“They only look at the lungs – as if the patient had no other organs”

Author: Dr Kieran Walsh

Multimorbidity is a growing problem in healthcare. The ageing population in all societies means that this problem will only get worse. Yet patients with multimorbidity deserve the same high-quality care that other patients receive. Can we be confident that they are getting such care?

Schiøtz et al have done an interesting study to attempt to find the answer to this question. (1) They reviewed the records of patients with multimorbidity and came up with some interesting findings. Worryingly they found that “the care provided to approximately two-thirds of the patients did not take comorbidities into account and insufficiently addressed more diffuse symptoms or problems.” The problems with management were encapsulated in the title quote – where physicians focussed on a single disease or organ system – and ignored any problem that was outside of their specialist area.

We might well ask why this could be the case. Boyd et al conducted another study that could help us answer this question. (2) They evaluated the applicability of clinical practice guidelines to the care of older individuals with several comorbid diseases. They found that most guidelines did not modify their recommendations when patients had comorbidities. Following several disease guidelines in a single patient with several diseases would also likely result in polypharmacy, drug interactions and increased costs - with little benefit to the patient.

Older patients with multiple chronic diseases  have been most affected

These issues have become even more clear in the Covid-19 pandemic. It is older patients with multiple chronic diseases who have been most affected. But we all know that the problems with comorbidities have been around for a long time and that the medical community has been slow to respond.

Managing patients with multiple chronic conditions

BMJ Best Practice is the clinical decision support tool of the BMJ. Until now, it has addressed single conditions only. However, we are now evaluating a new solution that will enable healthcare professionals to better manage patients with multiple chronic conditions. Speaking to users has revealed a stark need for such a solution. One cardiologist recently told me that he could not remember the last time he saw a patient with a single condition. Speaking to patients can also be telling. One patient recently told me that he was the only patient on a hospital ward with a single condition. When his doctors were taking a history, they repeatedly asked him if he was sure he had no other illnesses. They were very much accustomed to looking at patients with multiple comorbidities. BMJ Best Practice is working on a solution for the better management of patients with comorbidities, and we would be delighted to hear from you if you had suggestions on how we could help.

Please email on kmwalsh@bmj.com

References
1. Schiøtz ML, Høst D, Christensen MB, Domínguez H, Hamid Y, Almind M, Sørensen KL, Saxild T, Holm RH, Frølich A. Quality of care for people with multimorbidity - a case series. BMC Health Serv Res. 2017 Nov 18;17(1):745.
2. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005 Aug 10;294(6):716-24.

Competing interests
Kieran Walsh works for BMJ which produces the clinical decision support tool BMJ Best Practice.

 

Similar articles 

The Hidden Comorbidities by Dr Kieran Walsh

Multimorbidity in older people: the problem with diabetes by Dr Kieran Walsh