Primary Care in the Era of Multimorbidity: Policy Challenges for Integrated, Patient-Centred, Polypharmacy-Sensitive Care

Abstract

Background: Multimorbidity, the co-occurrence of two or more chronic conditions, is now the prevailing reality in primary care, particularly among ageing and socioeconomically disadvantaged populations. However, most health systems remain structurally oriented toward acute, single-disease management. This mismatch has contributed to fragmented care, excessive polypharmacy, and diminished patient experience.
Objectives: This review critically examines the policy and practice challenges in delivering integrated, patient-centred, and polypharmacy-sensitive care for multimorbid individuals. It identifies key barriers to implementation and outlines system-level reforms required to align primary care delivery with the complex realities of multimorbidity.
Methods: Drawing on global evidence, case studies, and health systems frameworks, this narrative review synthesises findings across domains including care integration, workforce models, financing, information infrastructure, clinical guidelines, and patient engagement.
Findings: Successful models share common elements: team-based care, interoperable digital tools, goal-oriented planning, rational prescribing, and active patient involvement. Yet, scale-up is often limited by political inertia, siloed funding streams, and capacity gaps. Structural reforms - such as payment redesign, co-produced service planning, and outcome measures aligned with patient priorities - are essential for sustainable transformation.
Interpretation: Multimorbidity must be treated as a defining feature of 21st century primary care, not as a deviation from the norm. Policy responses should prioritise integration, equity, and person-centeredness. Health systems that fail to adapt risk perpetuating inefficiencies and compromising care quality for their most vulnerable patients.