – Gianluca Fiorentini

 Multi-morbidity/safety - Oecd 2011

Health services research – Gianluca Fiorentini

 Multi-morbidity/polipharmacy - Oecd 2011

Health services research – Gianluca Fiorentini

 Multi-morbidity/polipharmacy - Oecd 2011

Health services research – Gianluca Fiorentini

 Multi-morbidity/polipharmacy - Oecd 2011

Health services research – Gianluca Fiorentini

 Multi-morbidity/polipharmacy - Oecd 2011

Health services research – Gianluca Fiorentini

 Multi-morbidity/polipharmacy - Oecd 2011

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Multi-morbidity/non life threatening Oecd 2011

Health services research – Gianluca Fiorentini

 Multi-morbidity/ Outcomes - Oecd 2011

Health services research – Gianluca Fiorentini

 Implications for research - Oecd 2011

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 Implications for guidelines - Oecd 2011

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 Implications for continuity of care - Oecd 2011

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 Implications for generalist care - Oecd 2011

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 Medical homes - Oecd 2011

Health services research – Gianluca Fiorentini

 Medical homes - Oecd 2011

Health services research – Gianluca Fiorentini

 Chronic care Model- Oecd 2011

Health services research – Gianluca Fiorentini

 Self management - Oecd 2011

Health services research – Gianluca Fiorentini

 Mental health - Oecd 2011

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 Performance measurement - Oecd 2011

Health services research – Gianluca Fiorentini

 Performance measurement - Oecd 2011

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 Conclusions - Oecd 2011

Health services research – Gianluca Fiorentini

 Epidemiology of multimorbidity – Barnett 2012

Health services research – Gianluca Fiorentini

 Cross-sectional study – Barnett 2012

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 Cross-sectional study – Barnett 2012

Health services research – Gianluca Fiorentini

 Socio-economic status – Barnett 2012

Based on 4 social indicators: low social class,

lack of car ownership, overcrowding and male
unemployment. Areas are split by postcode. 
Health services research – Gianluca Fiorentini
 Number of morbidities – Barnett 2012

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 Cumulate multimorbidities – Barnett 2012

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 Multimorbidities– Barnett 2012

Health services research – Gianluca Fiorentini

 Multimorbidities – Barnett 2012

Health services research – Gianluca Fiorentini

 Deprivation indicators – Barnett 2012

Health services research – Gianluca Fiorentini

 Multimorbidity and deprivation – Barnett 2012

Health services research – Gianluca Fiorentini

 Multimorbidity and socio-ec status–Barnett
2012

Health services research – Gianluca Fiorentini

 Multimorbidity and deprivation – Barnett 2012

Health services research – Gianluca Fiorentini

 Physical and mental disorders– Barnett 2012

Health services research – Gianluca Fiorentini

 Physical and mental disorders – Barnett 2012

Health services research – Gianluca Fiorentini

 Physical and mental disorders – Barnett 2012

Health services research – Gianluca Fiorentini

 Physical and mental disorders – Barnett 2012

Health services research – Gianluca Fiorentini

 Matrix of multimorbidities– Barnett 2012

Health services research – Gianluca Fiorentini

 Multimorbidity below 65 – Barnett 2012

Health services research – Gianluca Fiorentini

 Multimorbidity and deprivation – Barnett 2012

Health services research – Gianluca Fiorentini

 Multimorbidity and mental probs – Barnett
2012

Health services research – Gianluca Fiorentini

 Coordination of care – Barnett 2012

Health services research – Gianluca Fiorentini

 Call for more generalists – Barnett 2012

Health services research – Gianluca Fiorentini

 Primary care/social determinants – Barnett
2012

Health services research – Gianluca Fiorentini

 Primary care below 65 – Barnett 2012

Health services research – Gianluca Fiorentini

 Multipharmacy – Barnett 2012

Health services research – Gianluca Fiorentini