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J Health Serv Res Policy. 2013 Oct;18(2 Suppl):29-37. doi: 10.1177/1355819613492148.

Multimorbidity and delivery of care for long-term conditions in the English National Health Service: baseline data from a cohort study.

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Professor of Health Services Research, NIHR School for Primary Care Research, Centre for Primary Care, University of Manchester, UK.



Many patients with long-term conditions have multiple conditions. Current delivery of care is not designed around their needs and they may face barriers to effective self-management. This study assessed the relationships between multimorbidity, the delivery of care, and self-management.


We surveyed 2439 patients with long-term conditions concerning their experience of the delivery of care and self-management in England in 2011. We assessed multimorbidity in terms of a count of long-term conditions and the presence of 'probable depression'. We explored the relationships between multimorbidity, patient experience of the delivery of care, and self-management


Neither measure of multimorbidity was a significant predictor of patients' experience of the delivery of care. Patients with multimorbidity reported higher levels of self-management behaviour, while the presence of depression was associated with less positive attitudes towards self-management.


The current data do not demonstrate a consistent impact of multimorbidity on patients' experience of care or on self-management. Further research is required to assess those types of multimorbidity that are associated with significant deficits, or to identify other aspects of care that might be problematic in the context of multiple conditions.


long-term conditions care; multimorbidity; patient experience; self care

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