Introducing a unique solution to treating patients with multiple chronic conditions
Today, one in three patients admitted to hospital in Canada as an emergency has five or more conditions. Having to treat multiple chronic conditions is putting increasing demands on our healthcare systems. Now, more than ever, clinical teams need to adopt an integrated approach to patient care. This means recognizing a patient’s comorbidities - and how they interact. Simple to say, but how do we put this principle into practice?
Well, help is at hand. BMJ Best Practice Comorbidities is a point-of-care clinical decision support tool that helps professionals treat the whole patient. In fact, it is the only such clinical decision support tool currently available.
Multimorbidity is an important issue - but it is much neglected. According to Professor Christopher Whitty, Chief Medical Officer for England: “Treating each disease in a patient as if it exists in isolation will lead to less good outcomes and complicate and duplicate interactions with the healthcare system. Training from medical school onwards, clinical teams and clinical guidelines, however, all tend to be organized along with single disease or single organ lines.”
Professor Whitty made these remarks in The BMJ in January 2020, just weeks before the COVID-19 outbreak was declared a pandemic.
What has COVID-19 has taught us?
The COVID-19 pandemic has made the impact of comorbidities clear to everyone. Patients with COVID-19 and pre-existing illnesses are much more likely to become seriously ill and require hospitalization.
A meta-analysis by Espinosa and colleagues reviewed the “Prevalence of Comorbidities in Patients and Mortality Cases Affected by SARS-CoV2”. They found that 42% of patients with COVID-19 had comorbidities; 61% of those admitted to the Intensive Care Unit had comorbidities; and 77% of those who died had comorbidities. Hypertension was the most prevalent comorbidity (affecting 32% of patients). Other common comorbidities included diabetes (22%), heart disease (13%), and COPD (8%).
Acute and existing chronic conditions.
Treating patients with multiple chronic conditions is complicated. It is a balancing act, requiring careful consideration of the acute illness that might have precipitated a patient’s hospital admission and their pre-existing conditions.
The Comorbidities tool from BMJ Best Practice is the only point-of-care tool that supports the management of the whole patient by including guidance on the treatment of a patient’s acute condition alongside their pre-existing comorbidities. Access to this information should help professionals and providers improve patient outcomes, reduce costs, and avoid unnecessary treatments.
But don’t take our word for it. Listen to your fellow professionals. “BMJ Best Practice Comorbidities provides a logical approach to an area that could become hugely complex. When I choose a single comorbidity, the information is relevant, useful, and pragmatic.” Colin Mitchell, Consultant Geriatrician and Head of Specialty for Geriatrics at Imperial College London.
BMJ Best Practice Comorbidities prompts healthcare professionals to consider the patient’s comorbidities when accessing treatment information. The tool produces an initial management plan tailored to the unique needs of the patient.
Written by leading specialists, it provides treatment advice based on the latest and best available evidence. Where evidence is scarce and guidance therefore hard to supply, we have assembled a leading team of experts to draw on their experience in their fields.
In the acute hospital setting, healthcare professionals need fast access to the latest clinical information. And that’s exactly what BMJ Best Practice Comorbidities provides.
Tim Mossad, Consultant in Emergency Medicine, Chesterfield Royal Hospital, says: “I’d like to see BMJ Best Practice Comorbidities usage ingrained into our practice, both as a learning resource and as a practical resource for checking and verifying decisions made on the ward.”
Preparing for practice.
While the pandemic has raised the profile of patients with comorbidities, there is still a long way to go. Traditionally, training in medical institutions tends to be organized along single disease or single organ lines (an approach adopted by clinical teams, and further reinforced by clinical guidelines). This is not helpful. And it is compounded by a lack of relevant information on how to manage patients with comorbidities.
It is often when medical students are first exposed to patients on the wards that they see the complexity of patients with disease combinations presenting to healthcare professionals. BMJ Best Practice Comorbidities can help students prepare for the complexity of real-life patient care and can support their clinical learning on the wards.
John Sanders Professor of Medical Education at Edge Hill University states: “When faced with the complexity of a clinical case, I see many students focus on the acute reason for a patient’s admittance to hospital, rather than considering the patient’s pre-existing conditions. But, it’s this integration of knowledge that appears to make the biggest difference between the most and least effective doctors".
From enabling students to work through complex patients to preparing them for placements and supporting their learning on the wards, BMJ Best Practice Comorbidities enables more integrated learning. The tool helps students understand how to competently and confidently manage patients with multiple chronic conditions and implement a personal, patient-centered approach to care.
“BMJ Best Practice Comorbidities is an immensely helpful resource in helping medical students and junior doctors to understand the complexities of medicine.” Duncan Forsyth, Consultant Geriatrician, Cambridge University Hospital.
Counting the costs.
Let's look at one example. In England, chronic obstructive pulmonary disease (COPD) causes 115,000 emergency admissions a year. Around 10% to 20% of patients with COPD have diabetes. If diabetes is not managed correctly in patients with an exacerbation of COPD, there can be a range of unwanted consequences, including uncontrolled hyperglycemia, acute kidney injury, and pressure ulcers. All are associated with a prolonged stay in the hospital.
If just one patient with COPD and diabetes is managed incorrectly and has a prolonged length of stay of a few days, the cost to the health service will run to thousands of pounds. And remember, this is just one comorbidity added to one acute illness.
In a user survey, 99% of healthcare professionals would use BMJ Best Practice Comorbidities.
Shouldn’t you? Ask us for a demonstration today. See for yourself how BMJ Best Practice Comorbidities helps with the challenge of treating the ever-increasing number of patients admitted to hospital with multiple complex conditions.
- Espinosa OA, Zanetti ADS, Antunes EF, Longhi FG, Matos TA, Battaglini PF. Prevalence of comorbidities in patients and mortality cases affected by SARS-CoV2: a systematic review and meta-analysis. Rev Inst Med Trop Sao Paulo. 2020;62:e43. Published 2020 Jun 22. doi:10.1590/S1678-9946202062043
- Parappil A, Depczynski B, Collett P, Marks GB. Effect of comorbid diabetes on length of stay and risk of death in patients admitted with acute exacerbations of COPD. Respirology. 2010 Aug;15(6):918-22.
- Miller J, Edwards LD, Agustí A, Bakke P, Calverley PM, Celli B, Coxson HO, Crim C, Lomas DA, Miller BE, Rennard S, Silverman EK, Tal-Singer R, Vestbo J, Wouters E, Yates JC, Macnee W; Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Investigators. Comorbidity, systemic inflammation and outcomes in the ECLIPSE cohort. Respir Med. 2013 Sep;107(9):1376-84.
- Survey results from over 100 BMJ Best Practice Comorbidities tool users (August 2020)