“A simple way to start the conversation with a patient with multiple chronic conditions is to ask: ‘If you can get one thing out of this consultation what would it be?"
Dr Nina Barnett, consultant pharmacist in the UK National Health Service, talks about the challenges involved when managing patients with multiple chronic conditions (MCC), especially when evidence and research into this field is scarce. Dr Barnett has helped to transform pharmacy practice for people with MCC by empowering staff to place person-centered conversations with patients at the heart of a pharmacy consultation rather than focusing on specific conditions and medicines.
People globally are living longer than ever before. But the time they can expect to live in good health is nearly a decade shorter than the average life expectancy.1
Chronic conditions like cardiovascular disease, diabetes and cancer dramatically impair quality of life, and are becoming more frequent. Furthermore, people are increasingly grappling with multiple chronic conditions (MCCs), owing in part to a higher likelihood that certain conditions will cluster together (eg, Alzheimer’s disease and stroke).2
Research indicates that one in three adults already lives with MCCs; in the UK, the number of people with at least four chronic conditions is expected to double by 2035.3 Faced with growing demands from MCCs, health systems will have to deal with greater complexity and higher costs than managing single conditions. How well prepared are they for this challenge?
In “Assessing health system preparedness for multiple chronic conditions”, The Economist Intelligence Unit explores the readiness of health systems around the world to manage the growing prevalence of MCCs. As there is no standard definition of “MCCs”, the EIU uses the term to describe people who are living with more than one concurrent chronic disease diagnosis.
After conducting an in-depth literature review and convening a panel of international experts in chronic conditions management, the EIU developed an index that examines the ability of health systems in 25 countries to respond to MCCs effectively. The index serves as a tool to help countries assess their own efforts and gauge areas for improvement.
The index determines MCC preparedness by examining five broad categories, or “domains”, within each country:
- Guidelines and policy measures to manage MCCs;
- Health system infrastructure, including spending, staffing and support for patient advocacy;
- Patient-centricity, training and research capabilities to train the healthcare workforce and manage people with MCCs effectively;
- Clinical information systems and digital transformation to ensure that healthcare systems have the technical capacity to collect, organise and manage information about patients with MCCs; and
- Planning, prevention and risk management systems to collect data on MCC prevalence, assess risk and determine the best course of preventive action.
Key findings
Five key takeaways emerged from the research for managing MCCs successfully:
- An in-depth understanding of the epidemiology of MCCs is essential. This requires harmonising data collection and reporting of MCC prevalence rates. Global comparisons of epidemiological data are not possible because of inadequate data collection in most countries; in those that do gather estimates, varying definitions of MCCs and the chronic conditions they include undermine these efforts.4
A universally accepted definition would improve accuracy and allow for reliable comparisons over time and among countries. It would also keep patients better informed and help identify the support they need.
- Strong political leadership is necessary for designing effective MCC policy. Central to political leadership is establishing guidelines and policies targeting MCCs. Indeed, the index shows a positive correlation between the existence of these measures and the overall score, which reflects better preparedness in countries with these policies.
These instances are rare, however, given the time and resources needed to develop evidence-based clinical practice guidelines. Only five countries covered in the index—France, the Netherlands, Spain, the US and the UK—have a national guideline specific to MCCs. Political instability can hamper the development of MCC policy, especially when governments face more immediate concerns like warfare and social upheaval. But fiscal challenges can encourage policymakers to increase scrutiny of aberrations and inefficiencies in health systems.
- A robust health system infrastructure that includes generalist practitioners and patient advocacy groups is key to MCC preparedness. Of all the domains in the index, the quality of a country’s health system infrastructure—based on aspects like healthcare financing, and the availability of generalist practitioners, pharmacy services and patient advocacy groups—has the strongest correlation with MCC readiness. The majority of the top-performing countries have public healthcare systems in place. High-income countries are generally better equipped to manage MCCs. However, low-income countries can both improve their preparedness and expand coverage by leveraging generalist practitioners in cost-effective ways.
- Patient centricity is paramount for co-ordinating MCC care. The index shows a positive correlation between patient-centric care and MCC preparedness. Patient centricity involves the ability of a health system to provide integrated care for the prevention, diagnosis and treatment of MCCs. In contrast, disjointed health systems may struggle to co-ordinate care for even single conditions.
- Expanding access to electronic medical record (EMR) systems is critical to facilitating care co-ordination. EMRs hold great promise in co-ordinating care for MCCs. These systems can be useful for identifying a patient’s previous healthcare providers, facilitating contact and ongoing collaboration, and monitoring the progress of care, thereby encouraging follow-up treatment and reducing the risk of “dropping the baton” between providers.5 When used to manage MCCs, EMRs can alert healthcare professionals of adverse drug reactions and promote the efficient use of resources through decision support algorithms.
| Click here to download: Health System Preparedness for Multiple Chronic Conditions index |
[1]According to the World Health Organisation, the global average life expectancy at birth in 2016 (latest data available) is 72 years, whereas the healthy life expectancy (HALE) at birth is 63.3 years. https://www.who.int/gho/mortality_burden_disease/life_tables/en/
[2]Hajat C, Stein E. The global burden of multiple chronic conditions: A narrative review. Preventive medicine reports. 2018;12, 284–293. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214883/
[3] Ibid.
[4] Schellevis FG. Epidemiology of multiple chronic conditions: an international perspective. SAGE
Publications Sage UK: London, England; 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5636028/
[5] Rudin RS, Bates DW. Let the left hand know what the right is doing: a vision for care coordination and electronic health records. Journal of the American Medical Informatics Association. 2013;21(1):13-16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912706/
