MiMMS – Mixed Methods Multimorbidity Study

We are building a new computer based tool which will automatically detect conflict between clinical guidelines (MITCON).  However, to ensure that this tool works within the NHS, it needs to address some of the current challenges faced by healthcare professionals.

The Mixed Methods Multimorbidity Study (MiMMS) seeks to identify challenges GPs and hospital consultants’ face when managing patients with several chronic conditions.  In this study we will also identify factors that allow clinical guidelines to be incorporated into everyday practice, as well as assessing the number of medications prescribed in primary care in the West Midlands.  For this part of the work we will focus upon patients with at least two the following conditions: COPD, Ischaemic Heart Disease, Hypertension, Depression, Osteoarthritis, and Type 2 Diabetes Mellitus.  

Study outcomes

The outcomes for the qualitative work are:

  • To use Normalisation Process Theory to assess how guidelines are being implemented in primary and secondary care.
  • To use both Normalisation Process Theory and the Theoretical Domains Framework to assess how patients with multimorbidity are currently managed within primary and secondary care.
  • To understand influences on prescribing for patients with multimorbidity including which factors are taken into consideration and how clinical decisions are made.

The primary outcome for the quantitative work is:

  • To elicit the proportion of patients with pairwise condition combinations who have been prescribed two or more drugs with an interaction as defined by the latest gold standard reference.

Further secondary outcomes for this work are to elicit:

  • The total number, and severity, of interactions for each clinical condition as defined by the latest gold standard references.
  • To compare the numbers of patients identified with these clinical conditions with the practice disease register and to the national reported prevalence using the latest available QOF data.


Within the West Midlands the following settings will be sought:

-          Between 4 to 8 primary care centres

-          Up to 4 secondary care centres

-          Up to 2 community pharmacies


Poster presented at University of Birmingham’s Research Gala Oct 16


This work forms part of the grant ‘Automated Conflict Resolution in Clinical Pathways’ (EP/M014401/1) which has been funded by the Engineering and Physical Sciences Research Council (EPSRC). 


If you would like any further information about the study, please contact Ian Litchfield (Chief Investigator).