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People with multiple health conditions get raw deal, says report

They don’t get the right treatment and often suffer needless disability and early death

Caroline White

Thursday, 19 April 2018

Increasing numbers of people with several ongoing health conditions are getting a raw deal worldwide, suggests a report* from the Academy of Medical Sciences, published today.

They often endure life-long disability and premature death, because they don’t get the right treatment, amid what the Academy describes as “an alarming lack of information about multimorbidity”.

No one disputes that multimorbidity is on the increase, but by how much and how fast isn’t known, says the report. But the evidence suggests that it is most common in women and those on low incomes, and is becoming increasingly common in young people.

Professor Stephen MacMahon, chair of the Academy of Medical Sciences multimorbidity working group, said: “From what we do know, I estimate tens of millions of Britons suffer from multimorbidity, and globally the number could be a billion.

“This report should be the tipping point of recognising that multimorbidity is an enormous threat to global health. It is a priority to get the evidence we need to develop effective strategies for prevention and treatment.”

But a poor understanding of the causes means there’s scant evidence to guide policy and practice, says the report, drawn from a working group of 17 international health experts.

Most health services, including the NHS, are not designed to care for patients with multiple illnesses. This is likely to contribute to the increasing pressures on health systems and budgets worldwide, it suggests.

Without a better understanding of multimorbidity, no country can plan future healthcare resources and redesign services effectively. 

Health conditions that frequently group together include heart disease, high blood pressure, diabetes, cancer, depression, anxiety, chronic obstructive pulmonary disease (COPD) and chronic kidney disease.

But why this happens is poorly understood, making it difficult to predict which patients may be most in need of preventive or increased care.

The report also highlights how physical conditions, such as type 2 diabetes, can affect mental health, and vice versa. But the division between health services treating mental and physical health often means that patients with physical and mental conditions are at particular risk of poor care.

Clinical trials of new medicines often exclude patients with multiple conditions, and there’s no agreed definition of multimorbidity, which has hindered essential research. The report recommends that its own definition be adopted by researchers globally.

The scale of multimorbidity also raises questions about the suitability of healthcare systems which are organised around treating single diseases or individual organs, which is the norm in most major hospitals.

And it raises questions about the way in which general practice is organised – specifically whether individual GP consultations are generally too short to enable comprehensive management of multiple conditions.

“How to prevent and manage multiple diseases is a challenge that GPs face every day, yet we have almost no evidence on which to provide guidance as to how to do this most effectively,” commented Professor MacMahon.

“We are facing a tidal wave of patients living with multiple long-term health conditions, and our report demonstrates how little we know about how to manage this. Outcomes appear to be worse in these patients and yet there is growing evidence that people with multimorbidity are less likely to receive appropriate care for the individual diseases they have. We face a situation where those in greatest need are least likely to receive appropriate care.”

He added: “For too long we’ve focussed almost exclusively on the management of single diseases, such as cancer and HIV. This means we have neglected the reality that most people with any one long-term disease typically have others.”

Professor Sir Robert Lechler, president of the Academy of Medical Sciences, added:

“People living with more than one illness often have more medical appointments and medications to manage, and doctors can struggle to balance their care. The toll of this can have a big impact on the quality of life of patients and their families.”

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, explained that the College's own analysis indicates 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.

GPs were hampered, among other things, by a lack of research and to the most appropriate services to manage this in the community, she said.

And she pointed out: "Care beyond general practice is also currently focused on single disease conditions, which can be fragmented and simply doesn't work for patients living with more than one long-term illness who need individually-tailored treatment.”

* Multimorbidity: a priority for global health research. The Academy of Medical Sciences. April 2018.

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