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Proposed model of integrated care to improve health outcomes for individuals with multimorbidities

Authors Sampalli T, Fox R, Dickson, Fox

Received 20 June 2012

Accepted for publication 12 September 2012

Published 25 October 2012 Volume 2012:6 Pages 757—764

DOI https://doi.org/10.2147/PPA.S35201

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Tara Sampalli, Roy A Fox, Robert Dickson, Jonathan Fox

Integrated Chronic Care Service, Primary Health Care, Capital Health, Nova Scotia, Canada

Abstract: Multimorbidity is defined as the coexistence of multiple chronic conditions. Individuals with multimorbidity typically present with complex needs and show significant changes in their functional health and quality of life. Multimorbidity in the aging population is well recognized, but there has been limited research on ways to manage the problem effectively. More recent studies have demonstrated a high prevalence of multimorbidity in the younger demographics aged under 65 years. There is a definite need to develop models of care that can manage these individuals effectively and mitigate the impact of illness on individuals and the financial burden to the health care system. An integrated model of care has been developed and implemented in a facility in Nova Scotia that routinely treats individuals with multiple chronic conditions. This care model is designed to address the specific needs of this complex patient population, with integrated and coordinated care modules that meet the needs of the person versus the disease. The results of a pilot evaluation of this care model are also discussed.

Keywords: multimorbidities, integrated care, self-management, functional health, quality of life

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