ArticleBMJ open2019
Predicting poorer health outcomes in older community-dwelling patients with multimorbidity: prospective cohort study assessing the accuracy of different multimorbidity definitions.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Community care navigation intervention for people who are at risk of unplanned hospital presentations.The Cochrane database of systematic reviews · 2025Pooled it
- Components of the transitional care model (TCM) to reduce readmission in geriatric patients: a systematic review.BMC geriatrics · 2020Pooled it
- Community Specialist Teams for Older Persons (CST-OP) at risk of, or living with frailty in Ireland: a prospective cohort study of a new model of integrated care for community dwelling older adults.BMC primary care · 2025Observational
- A head-to-head comparison of the validity and predictive ability for health outcomes of diagnosis versus medication-based comorbidity indices.Aging clinical and experimental research · 2025Article
- Factors Affecting Medication Adherence in Middle-Aged and Elderly Patients in China: A Cross-Sectional Study.Medical science monitor : international medical journal of experimental and clinical research · 2025Article
- The Effect of Comorbidities on Asthma-Related Outcomes Over a Two-Year Period: A Prospective Analysis of Swiss Severe Asthma Registry (SSAR).Journal of asthma and allergy · 2025Article
- Medication regimen complexity and its impact on medication adherence in patients with multimorbidity at a comprehensive specialized hospital in Ethiopia.Frontiers in medicine · 2024Article
- Association between medication literacy and medication adherence and the mediating effect of self-efficacy in older people with multimorbidity.BMC geriatrics · 2023Article
- Article
- Medication Adherence Among Patients with Multimorbidity in the United Arab Emirates.Patient preference and adherence · 2022Article
- Comorbidity: From a Confounder in Longitudinal Clinical Research to the Main Issue in Population Management.Psychotherapy and psychosomatics · 2022Article
- Improvement of transitional care from hospital to home for older patients, the TIGER study: protocol of a randomised controlled trial.BMJ open · 2021Article
- Article
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeMultimorbidity is commonly defined and measured using condition counts. The UK National Institute for Health Care Excellence Guidelines for Multimorbidity suggest that a medication-orientated approach could be used to identify those in need of a multimorbidity approach to management.
objectivesTo compare the accuracy of medication-based and diagnosis-based multimorbidity measures at higher cut-points to identify older community-dwelling patients who are at risk of poorer health outcomes.
designA secondary analysis of a prospective cohort study with a 2-year follow-up (2010-2012).
setting15 general practices in Ireland.
participants904 older community-dwelling patients. EXPOSURE: Baseline multimorbidity measurements based on both medication classes count (MCC) and chronic disease count (CDC). OUTCOMES: Mortality, self-reported health related quality of life, mental health and physical functioning at follow-up. ANALYSIS: Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) adjusting for clustering by practice for each outcome using both definitions.
resultsOf the 904 baseline participants, 53 died during follow-up and 673 patients completed the follow-up questionnaire. At baseline, 223 patients had 3 or more chronic conditions and 89 patients were prescribed 10 or more medication classes. Sensitivity was low for both MCC and CDC measures for all outcomes. For specificity, MCC was better for all outcomes with estimates varying from 88.8% (95% CI 85.2% to 91.6%) for physical functioning to 90.9% (95% CI 86.2% to 94.1%) for self-reported health-related quality of life. There were no differences between MCC and CDC in terms of PPV and NPV for any outcomes.
conclusionsNeither measure demonstrated high sensitivity. However, MCC using a definition of 10 or more regular medication classes to define multimorbidity had higher specificity for predicting poorer health outcomes. While having limitations, this definition could be used for proactive identification of patients who may benefit from targeted clinical care.
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