Multiple Diseases, Multiple Problems

Health care system is inadequate for multi morbidities

/ Author:  / Reviewed by: Robert Carlson, M.D

In the age of multitasking, “one thing at a time” is as outdated as a polyester leisure suit. The same is true for doctors treating just one disease as it can lead to confusion and inferior care.

Diseases do not exist in a vacuum and multimorbidities, several diseases at once in addition to the main disease, are a growing concern for many individuals. Patients with chronic obstructive pulmonary disease (COPD) may also have pneumonia, influenza, heart disease or osteoporosis.

Because there is more than just one disease, there needs to be more than one treatment. Unfortunately, many individuals have to go to multiple specialists for multimorbidities.

This can lead to confusion and inadequate care because doctors are not communicating with one another.

Duplicate prescriptions for the same drug could be administered by different doctors and new drugs may not take into consideration individuals with more than one disease. This care fragmentation is especially important to the welfare of the elderly.

Elderly Care is Cause for Concern

Caring for the elderly is a complex issue taking into consideration the well being of the elderly that goes beyond just treating a disease. According to the American Geriatrics Society (AGS), approximately 50 percent of the elderly population have three or more chronic diseases.

This puts the elderly at a greater risk for death, serious injuries, poor quality of life and possible need for a senior living center.

Despite the need for extra attention when it comes to treating the elderly, current policies for doctors in America focus on specialist referrals. An elderly individual may have multiple diseases which could affect proper treatment.

The AGS gives an example of how a fragmented care system can be quite problematic in regards to an 87 year old man who has type 2 diabetes, osteoporosis, osteoarthritis, prostate enlargement, congestive heart failure, probable Alzheimer's disease and insomnia. Because of the multiple afflictions, this hypothetical person is taking a lot of prescription medication that may affect one another.

If the doctors are not talking to one another, and chances are they are not, the elderly man is taking 11 different kinds of medication that could benefit him but each drug has its own side effects. In a more comprehensive care system, doctors can work horizontally, not vertically, and develop a strategy to help treat the diseases while providing the individual with improved quality of life.

More practically, a drug's relatively small safety concern can lead to much greater problems. This is the case for the American Heart Association's (AHA) recommendation against using nonsteroidal anti-inflammatory drugs (NSAID), like aspirin, ibuprofen or naproxen for cardiovascular disease patients. In this case the risks far outweigh the benefits.

Risk and Rewards of Treatments

In 2007 the AHA recommended against the use of NSAID for individuals with cardiovascular disease. According to the AHA, NSAID increased the risk of death, stroke and death for individuals with cardiovascular problems. The AHA recommended a tiered-approach to using NSAID, which caused concern among doctors and rheumatologists.

There needs to be more taken into consideration than just possible safety issues, note doctors. NSAID are used for inflammation and can be used to help ease some pain and some cardiovascular risks can be adjusted. Weight loss can reduce cardiovascular risk as can taking statins, which can reduce cholesterol.

The AHA focused on general safety and not tailored treatment for the individual based on disease symptoms or medical history of the patient. This can limit therapy options and can lead to even greater risks for patients, in particular the elderly.

The restriction on NSAID may limit therapy options for the elderly. Instead of using NSAID because of the possible risks, doctors may recommend using narcotic painkillers for patients opting to use narcotics because they are deemed safer, not more effective. Some of the side effects of narcotics include dizziness and falls in the elderly. This can lead to death or serious injuries such as broken hips.

Medical care can be confusing and fragmented for everyone, not just the elderly.

Fragmented Care is a Concern for Everyone

While fragmented health care and doctors only treating one disease at a time are obvious concerns for the elderly, the same problems cross any generational gap. Inadequate care for multimorbidities affect close to 25 percent of Americans, according to Richard A. Goodman, MP, MPH, from the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention.

Individuals with multimorbidities have a daunting task to face that goes beyond just treatment. Multimorbidities add up to approximately 66 percent of total United States health care spending, notes Dr. Goodman. That is quite the burden, not just for the individual but for doctors and for the treatment of multiple diseases.

Fragmented health care for individuals with multiple chronic diseases is an international problem as well. In a new study published in The Lancet, led by Karen Barnett, PhD, from the University of Dundee, Scotland has a similar problem.

According to Dr. Barnett, of the 1,751,841 individuals that were a part of the study, using data collected from 314 medical facilities, 42 percent had one or more disease while 23 percent had multiple chronic diseases. Because of these large numbers, there is a strain on the current health care system that focuses on just one disease at a time. Health care needs to take into consideration this large population of patients with multimorbidities.

Inadequate care has been given plenty of attention and calls for change have resulted in the first steps of resolving fragmented care.

Recent recommendations by the United States Department of Health and Human Services have suggested goals to better care for this population of patients with multimorbidities. The framework included strengthening the overall health care system, providing the tools for an individual to use self-care management, providing tools to doctors and clinicians to handle multimorbidities and changing the research policies to integrate multimorbidities into the testing process for new treatments. 

Reviewed by: 
Review Date: 
May 11, 2012