07 February 2017

Caring for patients with more than one long-term health condition

Bruce Guthrie, GP and Professor of Primary Care Medicine at the University of Dundee Medical School shares his experiences of caring for patients with multimorbidity

Professor Bruce Guthrie

An increasing proportion of my work as a GP is providing care for people with complex health needs who struggle with the collective burden of having several conditions affecting their health, and juggling the treatments they take for them. 

Having several long-term health problems like this is called multimorbidity in medical circles. 

More people than ever are living with more than one long term health condition. In fact, most people with any chronic condition, and most of those over 65, have multiple health conditions. 

In many ways, multimorbidity is the price of success as advances in health care mean people are people living longer, and surviving events such as heart attacks or strokes. But this success creates a new set of challenges. 

Some people need extra care that takes into account all their different health conditions. If a particular combination of conditions means that someone has to take lots of medicines, which can often interact with each other, or looking after each condition means that specialist care is fragmented, then this can have a significant impact on their quality of life. 

NICE published its guideline on multimorbidity in September 2016 to outline what good care should look like for these people. 

Building on this, NICE have now published a quality standard which identifies four priority areas from the guideline, from discussing someone's values and goals to reviewing their medicines and treatments. 

From a personal perspective, I think that the key questions that doctors and clinicians should ask themselves are: 

  • Does this person need an approach to care that takes into account their multiple health conditions? To answer this, I need to understand how their conditions affect their life and whether their treatment and care causes them problems.
  • What are we trying to achieve with treatment? To answer this, I need to understand what a person’s goals, values and priorities are. Long-term prevention and disease goals may be the most important thing to them, but other people will want to prioritise quality of life now.
  • If the person needs care co-ordination, then is it clear who is responsible? And if it isn’t clear, then should it be me? 

None of this is easy. The potential workload is large, and not all patients or carers want to or are able to engage in conversations about the implications of frailty, or if the medicines they’re taking for long-term benefit are worth taking because they have a short life expectancy. 

But not addressing the issue of multimorbidity leaves many patients struggling to navigate health services that are, in the majority, focused on single diseases. And patients could be left taking treatments where the original rationale for taking them is no longer relevant, particularly if they have since been diagnosed with another health condition. 

The final quality standard on multimorbidity can be found here.

3 comments

  • We are all missing the "gorilla in the room", we cannot achieve such noble endevours in the 10 minute GP consultation time.

    First lobby for more time with our patients, then the doctors will follow you in their droves.

  • We’re sorry to hear you didn’t find out about the consultation in time to comment Simon. Please email nice@nice.org.uk and let us know who you received your email from and we’ll look into this for you. Teresa.

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