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Innovative practices to care for people with multimorbidity in Europe.

Heide, I. van der, Boerma, W., Schellevis, F.G., Rijken, P.M. Innovative practices to care for people with multimorbidity in Europe. European Journal of Public Health: 2015, 25(spl. 3) 47. Abstract: 8th European Public Health Conference: "Health in Europe - from global to local policies, methods and practices". 14-17 oktober 2015 in Milan.
Background
With this first presentation, the challenge of care for people with multimorbidity will be discussed and characteristics of 101 integrated care practices targeting people with multimorbidity will be presented. Based on these characteristics, a typology of integrated care practices addressing multimorbidity will be presented.

Methods
Integrated care practices addressing multimorbidity were identified by country experts in 24 European countries. Contact persons provided data on their characteristics, implementation and outcomes. Besides descriptive analysis, we conducted cluster analysis to explore whether some prototypes of integrated practices addressing multimorbidity could be distinguished based on their characteristics (e.g. target group, main objectives, organizations and care providers involved, organizational structures).

Results
Of the 101 integrated care practices, 58% focused on multimorbidity in general (irrespective of the type of chronic diseases of the patients) and 42% on specific combinations of diseases. Primary care practices were involved in 69% of the practices. Primary care practices, nursing homes, social care and community services were significantly more often involved in practices focusing on multimorbidity in general than in practices focusing on specific diseases. Medical specialists were involved in 83% of the practices focusing on specific combinations of diseases, but only in 54% of the practices focusing on multimorbidity in general. Some prototypes of practices could be distinguished, mainly based on variation in the involvement of primary care.

Conclusion
European practices addressing multimorbidity often have similar objectives, but differ in the organizations or care providers involved. The next step in the ICARE4EU project is to reveal whether the occurrence of practices of certain types relate to specific characteristics of a country or region such as its population or the structure of its healthcare system.