Transforming Care: collective research leads the way in tackling multimorbidity

Posted on: 14 November 2025

The programme, which ran from 2018-2025, supported a national cohort of four PhD Scholars whose studies collectively addressed the significant global health challenge of multimorbidity, focusing on areas from medication adherence and financial burden to social prescribing and GP-based pharmacists.  This research, funded by the Health Research Board (HRB), and involved Trinity College, University of Galway and RCSI, University of Medicine and Health Sciences,  Croí, and HIQA, generated practical, patient-centred evidence to inform clinical practice and health policy.

Professor Susan Smith, Programme Lead of the HRB CDA in Multimorbidity, said:

"This programme has significantly strengthened the foundation for better multimorbidity care, providing practical, real-world solutions that inform policy and practice. Our skilled cohort of researchers has delivered high-impact, patient-centred evidence, demonstrating that continued investment in collaborative, cross-sectoral research is vital for equitable and sustainable care for people living with multiple long-term conditions.”

Professor Andrew Murphy of the University of Galway commented that:

 “The programme has been really successful in developing research leaders for the future. A key ingredient to this success was the way in which public and patient involvement in research was embraced by the researchers throughout the research cycle.”

Dr Annalisa Montesanti, Programme Manager, Health Research Board, said:

"The HRB is deeply committed to building robust capacity in health research, and our CDA scheme exemplifies this, cultivating a new generation of health researchers who are equipped to advance knowledge and translate it directly into improved patient care and health outcomes."

Key findings and impacts across four PhD projects:

The four PhD Scholars investigated distinct yet interconnected aspects of multimorbidity care, revealing significant challenges and promising solutions:

1. Medication Non-Adherence is Widespread and Patient-Driven, Demanding Personalised Support: Dr Louise Foley’s research reveals that nearly half of all people with multimorbidity (approximately 43%) struggle with medication non-adherence, a complex issue not simply tied to the number of conditions or medicines. Living with multiple conditions intensifies the burden of managing treatments, prompting patients to adopt coping strategies like prioritisation or resignation, for example, choosing one medicine over another.
2. Financial Burden Forces Unacceptable Choices, Underscoring Need for Policy Reform:         Dr James Larkin’s studies expose the severe financial strain on people with        multimorbidity, who face significantly higher out-of-pocket (OOP) healthcare costs, averaging €807 to €886 annually compared to €580 for those without chronic conditions. This burden leads to alarming consequences, with 16% non-adherent to medications and 31% missing appointments. Many report they would use savings (30%), reduce food spending (22%), or borrow money (9%) to cope. This research highlights that patients often prioritise medicines over other crucial healthcare services when financially constrained, underscoring the urgent need for policy changes to alleviate this burden.

3. GP-based Pharmacists Revolutionise Medication Safety and Patient Experience in Primary Care: Dr Aisling Croke’s research provides compelling evidence for integrating pharmacists into general practice, demonstrating it as a feasible and highly effective intervention for improving medication safety. Pharmacists can significantly reduce potentially inappropriate prescribing (PIP), which is linked to adverse drug reactions and hospitalisations, leading to an estimated €12,087.71 in cost savings over 12 months from medication interventions.
4. Social Prescribing: Promising Potential, Needs Rigorous Evaluation for Effective Implementation: Dr Bridget Kiely’s study on social prescribing link workers reveals promising potential for improving well-being and cost-effectiveness, particularly if link workers based in GP practices operate at full capacity, with a 79% probability of cost-effectiveness based on Ireland’s threshold for paying for healthcare interventions. Patients welcomed the social prescribing support, with an 85% uptake and many describing link workers as "like a friend". However, the research also highlighted the critical need for stronger, longer-term evaluations to fully establish effectiveness and opportunity costs before widespread rollout, as initial global evidence was limited.

Overarching Recommendations for Policy and Practice

The collective findings from the HRB CDA in Multi morbidity underscore the need for a reorientation towards integrated, patient-centred care, acknowledging the complexity faced by people with multimorbidity. Key recommendations include:

• Personalised Care and Shared Decision Making: Support people with multimorbidity in making individualised decisions about their care, particularly regarding medication, by addressing medication-related concerns and tailoring involvement to avoid adding further treatment burden.
• Address Financial and Treatment Burden: Implement cost-of-care conversations in routine practice, reduce user charges for care, and consider reimbursing travel costs to alleviate the significant financial strain on more vulnerable patients.
• Integrate GP-Based Pharmacists: Empower patients through patient-centred medication review structures and formally integrate pharmacists into general practice to optimise prescribing and enhance medication safety.
• Strategic Social Prescribing: Implement longer-term social prescribing supports with stronger GP links, especially for patients with more complex health problems. Crucially, robust evaluations are needed to establish effectiveness and opportunity costs before widespread rollout, focusing on targeted approaches and equitable resource provision in deprived areas.
• Health System Reorientation: Address health inequalities, target primary and secondary prevention, and move towards a defragmented, integrated care system that consistently addresses multimorbidity in all care delivery decisions.

This groundbreaking research strengthens the foundation for better multimorbidity care and informs  policy with practical, real-world solutions. Continued investment in collaborative, cross-sectoral, patient-focused research is essential for delivering equitable, effective, and sustainable care for people living with multiple long-term conditions, ultimately impacting individual and population health.

READ MORE: The full report is available to download and read at the following link here

About the HRB CDA in Multimorbidity The HRB Collaborative Doctoral Award in Multimorbidity (2018-2024) funded a national cohort of four PhD Scholars to generate evidence-based solutions for people living with multiple long-term conditions. This final report of the HRB CDA in Multimorbidity showcases the range of work that the four PhD students have completed, supported by a team of Supervisors from the RCSI University of Medicine and Health Sciences, University of Galway, Trinity College Dublin, Croí, and HIQA and an international panel of leading researchers in the field of multimorbidity. The programme aimed to develop a skilled cohort of researchers and produce high-impact, patient-centred evidence to improve health outcomes and inform policy.

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