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Long-term health conditions are by far the largest contributor to health loss in New Zealand, accounting for 88% of disability–adjusted life years. The economic cost and burden on the health system is substantial and growing. There are important inequities both in the incidence and the outcomes from long-term conditions (LTCs). Multimorbidity is the coexistence of more than one chronic disease. Multimorbidity results in high health service use, competing demands on patients and health care professionals, reduced quality of life and higher mortality, with greater impact for Māori and Pacific people, and those living in deprived areas. In order to create sustainable health systems with empowered patients and communities, we need a radical change in our approach to managing these conditions. Research focused on multimorbidity is scarce internationally and almost non-existent in NZ. Our aims are to describe the prevalence, patterns and impact of multimorbidity in NZ, increase our understanding of patients’ experience of living with multimorbidity, and develop novel health service interventions aimed at reducing the impact of multimorbidity.

Kei ngā māuiui tūroa te tino wāhanga o te hauora ngaro ki Aotearoa, ka eke ki te 88% o ngā tau o te tangata e pāngia ana e te kopakopatanga. He nui tonu te utu ōhanga me te taimahatanga ka rangona e te pūnaha hauora, ā, kei te nui haere. Tērā tonu ngā ōritenga kore, arā mō te nui o te whai pānga me ngā huanga, i ngā māuiui tūroa nei. Ko te takimaha o ngā māuiui tūroa, koia ko te pānga atu o ngā māuiui tūroa e rua, nuku atu, ki te tangata kotahi. Ka hua i te takimaha o ngā māuiui tūroa nei, ko te rite tonu o te whakamahi i ngā ratonga hauora, ko te whakataetae o ngā whakakuene a ngā tūroro me ngā mātanga hauora, ko te whakaiti i te pai o te ora, ko te nui o te mate, ā, ka nui kē atu te whai pānga ki a Ngāi Māori me ngā iwi o te Moana-nui-a-Kiwa, me ngā tāngata kei te noho ki ngā takiwā pōhara. E hangā ai he pūnaha hauora e whakauka ana, e whai mana ana ngā tūroro me ngā hapori, me tino whakarerekē tātau i tā tātau whakahaere i ēnei āhuatanga. He ruarua noa iho nei ngā rangahau mō te takimaha o ngā māuiui tūroa i te ao, ā, e tino kore nei e kitea ki Aotearoa. Kei te whai mātau ki te whakamārama i te nui, i ngā āhuatanga, i te pānga hoki o te takimaha o ngā māuiui tūroa ki Aotearoa, ki te whakapiki i tō mātau mōhiotanga ki ngā wheako o ngā tūroro mō te ora me te takimaha o ngā māuiui tūroa, ki te whakarite hoki i tētahi kaupapa hou māna ka whakamāmā i te pānga atu o te takimaha o ngā māuiui tūroa.

Projects

Key publications

Elinor Millar, Jason Gurney, James Stanley, Jeannie Stairmand, Cheryl Davies, Kelly Semper, Anthony Dowell, Ross Lawrenson, Dee Mangin, Diana Sarfati (2019).  A pill for this and a pill for that: use and understanding of medication among people with multimorbidity.  Australasian Journal on Aging, 38(2), p91-97.

Stanley J, Semper K, Millar I, Sarfati D. Epidemiology of multimorbidity in New Zealand: A cross-sectional study using national-level hospital and pharmaceutical data. BMJ Open 2018;
8:e021689.

Stairmand J, Gurney J, Stanley J, Millar E, Davies C, Semper K, Dowell A, Mangin D, Lawrenson R, Sarfati D. The impact of multimorbidity on people’s lives: a cross-sectional survey. NZMJ 2018; 131(1477): 78-90.

Gurney J, Stanley J, Sarfati D. The M3 multimorbidity index outperforms both Charlson and Elixhauser indices when predicting adverse outcomes in people with diabetes. Journal of Clinical Epidemiology 2018; 99: 144-52.

Millar E, Stanley J, Gurney J, Stairmand J, Davies C, Semper K, Dowell T, Mangin D, Lawrenson R, Sarfati D. Impact of multimorbidity on health service utilisation and healthcare experiences J Primary Health Care 2018; 10(10): 44-53.

Millar E, Mangin D, Lawrenson R, Dowell A, Sarfati D. Clinical Guidelines: what happens when people have multiple conditions? NZ Medical Journal 2018 (1472): 73-81.

Stanley J, Sarfati D. Development and validation of the M3 index for measuring multimorbidity load for risk of mortality. Journal of Clinical Epidemiology 2017 (DOI: http://dx.doi.org/10.1016/j.jclinepi.2017.08.005)

Gurney J, Stanley J, York S, Rosenbaum D, Sarfati D. Risk of lower limb amputation in a national prevalent cohort of patients with diabetes. Diabetologia 2017; https://doi.org/10.1007/s00125-017-4488-8.

Signal L, Semper K, Stairmand J, Davies C, Millar E, Dowell T, Lawrenson R, Mangin D, Sarfati, D. A walking stick in one hand and a chainsaw in the other: patients’ perspectives of living with multimorbidity. NZ Med J 2017; 130 (1455): 65-76.

Sarfati D.(2016) ‘How to measure comorbidity’ In Koczwara B (ed Cancer and Chronic Conditions: Addressing the problem of multimorbidity in cancer patients and survivors. Singapore, Springer.

Sarfati D and Gurney J. (2016). ‘What is comorbidity?’ In Koczwara B (ed) Cancer and Chronic Conditions: Addressing the problem of multimorbidity in cancer patients and survivors. Singapore, Springer.

Fleming S, Sarfati D, Kimmick G, Schoenberg N, Cunningham R.(2016) ‘Impact of Comorbidity on Screening and Diagnosis’. In Koczwara B (ed) Cancer and Chronic Conditions: Addressing the problem of multimorbidity in cancer patients and survivors. Singapore, Springer.