Outlook: Newsletter of the Society of Behavorial Medicine

Fall 2018

Opportunities Abound for SBM Members to Lead Integration Efforts Directed at Multi-Morbidities

Jerry M. Suls, PhD, Multi-Morbidities SIG Co-Chair

The Multi-Morbidities SIG was established to recognize and facilitate research, intervention and policy to face the challenge posed by the increasing prevalence of patients with multiple health conditions. Behavioral medicine has a significant role in advancing understanding of the biological and psychosocial pathways leading to multimorbidity, the contribution of positive and negative health behaviors, and to develop and test interventions for patients with multiple health conditions. Our hope is that SBM members and other SIG’s will consider efforts to collaborate to confront this tremendous challenge to public health. The question of multimorbidity touches on virtually all of the SIG’s, such as Cancer, Multiple Health Behavior Change, Aging, Women’s Health, Integrated Primary Care, Health Decision Making, Evidence-Based Behavioral Medicine, etc.

In some ways, European medical and behavioral medicine researchers and practitioners are ahead of US efforts. Earlier this year, three articles in Health Policy reported the findings of two European consortia established to help meet the needs of patients with multimorbidity. The findings of these European research consortia can provide insights to other health care systems that also are coping with the increasing numbers of patients with multiple medical conditions.

One of the consortia is the SELFIE research project (Sustainable intEgrated chronic care modeLs for multimorbidity delivery, FInancing and performancE), which strives to improve person-centered care for persons with multimorbidity. The Netherlands, Austria, Croatia, Germany, Hungary, Norway, Spain, and the UK make-up the consortium.

In a scoping review conducted by SELFIE, Struckmann et al. identified several integrated health programs in Europe (n =11) and the US (n =5).1 The majority adopted the Wagner Chronic Care Model or the Guided Care Model although the authors observed that neither model actually focuses on patients with multiple chronic conditions. SELFIE’s “take-home message” was the need to shift from disease-centered care to person-centered care. An element of the latter is the use of holistic assessment, which ascertains patient’s needs and preferences to determine which type of care is needed followed by prioritization of health problems where person preferences are taken into account. The review observes that the use of multidisciplinary team, that includes psychologists, is recommended. Other essential components of interdisciplinary care are self-management and use of an electronic information system.

A second SELFIE effort identified concepts for integrated care for multimorbidity. A framework is presented that encompasses micro, meso and macro levels and groups concepts into six key components, adapted from the World Health Organization’s key components of health systems: leadership and governance, health information systems, health financing, human resources for health, essential medical products and technologies, and service delivery.2

The other European consortium, ICARE4EU, seeks to increase and disseminate knowledge of European integrated care program addressing multimorbidity. Rijken et al. identified described and characterized innovative care practices for patients with multiple medical conditions in 24 countries.3 They found that practices that focus on a specific disease or a combination of specific diseases exhibit less integration in type, breadth and integration than practices that focus on any combination of diseases. Furthermore, those that focus on any disease combinations involve more disciplines (e.g., community nurses, psychologists, physiotherapists, etc.) that work in the same primary care practice as the general practitioners. These results reinforce the idea that the patient medical home concept works best when all the relevant health care professionals work in the same space rather than at a distance or only at specific times. Integrated Primary Care started by emphasizing the important role for health care psychologists in serving the mental health and substance use needs of patients. The two European consortia reinforce the idea that that psychologists in primary care also can make useful contributions with respect to multiple psychological and physical conditions and bridge the vertical silo’s created by specialty care.

We urge SBM members to think about how their area of concentration touches on the multimorbidity challenge and how their SIG can engage in meaningful ways with other SIGs. It is time for SBM members to reach out within the society, and also at the national and international level to establish consortia to assess guidelines and care policies for persons at risk or living with multiple health conditions.



  1. Strickmanm, V., Leijten, F., van Ginnekin, E., Kraus, M., Reiss, M., Spanger, A. ...(2018). Relevant models and elements of integrated care for multi-morbidity: Results of a scoping review. Health Policy, 122, 23-35.
  2. Leijten, R.M., Struckman, V., van Ginnekin, E., Czypionka, T., Kraus, M., Reiss, M…. (2018). The SELFIE framework for integrated care for multi-morbidity, Health Affairs, 122, 12-22.
  3. Rijken, M., Hujala, A., van Ginneken, E., Melchiorre, M.G., Groenewegen, P., & Schellevis, F. (2018). Managing multimorbidity: Profiles of integrated care approaches targeting people with multiple chronic conditions in Europe. Health Policy, 122, 44-52.