Assessing the extent of drug interactions among patients with multimorbidity in primary and secondary care in the West Midlands (UK): a study protocol for the Mixed Methods Multimorbidity Study (MiMMS)

BMJ Open. 2017 Sep 18;7(9):e016713. doi: 10.1136/bmjopen-2017-016713.


Introduction: The numbers of patients with three or more chronic conditions (multimorbidity) are increasing, and will rise to 2.9 million by 2018 in the UK alone. Currently in the UK, conditions are mainly managed using over 250 sets of single-condition guidance, which has the potential to generate conflicting recommendations for lifestyle and concurrent medication for individual patients with more than one condition. To address some of these issues, we are developing a new computer-based tool to help manage these patients more effectively. For this tool to be applicable and relevant to current practice, we must first better understand how existing patients with multimorbidity are being managed, particularly relating to concerns over prescribing and potential polypharmacy.

Methods and analysis: Up to four secondary care centres, two community pharmacies and between four and eight primary care centres in the West Midlands will be recruited. Interviewees will be purposively sampled from these sites, up to a maximum of 30. In this mixed methods study, we will perform a dual framework analysis on the qualitative data; the first analysis will use the Theoretical Domains Framework to assess barriers and enablers for healthcare professionals around the management of multimorbid patients; the second analysis will use Normalisation Process Theory to understand how interventions are currently being successfully implemented in both settings. We will also extract quantitative anonymised patient data from primary care to determine the extent of polypharmacy currently present for patients with multimorbidity in the West Midlands.

Discussion: We aim to combine these data so that we can build a useful, fully implementable tool which addresses the barriers most amenable to change within both primary and secondary care contexts.

Ethics and dissemination: Favourable ethical approval has been granted by The University of Birmingham Research Ethics Committee (ERN_16-0074) on 17 May 2016. Our work will be disseminated through peer-reviewed literature, trade journals and conferences. We will also use the dedicated web page hosted by the University to serve as a central point of contact and as a repository of our findings. We aim to produce a minimum of three articles from this work to contribute to the international scientific literature.

Protocol registration number: NIHR Clinical Research Network Portfolio Registration CPMS ID 30613.

Keywords: NHS; multimorbidity; polypharmacy; primary care; protocol; secondary care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Chronic Disease / drug therapy*
  • Chronic Disease / epidemiology*
  • Decision Making, Computer-Assisted
  • Drug Interactions*
  • Drug Prescriptions
  • Humans
  • Interviews as Topic
  • Middle Aged
  • Multimorbidity*
  • Polypharmacy*
  • Primary Health Care* / statistics & numerical data
  • Research Design
  • Secondary Care*
  • United Kingdom / epidemiology
  • Young Adult