Optimizing care for patients with multiple chronic conditions

Multiple chronic conditions (MCC) are a growing concern among physicians.

The number of patients with MCC is rising, and comes at considerable cost and burden to the healthcare system. Nevertheless, this population is often overlooked.

How can it be better served by healthcare professionals?

Scope of the issue

The Agency for Healthcare Research and Quality (AHRQ) estimates that one of three American adults, and four of five Medicare beneficiaries, have MCC.^[] MCC accounts for 64% of clinic visits, 70% of inpatient stays, and 71% of healthcare spending.

According to the AHRQ, a mismatch exists between the delivery of care, which is disease-specific, and the needs of patients with MCC. They need patient-centered care, which takes the whole person into account. Without this approach, therapy is less effective, with worse outcomes and higher costs resulting.

Another problem facing the MCC patient population is that practice guidelines are geared toward the care of a single condition and not comorbidities. It’s possible that treatments recommended separately for two different conditions could interact in harmful ways.

What MCC patients want

“Most treatments are recommended to address disease-specific outcomes or survival, whereas older adults with MCCs vary in the outcome goals that they most desire,” wrote the authors of a JAMA Network Open study.^[] “Furthermore, the medications, healthcare visits, testing, procedures, and self-management tasks entailed in treating MCCs require investments of time and effort that may be burdensome and conflict with what patients are willing and able to do.”

In the study, US researchers surveyed 163 older adults with MCC for common goals and healthcare preferences. These included friends/family (24.2%), shopping (6.1%), exercising (4.6%), and independent living (4.4%). The investigators recommended that such goals be taken into consideration when making treatment decisions.

Caring for MCC patients

In an article published in the American Journal of Managed Care, author Bruce W. Sherman, MD, outlined the following management concerns commonly encountered with patients with MCC (which he stressed is a growing population).^[]

• Delivery systems. Coordination between primary care and specialist physicians could improve outcomes and avoid drug-drug interactions. It’s also important to integrate behavioral-health services in total care.

• Evidence-based care. Because guidelines are mostly disease-centric and many don’t consider the complexity of condition-condition interactions, concerns over evidence-based care exist.

• Patient-physician dynamic. Lack of trust or connection with the provider can impact patient adherence. The busy physician may not have enough time to address all of a patient’s concerns potentially spanning multiple organ systems. Social stressors affecting care may also not be addressed due to lack of time.

• Patient-centered goals. Clarity regarding patient preferences can inform treatment priorities and enhance the patient experience. Such goals could include short- or long-term clinical outcomes, quality of life, and expense.

It also recommends that technology be used to improve integration, coordination, and efficacy of care.