Multimorbidity, the co-existence of two or more chronic conditions in an individual without considering the index disease, is an increasing public health challenge globally. Recent systematic reviews indicate multimorbidity trend to be rising in low-and-middle income countries (LMICs) including India. Moreover, in LMICs, the magnitude of non-communicable diseases (NCDs) is compounded by prevalent chronic infectious diseases (HIV, TB) leading to a disproportionate burden of multimorbidity. The study, first to assess the burden of multimorbidity among primary care patient population in India, found a high prevalence of over 28%. Multimorbidity is also found to be significantly prevalent across different age groups, care settings, and vulnerable populations. Researchers in LMICs, such as Pakistan and Ethiopia, have also reported a high prevalence of multimorbidity using our validated Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC) tool.
Multimorbidity is associated with poorer patient reported outcome measures such as functional ability, psycho-social well-being and health-related quality of life. Further, the complex care needs in multimorbidity leads to polypharmacy, increased healthcare utilization and expenditure. Recent studies indicate multimorbidity to be associated with a higher risk of frailty, falls and abuse, especially among older adults. Furthermore, in the absence of an integrated management protocol, clinical decision-making for multimorbidity is often complicated by conflicting disease specific guidelines leading to fragmented care seeking pathways, decreased patient enablement and poor primary-secondary care interface. In order to address the varied healthcare challenges of multimorbidity, a comprehensive health systems response is essential. Primary healthcare being the first and foremost point of contact for most patients with multimorbidity should be the fulcrum for providing continuous and coordinated care. At the same time there is a need for health systems strengthening, building physician competency, patient activation and empowerment supported by technology-enabled innovations and evidence informed policy and practice guidelines. This requires context-specific research on multimorbidity using an integrated practice, research and academics approach through an enabling platform for research and capacity building. Although multimorbidity is on the rise, research, training and innovations in multimorbidity has not gained pace commensurately in theLMICs. This necessitates strengthening of research ecosystem and capacity in multimorbidity at all levels of healthcare in LMICs.
