Multimorbidity is defined by multiple co-existing chronic conditions. Research has shown that 80% of GP consultations are with patients with mulimorbidity, and these patients often have complex health needs.
Please look at the following resources to learn more about multimorbidity:
1) Listen to this podcast about managing multimorbidity in primary care
2) Read the NICE clinical knowledge summaries around managing multimorbidity
You may find it useful to review the NICE CKS guidelines on COPD, Diabetes, Acute Kidney Injury and Chronic Kidney Disease as well as the DAMN drug review and sick day rules
SDM has been described by NICE as when health professionals and patients work together putting people at the centre of decisions about their own treatment and care. NICE describe some of the benefits, how they are supporting shared decision making and patient decision aids. However SDM is not necessarily simple to achieve in the time allotted to GP consultations.
This article explores reasons for failures in SDM such as: doctors’ perceptions about patients’ desire to share decisions; doctors’ ability to facilitate shared decision making; concerns regarding time pressures; apprehension about what patients will demand; and a false perception by clinicians that they are already doing SDM effectively.
Another article calls for more honesty on what is possible regarding SDM: Shared decision making a need for honesty Despite these challenges there is evidence of development of language around SDM, for example with medication taking, with movement from the concept of patient 'compliance' to 'adherence' and more recently the concept of 'concordance' being used. To understand these better, read the core tip section of the following article.