Multiple Chronic Conditions?
Coordinated Comprehensive Care Can Improve Your Quality of Life
Avinash Reddy, M.D.
As the science and technology of medicine improves, Americans are living longer than ever. Unfortunately, a longer life doesn’t always mean a healthier life. An increasing number of older Americans suffer from chronic medical conditions as they age and the management of multiple chronic diseases presents a significant challenge for both physicians and modern medicine.
Older patients suffer from diabetes, hypertension, osteoporosis, arthritis, heart disease and a multitude of other medical conditions. Often, these patients see multiple specialists, in addition to their primary care physician, all of whom prescribe drugs or treatments. Unfortunately, these medications and treatments can have unpredictable interactions. In addition, a medicine prescribed for management of a single condition when that treatment could worsen other conditions.
Second, the article also recommends that clinicians place a stronger emphasis on patient preference when they prescribe treatments for various conditions. Patients should be educated on potential risks and benefits prior to initiating any new treatment and their preferences should be taken into account before starting treatment. For example, a medicine prescribed for diabetes may worsen heart failure. Another medication prescribed for hypertension may worsen diabetes. This makes the treatment of patients with multiple chronic illnesses complex and sometimes even dangerous.
In an effort to improve treatment of patients with multiple chronic conditions, or multimorbidity, the American Geriatrics Society recently convened a panel of 11 geriatrics experts to develop a better approach for the care of patients with multiple chronic illnesses. The list below contains the panel’s recommended approach to the evaluation and management of multimorbidity.
The resulting document, “Guiding Principles for the Care of Older Adults with Multimorbidity,” was published in the recent Journal of the American Geriatric Society. It contains a set of recommendations for clinicians in the treatment of multimorbidity. The article recommends that clinicians focus on two separate aspects of patient care when treating patients with multiple chronic illnesses. First and foremost, the article recommends that doctors shift from a single-disease focus, to a more comprehensive approach. Clinicians should not blindly follow treatment guidelines for one medical problem can worsen another.
- Inquire about the patient’s primary concern (and that of family and/or friends, if applicable) and any additional objectives for the visit.
- Conduct a complete review of a care plan for the person with multimorbidity OR focus on a specific aspect of care for the person with multimorbidity.
- What are the current medical conditions and interventions? Is there adherence/comfort with the treatment plan?
- Consider patient preferences.
- Is relevant evidence available regarding important outcomes?
- Consider prognosis.
- Consider interactions within and among treatments and conditions.
- Weigh benefits and harms of components of the treatment plan.
- Communicate and decide for or against implementation or continuation of intervention / treatment.
- Reassess at selected intervals: for benefit, feasibility, adherence, alignment with preferences.
In conclusion, physicians should focus on treating the patient instead of focusing on an individual medical condition. Patient preferences and expectations should be assessed and taken into account prior to initiating or continuing therapy. Patient prognosis and possible interactions should also be assessed prior to starting any new therapy. If the patient’s prognosis is poor, there may not be a compelling reason to start a new treatment and it may even be worthwhile to consider discontinuing some of their medications. If there is a significant risk of medication interaction or adverse effects, it may be worthwhile to consider other treatment options. Finally, clinicians should reassess patients periodically to see if prescribed treatments should be reduced or discontinued.
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