Is multi-morbidity becoming normal?

Abstract

Introduction: Chronic conditions are known to be increasing with implications for their ongoing care; to date there is little information available regarding patient conditions within the Maltese outpatient sector. We assessed referrals to Medical Consultant Clinics/Schedule V Clinics, aiming to classify the reasons for referral, the relevant systems and identify multi-morbidity, defined as two or more concurrent medical conditions in the same patient. Methods: 100 consecutive Tickets of Referral (TOR) were prospectively analysed to identify the reasons for referral, the relevant system and whether multi-morbidity was present. All personal data were anonymised at source, with no possible backward linkage. Data were entered into an Excel ® sheet and analysed using a framework from the literature. Results: N=lOO, men 45%, women 49%, 6% unclear from TOR. The clinical tasks identified from the 'Reasons for referral' included treatment (89%), review (23%), diagnosis (5%) and handover (1%).93% were cardiometabolic referrals,2% respiratory, 2% neurology, 3% unclear referrals (to Schedule V Clinic). 80% of referrals were hypertensive, 17% diabetic, and 23% dyslipidaemic. Multimorbidity was indicated in 41%. Conclusion: Cardiovascular conditions accounted for the majority of referrals, who were referred mainly for treatment and review, reflecting ongoing chronic disease management. Just over a third of referrals had information indicating multi-morbidity in their TOR-the real proportion is likely to be higher given that the patients were still due to be assessed. In view of the implications of multi-morbidity for individual risk and prognosis, healthcare utilisation and cost, this figure is of concern, and warrants further investigation.