Table 2 Proposed research questions for the different topics and themes

Measuring multimorbidity

Developing or finding measurement tool for multimorbidity

What tool could be designed using the definition of multimorbidity to enhance medical decision making (including shared decision-making)? Then design an application to be implemented in electronic medical records and evaluate that tool’s effectiveness in decision-making.

Epidemiology of multimorbidity

Are there clear trends in the development of multimorbidity at the individual (patient) level? What are the predictors of multimorbidity and are there any specific patterns of accumulation? Are there specific patterns and conditions which are likely to accelerate the development of multimorbidity? Evaluation of MM in EU countries? Would it be possible to measure the different levels of multimorbidity in order to describe the patient's complexity?

Impact of multimorbidity

Impact of multimorbidity on patient or health service outcomes.

Have the different criteria included in the definition of multimorbidity different predictive powers in terms of patient outcomes (Mortality, health status, frailty, health outcomes decline, poly-pharmacy, depression) or health system outcomes (cost of care or poly-pharmacy or health services utilization)? With an additional question for depression: is depression a specific factor or is it related to Pain in Multimorbidity measurement?

Impact of socioeconomic status on multimorbidity

What is the Impact of multimorbidity on particular groups (low socioeconomic status, addictive persons, societies in economic crisis)? What is the role of socioeconomic differences in multimorbidity?

Management of multimorbidity

Multimorbidity management in General Practice

What are the methods to promote medical audit in patients with multimorbidity? How does multimorbidity influence FP management? How can medical records of co-morbid patients be improved?

Patient Doctor relationship evaluation in the management of multimorbidity

Is the doctor- patient relationship a modifying factor in the concept of multimorbidity? This study will take into account communicative challenges, including, not only FPs’ communicative skills/ communicative competence, but in particular, FPs’ ability to cope with their own emotions and the patients’ emotions.

FP workload and burden of multimorbidity

Do FPs of multimorbid patients have an unchanged quality of life when their patients' multimorbidity increases? Selecting groups of FPs according to their patients’ multimorbidity, using the definition of multimorbidity and comparing their quality of life.

Patient perspective

Multimorbid patient's perspective

How do patients conceptualize the multimorbidity condition using their own language, concepts, metaphors, and expectations? With the intention of looking at the impact of multimorbidity on patients’ experiences of self-management and health care

Burden of diseases effect on multimorbidity (from patient’s perspective) and prevention strategies

What is the role of the patient perceived burden of diseases into the multimorbidity definition? Is the burden of disease, as perceived by the patient, a modifier of multimorbidity or should it be included in the defining illnesses? Is it possible to assert that only diseases with a burden should be considered to contribute to multimorbidy? (For example, not a healed cataract or stabilized hypertension).

Links between complexity and multimorbidity

Multimorbidity definition as a help in detecting complexity

How could the concept of multimorbidity improve the ability to detect complex patients in family medicine? As risk factors, guidelines and recommendation for secondary prevention are well defined for cardiovascular diseases and diabetes mellitus, the aim of the study might be to identify the level of comorbidity (in terms of complexity) in these patients, to define barriers, to follow preventive activities which are well defined by European associations of cardiologists and diabetologists. It can be measured from the FP’s perspective, and specific diseases perspective and from the patient’s perspective), with the aim of formulating more specific recommendation for the preventive and curative care of multimorbid patients with cardiovascular diseases.

Stakeholders’ perspective

Consensus for multimorbidity research according to stakeholders’ interest

Are stakeholders interested in the patient’s perspective (multimorbidity: perceived severity and grading, self-management and individualized patient-centered plan) or health professional’s perspective (operational definition of MM, improvement of clinical decision support, practice-based guidelines in multimorbidity and poly-pharmacy) or in research perspective (gaps in multimorbidity research, consensus-based set of recommendations for inclusion and reporting of multimorbid patients in Randomized Controlled Trials, and for addressing multimorbidity in Clinical Practice Guidelines)