Multimorbidity, typically defined as having two or more long-term health conditions, has become a topic of increasing focus for healthcare providers. Many elderly people are affected by multimorbidity, with the majority of people aged 65 or above reporting more than one chronic health condition, and it is common for people with rare diseases to experience several on-going health issues.
Often described as one of the biggest challenges facing healthcare, multimorbidity is associated with a lower quality of life, worse mental health, and a reduced life expectancy. To address this, some doctors are arguing that current methods that look at each health issue independently need to be re-assessed to take into account those with more than one condition.
Multimorbidity in Patient Treatment
Many of the criticisms of the single-condition approach are outlined in a recent publication by The Academy of Medical Sciences. Current clinical guidelines outline best practices for specific conditions, but, according to the report, this means that when treating a patient with multimorbidity, a doctor could be faced with conflicting recommendations.
Addressing It Early On
Some medical professionals, such as Dr. Tracy Hussell who wrote an article on the topic in The Conversation, are arguing that the problem begins early on, in clinical trials. Researchers have estimated from a sample of over 300 studies that more than three-quarters of trials of treatments for patients with chronic conditions exclude people with multimorbidity, despite the large number of patients within that category. For example, about 90% of people with coronary heart disease (CHD) are thought to have multiple chronic conditions, but almost 70% of trials for CHD were found to exclude these patients. As Dr. Hussell points out, this may mean that researchers are inadvertently biasing their samples towards patients who might be at an earlier stage of the condition, and perhaps younger – two factors that could influence their response to a drug.
Another possible drawback to this approach, says The Academy of Medical Sciences, it that there might not be enough information about how the presence of having multiple conditions could affect a patient’s response or the risk of adverse effects.
Suggested Changes
Both Dr. Hussell and The Academy suggest including more sub-categories of patients with multiple conditions in clinical trials. Although there are a huge number of potential disease combinations, some, such as heart disease and high blood pressure, are much more common and could be studied as a sub-category. Dr. Hussell also advocates developing new tissue and animal models that better reflect disease complexity, while The Academy suggests collecting data from patients when they go to routine medical appointments. At a larger scale, The Academy proposes re-thinking models of care to make sure the focus is on the patient, rather than specialist disciplines.
