Living with multiple chronic conditions (multimorbidity) -and facing complex, uncoordinated and fragmented care -is part of the daily life of a growing number of Canadians. Methods: We undertook: a knowledge synthesis; a "gap analysis" of existing systematic reviews; an issue brief that synthesized the available evidence about the problem, three options for addressing it and implementation considerations; a stakeholder dialogue involving key health-system leaders; and a citizen panel. Results:

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... e identified several recommendations for actions that can be taken, including: developing evidence-based guidance that providers can use to help achieve goals set by patients; embracing approaches to supporting self-management; supporting greater communication and collaboration across healthcare providers as well as between healthcare providers and patients; and investing more efforts in health promotion and disease prevention. Conclusions: Our results point to the need for health system decision-makers to support bottom-up, person-centred approaches to developing models of care that are tailored for people with multimorbidity and support a research agenda to address the identified priorities. Designing Integrated Approaches to Support People with Multimorbidity e[100] HEALTHCARE POLICY Vol.12 No.2, 2016 Discussion Key findings across projects While much of the evidence is mixed and inconclusive or lacking (e.g., in the case of guidelines), several key messages emerged from the literature we identified: (1) the main consequences of multimorbidity (functional impairment, poor quality of life, high healthcare utilization, high out-of-pocket costs and increased burden on the patient for their care); (2) interventions that are more targeted (e.g., integrated treatment programs coordinated by care managers) are more effective than those with a broader or more generic approach (e.g., case management or changes in care delivery); (3) "complex and multifaceted pharmaceutical care" can reduce inappropriate medication use and adverse drug events; and (4) recommendations exist for developing multimorbidity-specific guidelines. Our findings also suggest strong alignment between stakeholders' priorities and citizens' values and preferences, which point to several actions that can be taken, including: (1) developing evidence-based guidance that providers can use to help achieve goals set by patients; (2) embracing approaches to supporting self-management; (3) supporting greater communication and collaboration across healthcare providers as well as between healthcare providers and patients; and (4) investing more efforts in health promotion and prevention. Join the conversation @ longwoodsnotes youtube.com/LongwoodsTV facebook.com/LongwoodsPublishingCorporation pinterest.com/longwoods