Multimorbidity is a clinical condition which is defined as a state where three or more chronic illness conditions prevail in a patient either centrally or dependant upon one or more central condition (Fortin et al., 2007). This clinical condition is characterised by overlapping pathophysiology, synergetic disease intensity and intersection of individual illnesses management (Boyd et al., 2010). Few examples of the composing illnesses include coronary heart diseases, dyspepsia, migraines, sleep disturbances, bowel imbalance and Sarcopenia ( Fortin et al., 2007)

Prevalence of multi morbidity varies across different parts of the world depending upon variance of population sample, age group of the society, advancement of health care monitoring systems and ethnic conditions. In developing countries like most of the Asian countries, rates of life expectancy are reported to increase due to advances is environmental and working conditions of the population. With the increase in life expectancy rates, the prevalence of coexistence of these diseases also steeply increases and is directly proportional (Akker et al., 1998). Further more, the prevalence of this clinical condition is more in developing countries when compared to that of developed countries due to increased percentage of vulnerable groups like young children, diseased and unattended patients and poor economical conditions (Valderas et al., 2009).

The government of UK launched a initiative in collaboration with the NHS to effectively manage care for patients with long term conditions. The initiative was designed in 2005 and termed as NHS and social care model. According to this model, people will be toughly identified based on the intensity of the long term illness and care plan is designed according to the identified degree of illness. After identification, people are graded in groups based on intensity and a systematic approach of treatment by a multidisciplinary team is levied with the support of specialist advice ( Scotland health white paper, 2003) The key principles of this ongoing program in Scotland include designing of pathways focusing on individual care plans, long term partnership plans of patients with service users and health care providers, partnership among different service users in providing care, self care and integrated solutions (Cretin et al, 2004).

NHS and Social care model gained immense response from people of Scotland and UK. The key features responsible for Improvement of long term care were investigated by the researchers as personal attention of matrons in every individual case, self control and setting up of some multi disciplinary groups.
The Wagner's chronic care model of Scotland worked enormously well in fulfilling purpose as it supported governing principles of various evidence based interventions. In addition, the principle of empowering people to make their own choice in terms of treatment contributed to effective working of this model (Wagner, 1998)

Through this process of empowerment, every individual thus formed a part of a team and designed care system to suit their needs according to the convenience (Wagner, 1998) The care system is therefore described as a unique blend of anticipatory care, early intervention of disorder, prevention and team work through a person centred model treatment which thereby reduced dependency and fear The quality of care designed by this approach in Scotland has been recognised on the world front due to features like safety, efficacy, efficiency, aptness, equitability and person centred approach. The fusion of high level quality service equipped with self management of individual with the necessary support made the health care model a huge success (Bodenheimer et al., 2002).

References:

Fortin M, Soubhi H, Hudon C, Bayliss EA, van den Akker M. Multimorbidity’s many challenges. BMJ. 2007;334:1016-7.

Boyd CM, Leff B, Wolff JL, et al. Informing Clinical Practice Guideline Development and Implementation: Prevalence of Co-existing Conditions Among Adults with Coronary Heart Disease. J Am Geriatr Soc. 2010;In Press.

Van den Akker M, Buntinx F, Metsemakers JF, Roos S, Knottnerus JA. Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. Journal of Clinical Epidemiology 1998;51:367–75.

Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health ser- vices. Annals of Family Medicine 2009;7:357–63.

Partnership for Care: Scotland's Health White Paper. http://www.scotland.gov.uk/Publications/2003/02/16476/18736 Cretin S, Shortell SM, Keeler EB. An evaluation of collaborative interventions to improve chronic illnesscare: framework and study design. Evaluation Review 2004; 28(1): 28-51.

Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998;1:2–4.

Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, Part 2. 2002 Oct 16;288(15):1909–14.