Managing Chronic disease and multimorbidity

Calculator, pen, data on a sheet and stethoscopeThe role played by primary care in the management of chronic disease continues to grow. Novel ways of meeting the demands of an aging chronically ill population within the pressurised environment of modern family practice are required and we are using the latest methods in software engineering and informatics to both support patients and inform care. 

Tom Marshall

Theme lead
Professor Tom Marshall

Professor of Public Health and Primary Care

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Aims of the research

The aims of the research are:

  • Use original analysis of electronic primary care records to understand and refine existing models of primary health care, and prescribing.
  • Exploit software engineering solutions to manage the care of complex chronically ill patients.

Current research groups

Chronic disease epidemiology and management

Birmingham Lung Improvement Studies (BLISS)
The BLISS programme represents a series of connected research studies about Chronic Obstructive Pulmonary Disease (COPD) funded by a five-year programme grant from the National Institute for Health Research. The overall aim of the programme is to evaluate new ways of better identifying and managing patients with COPD in the community.


Professor Tom Marshall  leads the MRC funded BIRMCAM project researching methodologies for identification of multimorbidity clusters in electronic primary care records.


Self-management of chronic conditions supported by primary care providers is central to the strategy for treating patients with chronic conditions. A variety of work is being undertaken across IAHR including projects involving Vascultis and Type 1 Diabetes.

Health informatics

A large and growing area of research involves the use of large datasets of electronic health records, in particular primary care records. The Health Informatics group led by Dr Krishnarajah Nirantharakumar and Professor Tom Marshall undertakes a wide range of research including epidemiology, health services research and methodological research.


Banerjee A,, Benedetto V, Gichuru P, Burnell J, Antoniou S, Schilling RJ, Strain WD, Ryan R, Watkins C, Marshall T, Sutton CJ. Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study. Heart. 2019 Oct 10. pii: heartjnl-2019-315307. doi: 10.1136/heartjnl-2019-315307. 

Šumilo D; Nichols L, Ryan R, Marshall T. Incidence of indications for tonsillectomy and frequency of evidence-based surgery: a 12-year retrospective cohort study of primary care electronic records. BJGP 2019 Jan;69(678):e33-e41. doi: 10.3399/bjgp18X699833. 

Enocson A, Jolly K, Jordan R, Fitzmaurice D, Greenfield S, Adab P, Cheng K, Cooper BG, Daley A, Dickens A, O'Beirne-Elliman J, Haroon S, Jowett S, Kalirai K, Marsh J, Miller MR, Riley R., Stockley R, Turner A. 2018. Case-finding for COPD in Primary Care: A qualitative study of patients’ perspectives. International Journal of COPD. 

Adderley N., Nirantharakumar K., Marshall T. Risk of stroke and transient ischaemic attack in patients with a diagnosis of ‘resolved’ atrial fibrillation. BMJ. 2018 May 9;361:k1717. 

I. Litchfield, C. Hoye, D. Shukla, R. Backman, A. Turner, M. Lee, P. Weber. Automated conflict resolution between multiple clinical pathways: A technology report BMJ Health Inform. 2018;25(3):142–148. 

Weber, Philip, João Bosco Ferreira Filho, Behzad Bordbar, Mark Lee, Ian J Litchfield and Ruth Backman. Automated conflict detection between medical care pathways.  Journal of Software: Evolution and Process 30 (2018):