Year 2021
October 2021


Abstract Title
Defining and Measuring Multimorbidity in Primary Care in Singapore: Results of an Online Delphi Study



MOH Office for Healthcare Transformation Pte Ltd1, Singapore General Hospital2

Background & Hypothesis

Multimorbidity, common in primary care setting, has diverse implications for both patient and the healthcare system. However, there is no consensus on the definition of multimorbidity globally. Thus, we aimed to conduct a Delphi study to gain consensus on definition of multimorbidity, the list and number of chronic conditions used for defining multimorbidity in the Singapore primary care setting.


Our Delphi study comprised of three rounds of online voting from purposively sampled family physicians in both public and private settings. Delphi round 1 included open-ended questions for idea generation. The subsequent two rounds used questions with pre-selected options.  Consensus was achieved based on a pre-defined criteria following an iterative process.


The response rates for the three rounds were 66.67%, 86.49% and 93.75%, respectively. Among 40 panellists who responded, 46% were 31-40 years old, 65% were male and 73% were from public primary healthcare setting. Based on findings of rounds 1, 2 and 3, consensus on the definition of a chronic condition, multimorbidity and finalised list of chronic conditions were achieved. For a condition to be chronic, it should last for six months or more, be recurrent or persistent, impact patient across multiple domains and require long-term management. The consensus-derived definition of multimorbidity is the presence of three or more chronic conditions from a finalised list of 23 chronic conditions.

Discussion & Conclusion

Our findings will inform multimorbidity conceptualisation at the national level, standardise multimorbidity measurement in primary care and facilitate resource allocation for patients with multimorbidity.