Key Notes

Introduction

The Ariadne principles have been developed 12 years ago with the aim to support the management of patients with multimorbidity – in particular, in primary care consultations. ¹ In the Spanish MultiPAP trial, they have been shown to be effective to improve the medication appropriateness in younger old people with multimorbidity and polypharmacy. ² Ariadne was also used in guideline frameworks. ³, ⁴

Bruce Guthrie will discuss the importance of consistency of measurement in multimorbidity research, and the potential benefits and limitations of AI approaches to identify clusters and patterns of multimorbidity, and to improve outcome prediction in the face of complexity.

Elisa Fabbri will report on current approaches to the use of biomarkers in aging research on frailty and multimorbidity. In her presentation, she will present the aims and expectations associated with this.

Rafael Perera will comment on both technologies and point out recognisable limitations.

Susan Smith will summarize the evidence on interventions in multimorbidity. Her key note will focus on methodological problems in multimorbidity trials: do we measure the right things and do we measure them right?

Sharon Straus will shed a light on the nature of multimorbidity interventions with regard to the intended behaviour changes. Her key note will provide insights in the approaches of knowledge translation: do we need to embrace implementation issues right from the start of the intervention development?

Victor Montori will present the concept of treatment burden and minimally disruptive medicine. He will provide practical examples of shared decision making with patients with multimorbidity.

Mike Steinman will introduce deprescribing, which has quickly developed into an important concept in polypharmacy research and clinical practice. Areas he will cover include overdiagnosis and misdiagnosis that can result from adverse drug effects and how polypharmacy and deprescribing intersect with treatment burden. He will also explore potential links with the Ariadne framework.

Paul Glasziou will focus on overdiagnosis and overtreatment and its potential impact on the emerging “epidemic” of multimorbidity. He will identify threats of overdiagnosis and potential strategies in clinical decision making to avoid overdiagnosis in people with multimorbidity.

Jose Valderas will discuss the inconclusive evidence for available interventions as well as the reasonable doubts that the existing evidence based may not be applicable to large numbers of people with multimorbidity. How do we then promote, incentivize, and appraise quality when caring for people with multimorbidity?

Mieke Rijken will focus on person-centred coordinated care for people with multimorbidity. Countries are adapting their health and social care systems to better meet the needs of growing populations with (multiple) chronic conditions. However, little information is available about how health systems perform from the perspective of people living with multimorbidity.