Multimorbidity: a primary health care checklist

The multitude of practitioners can lead to fragmented care which can seem to be unnecessarily time consuming or disruptive for those affected as well as their partners, carents and carers.

It can also be frustrating because symptoms and concerns have to be repeated to everyone involved with the added risk of confusing or even losing the key messages and advice.

Effective treatment for people living with multimorbidity can be challenging and can seem elusive. Each condition usually requires its own medication and therapy regime and as the number of health problems increases, so does the number of medicines and treatments. The different medicines are not always compatible which can sometimes offset their benefits or cause unwanted interactions with unpleasant or risky side effects.

The administrative challenge of multimorbidity can also be onerous, even overwhelming – a constant stream of letters, forms, care plans, prescriptions, and appointments to (re)schedule. With limited time, poor health and competing demands, even the paperwork can seem unnecessary complex.

Everyone has their own perspective on life and what they want from it and their care. This is often shaped by personal values, priorities or goals. Personalising care involves understanding these perspectives and tailoring care accordingly.

Care can be tailored towards personal priorities such as:
• maintaining independence
• preventing something awful happening eg a stroke
• reducing the number of tablets you take or the range of appointments you attend
• living longer
• being able to participate in hobbies, social activities, work, family life
• reducing medicine related side effects or risks
• lengthening life.

Before the special appointment, it will be useful if you can help your parent consider their own priorities – what matters most to them? and what they want the GP to take into account? These questions might be helpful for them to consider:
• How do your health problems affect you? How do you feel about that?
• Are your treatments helping, or do you have any side effects that cause you problems?
• Is it difficult to get to your healthcare appointments? Are they a long way from your home?
• What matters most to you about your health and everyday life?
• Is there one problem that bothers you more than others?
• Are you most concerned about symptoms you have now, or worried about future problems?
• Are you worried about losing your independence?
• What sort of activities do you want to be able to do?

The special appointment is also an opportunity for you and your parent to ask the GP questions about care. These questions can cover lifestyle and support, medicines, decisions about treatments, healthcare appointments. This link will give you some ideas about the sorts of things other people ask and which you might want to explore.

Medication reviews are an important and essential part of care for anyone. Reviewing medicines is an opportunity to stop some medicines and start others. This might be done as part of the special appointment or it could be done at (yet) another appointment.

In reviewing your parent’s prescriptions, a GP or pharmacist should discuss:
• how helpful each medicine is in terms of treating current problems and preventing other
• any side effects from the medicine eg constipation, drowsiness, feeling unsteady
• what could happen by stopping a medicine
• alternative medicines which might have different risks or benefits.

Together, you (if that’s what your parent wants), your parent and their GP, should agree a plan which will improve their care and quality of life. It should say who will coordinate all the care across different health and care services and what will happen in an emergency or urgent situation. It should also say what has been agreed about any changes to medicines, treatments or appointments, and when things will be reviewed again.

The plan should be given to your parent in a way that is easy for them to use and to understand. With their agreement, family members, carents or carers can also have a copy of the plan .