MSL Conversations

As we age, we’re more likely to experience multiple medical problems. About 80% of people age 65 and older have one chronic disease and half have more than one, says the U.S. Centers for Disease Control and Prevention[i]. And every day, 10,000 more people in the U.S. turn 65. [ii]

Annals of Family Medicine, a journal of the American Academy of Family Physicians (AAFP) focuses it’s January/February 2012 issue on “multimorbidity, the coexistence of multiple chronic health conditions in a single individual.’’ [iii] It’s “a phenomenon that is growing at an alarming rate and bankrupting the U.S. health care system,’’ the academy says. By 2020, a quarter of the entire population will have multiple chronic conditions, and managing those conditions will ring up a price tag of $1.07 trillion, the journal says.

Through several articles and an editorial, researchers and other experts address the causes of ineffective and costly treatment of patients with multiple chronic conditions. Chief among them is the acute-care approach of the U.S. medical system, which often fails to address the underlying chronic care needs of patients, leading to medical errors, adverse drug reactions, poor disease monitoring, under-diagnosis and other problems.

Many people who have a family member affected by complex and diverse medical issues have seen this in action: specialists in one disease area may overlook or lack expertise in treating a concurrent condition that might be more urgent; patients may not inform the doctor of all medications and medical conditions for which they are being treated; or patients may not have access to all the care and support needed.

One way to address these concerns, the researchers propose, is to make greater use of the “medical home’’ concept [iv]. The AAFP describes this idea as a primary care office that serves as a central medical access point focusing on the “whole person.’’ Each patient is provided with a personal physician who coordinates their care based on needs and priorities. Patients in this model have access to their own medical information via a secure on-line system, same day appointments, email communications and tailored information about screening and treatments.

An analysis by researchers at University of California, Davis, of data on 52,241 patients ages 18 to 90, found lower rates of death among those whose source of medical care offered treatment through a “medical home” setting, reinforcing that the approach works.

Other articles in the journal discuss the effectiveness of a team-based approach to caring for patients with multiple chronic diseases, something that is standard practice in some hospitals and large medical practices. This approach could be extended to collaborations among smaller practices with support, including the integration of care coordinators with primary care physicians, and additional reimbursement for time spent coordinating care.

Dr. Elizabeth Bayliss, associate editor of Annals of Family Medicine and director of scientific development at the Kaiser Permanente Institute for Health Research, in an accompanying editorial, calls for “effective, integrated, multidimensional care management for patients with complex care needs,’’ and expresses hope for a change in reimbursement policies that will encourage comprehensive management and improved care for the growing number of people with one, two or more chronic medical conditions.

Clearly, the need for strategies to better coordinate effective care for people with more than a single medical condition is here, and will become more urgent as the proportion of the medically complex population over 65 increases. Until better systems are in place, the onus continues to be on individual patients and healthcare professionals to better communicate with one another about the diagnosis of multiple illnesses and the medications used to treat them.

Anita Manning is a former award-winning newspaper reporter and editor. During her more than 28 years with Gannett and USA Today, she covered a wide range of health topics, focusing primarily on infectious diseases, vaccines and diabetes. Her beat areas also included pandemic preparedness, bioterrorism and food safety. Anita also has served as a media consultant, working with clients, including pharmaceutical companies and non-profits. She has been a featured speaker or panelist at meetings sponsored by the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services.

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[i] http://www.cdc.gov/chronicdisease/resources/publications/AAG/aging.htm

[ii] http://www.silverbook.org/browse.php?id=57

[iii] http://www.annfammed.org/

[iv] http://www.aafp.org/fpm/2007/0900/p38.html