Patients with multiple conditions not getting best possible care, say experts

CREDIT: This story was first seen in The Guardian

Millions of people in the UK and many more across the world are suffering from multiple long-term illnesses and may not be getting the best possible treatment from health services that focus on one disease at a time, say experts.

The Guardian reports that a team from the Academy of Medical Sciences in the UK says this is a growing problem and a huge potential burden on the NHS and other health services. ‘Clusters of diseases are becoming more common, they say, such as type 2 diabetes, high blood pressure, osteoarthritis, depression and chronic obstructive pulmonary disease of the lungs.

Specialised hospital doctors treat each one of these conditions individually. Patients may have one problem treated and then have to wait months to see a different specialist for another condition. The experts are calling for a greater role for the GP, who can look at the whole person but needs more time than a 10-minute consultation.

Prof Stephen MacMahon, principal director of the George Institute for Global Health and chair of the Academy’s steering group on multimorbidity said the best evidence on the numbers came from Australia, but there was no reason to think other countries would be different. “Among Australians seeing a general practitioner, half have two diseases or more, a third have three or more and 10% have six diseases or more,” he said. “This is not a small problem.”

In the UK a study published in 2016 showed that the numbers of patients over the age of 50 with multiple conditions rose over the decade from 2002/3 from 31.7% to 43%. The Royal College of GPs said its own analysis has shown that the number of people living with more than one serious, long-term condition in the UK will increase by nearly one million to 9.1 million by 2025.

These people are more likely to die early, be hospitalised, suffer disability and have a poor quality of life, said the Academy. They could be on dozens of pills each day, raising the chances of interactions and side-effects.

“If you have multiple conditions, any one of those conditions is likely not to be treated as well as it might be if you were treated for one condition alone,” MacMahon said.

Mental and physical conditions go hand in hand, say the experts. Heart disease patients may have depression. People with dementia may develop other physical illnesses. There were links between depression and heart attacks. People with depression were more likely to smoke – or not give up smoking – and more likely to become obese, said Martin Prince, professor of epidemiological psychiatry at King’s College London. People with mental health conditions were less likely to adhere to their medication.

The experts say there is not enough evidence to know why there is such an increase in multiple conditions and call for more research, but an ageing population and the effects of modern lifestyles in obesity and alcohol and smoking-related disease must all play a part.

The most dramatic surge around the world has been in type 2 diabetes, which is obesity-related. The numbers are projected to reach 630 million, said Melanie Davies, professor of diabetes medicine at the University of Leicester. “That is nearly one in every 10 people on the planet,” she said.

Those people often had other health problems. “Under the age of 65, you have a mean of three long-term conditions. Over-65 you have seven other conditions.” She is now seeing many young people with a disease that was almost unheard of in their age group 20 years ago. Now there are 500 children with type 2 diabetes in the UK.

Many of those young people had other conditions as well. “We need to rethink how we deliver care,” she said, involving pharmacists for their multiple drugs as well as social workers and care co-ordinators.

Prof Helen Stokes-Lampard, chair of the Royal College of GPs said: “GPs play a major role in looking after patients living with multimorbidities, but often find ourselves coming up against barriers to their care. A lack of research, as this study highlights, into the extent of the crisis is one; another is understanding how best to treat patients living with both physical and psychological conditions – and having access to the most appropriate services to manage this in the community.”

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