Impact of COVID-19 on individuals with multimorbidity in primary care

BACKGROUND

Defined as the coexistence of two or more chronic conditions in the same individual,¹ multimorbidity (MM) affects over a quarter of people in England.² Encompassing mental and physical health, MM requires engagement with numerous healthcare providers and settings, and accounts for half of GP consultations and hospital admissions.²

Primary care is an ideal setting to tackle health system navigation, care integration, and continuity challenges affecting individuals with MM.^1,3 However, effective primary care management of MM still presents difficulties. Complex needs in MM necessitate substantial administrative effort in proactive identification and tailored access, as well as extended consultations to support a holistic approach and essential continuity of care.^1,3

These challenges were compounded by the COVID-19 pandemic, which stretched limited primary care resources globally. With age and existing MM presenting significant risk factors for infection and serious adverse outcomes,⁴ COVID-19 has the potential to affect negatively the health and wellbeing of individuals with MM through multiple pathways.

This article explores the direct impact of COVID-19 on individuals with MM, and indirect effects on their care through changes in healthcare provision necessitated by the pandemic, and considers the potential future impact of these changes.

DIRECT IMPACT: MULTIMORBIDITY AND VULNERABILITY TO COVID-19

As the pandemic developed, it quickly became evident that certain groups had greater vulnerability to COVID-19 infection, serious complications, and mortality. Older age,⁵ ethnic minority background, obesity, long-term conditions (LTCs),^4,6 and socioeconomic deprivation⁶ were identified as significant risk factors.

MM is associated with increased risk of COVID-19; those with at least two LTCs are at 48% higher …