Background Patients with multimorbidity often face fragmented treatments. Steno Diabetes Center Aarhus has introduced an intervention for outpatients to initiate and participate in Multidisciplinary Team (MDT) meetings with specialists from various clinics, intended to potentially improve care coordination and treatment outcomes. The aim of this study was to gain an in-depth understanding of the experiences and perspectives of patients with multimorbidity regarding their participation in patient-initiated MDT meetings. Methods Data were gathered from 16 semi-structured interviews with patients who initiated and participated in MDT meetings. The study used Interpretive Description as the methodology and Janet K. Shim’s concept of Cultural Health Capital as the theoretical framework. Results Analysis identified three main themes: Group Composition, including sub-themes on Content of the Conversation and Familiarity with Specialists; Communication and Decision-Making Involvement; and Post-MDT Meeting Reflections and Outcomes. Participants found the meetings effective in addressing issues with specialist coordination and medication. The majority reported satisfaction with the dialogue and their involvement, though the specialist composition did not always meet expectations. Conclusion Patient-initiated MDT meetings have the potential to improve collaboration between patients and specialists, reduce concerns, and provide patients with greater security. For effectiveness, meetings should address issues across multiple specialties, with clear alignment of expectations and information. Medication review was highly prioritized by patients and should be given higher priority beyond the MDT framework. Additional research is needed to explore how patients with severe, complex, and multidisciplinary treatment needs can be encouraged to participate in MDT meetings or similar forums, tailored to their specific requirements.
Background Treatment burden is a key determinant of outcomes for people living with multimorbidity (PLWMM). However, contextually appropriate measures are lacking in low-income settings. We developed and conducted initial validation of the SIMMBA patient-reported outcome measure (PROM) to assess multidimensional treatment burden in South Africa. Methods Following COSMIN guidelines, items were generated through literature review, expert consultation, and cognitive interviews, and translated into local languages, Afrikaans and IsiXhosa. A cross-sectional study was conducted among 332 adults with multimorbidity attending public primary care clinics in Cape Town. Psychometric evaluation included exploratory factor analysis (EFA), internal consistency (McDonald’s omega and Cronbach’s alpha), test–retest (n=99) reliability (Spearman correlation and intraclass correlation coefficients [ICC]), and differential item functioning (DIF) by gender. Results Internal consistency was acceptable to good across all domains (ω=0.54–0.83; α=0.643–0.803), except medication burden (ω≈0.21). Most domains showed no evidence of DIF, with two items flagged. Test–retest reliability was predominantly poor to fair (ICC range 0.33–0.55), indicating limited temporal stability. EFA supported a 64% of variance, with generally strong item loadings, although some cross-loadings and low communalities were observed. Participants reported highest burden in the financial domain and lowest in social support. Conclusions The SIMMBA PROM demonstrates promising preliminary validity in capturing context-specific treatment burden among PLWMM in low-income South African settings. However, further structural refinement, convergent validation, and improved reliability testing are required prior to implementation.
Background Chronic liver disease (CLD) is a major global health threat traditionally managed through a “hepatocentric” lens, which often overlooks the systemic complexity of the disease. This systematic review aims to identify multimorbidity patterns (clusters) in adults with CLD and evaluate their specific impact on clinical outcomes and mortality risk. Methods A systematic search was performed across PubMed, Scopus, CINAHL, and Web of Science for studies published until July 2025. Following PRISMA guidelines, 19 high-quality studies (12 cohort and 7 cross-sectional) were selected. We analysed multimorbidity clusters, focusing on cardiometabolic, mental health, and musculoskeletal domains, and extracted effect sizes (HR and OR) to determine prognostic impact. Results Multimorbidity affects up to 99% of patients with CLD. Three primary clusters were identified: the cardiometabolic cluster, linked to the Liver-Cardio-Kidney-Metabolic (CKM) syndrome; the mental health cluster, where depression increases mortality risk by 49% (HR 1.49); and the musculoskeletal cluster, where myosteatosis is associated with a 2.9-fold increased risk of severe fibrosis (OR 2.9). Notably, the presence of two or more extrahepatic conditions doubles the mortality risk (HR 2.00). These findings demonstrate that extrahepatic clusters are independent predictors of poor prognosis in patients with liver dysfunction. Conclusion The survival of CLD patients depends on the totality of the disease network rather than isolated hepatic function. Effective management requires a transition to an integrated multidisciplinary model, incorporating routine screening for sarcopenia and mental health disorders to mitigate systemic frailty.
Background Multimorbidity is often overlooked in young people. More research is needed to determine how it should be defined in this population and how including psychiatric conditions affects overall and race/ethnicity-specific prevalence estimates. Methods Using data from the Healthy Minds Study (N = 96,050; September 2020–June 2021)—a weighted, nonprobability sample of students aged 18–29 years—we estimated the prevalence of multimorbidity based on 13 physical and 10 psychiatric conditions. We also used multivariable logistic regression to examine associations between race/ethnicity and physical, psychiatric, mixed, and any multimorbidity. Results The prevalence of multimorbidity was 5.3% for physical, 26.5% for psychiatric, 14.2% for mixed, and 32.2% for any multimorbidity. By unweighted co-occurrence count, the most common pair-wise co-occurences were asthma and other chronic disease for physical conditions, anxiety and depression for psychiatric conditions, and anxiety and asthma for mixed conditions. Including psychiatric conditions substantially increased the prevalence of any multimorbidity, with the largest absolute increase among American Indian/Alaska Native students and White students. Conclusion This study explored the value of integrating physical and psychiatric conditions into a working definition of multimorbidity in a large sample of young adult students in higher education in the United States. The findings show how the operational definition of multimorbidity can differentially affect prevalence estimates across racial/ethnic groups.
