Multimorbidity Treatment Challenges

Multimorbidity is defined as the presence of two or more long-term diseases at the same time. Its prevalence is strongly linked to age, sex and the socio-economic status and is becoming an increasing challenge in the aging population today, particularly in the primary healthcare system. While patient education and access to healthcare for distinct chronic conditions is increasing, the improvement of long-term interdisciplinary care remains a challenge.

Defining Multimorbidity

Defining multimorbidity poses a challenge by itself. Different studies use different diagnostic frameworks to define chronic illnesses that must exist alongside one another in multimorbidity. This leads to vastly different estimations of the prevalence of multimorbidity. Another question is that of how strongly the diseases developed are linked with one another – whether one of them is a direct result of another, rather than a separate condition on its own. Still, the needs of a patient suffering from multiple long-term conditions remain the same and pose similar challenges to the healthcare system.

Multimorbidity and the Need for Combined Treatment

The treatment offered to patients today is largely based on managing one condition at a time. A few conditions may be treated simultaneously by a qualified doctor if they all fall in the same area of expertise – for example coronary heart disease and hypertension. However, multimorbidity, by definition, is the existence of multiple long-term conditions which affect different systems of the body, without any one of those conditions being seen as dominant.

Frequently, multiple diseases affect both the physical and mental health of a patient, such as the existence of depression and anxiety alongside osteoarthritis and chronic pain. As such, in order to provide the patient with comprehensive treatment, a doctor must consider all the coexisting conditions not only separately, but as interlinked conditions.

Currently, patients seeking help often find themselves having to visit a number of specialists and may receive different and conflicting advice regarding their treatment. This may lead to patients feeling as though they do not receive holistic treatment, emphasizing the need for an integrative approach in the treatment of multimorbidity.

The Importance of Primary Care

The primary healthcare system plays a pivotal role in the treatment of patients suffering from multiple chronic conditions. It is the general practitioner’s role to examine the patient in the first instance and provide comprehensive medical advice, as well as a referral to a specialist when necessary.

With the increase in the age of the population today, more elderly patients seek advice from their family doctor and are more likely to report the existence of two or more chronic conditions at any one time.

Those patients are also more likely to suffer from decreased life satisfaction, as well as report co-existing mental health, emotional and psychosocial problems.

Polypharmacy – The Use of Several Medications Simultaneously

The management of patients who suffer from multiple chronic conditions poses a challenge for the doctor who needs to prescribe a number of medications.

As each of these is usually designed to treat a particular condition, managing them simultaneously poses a challenge when considering the drug interactions and the combined side effects of treatment.

Limited data is available on certain drug interactions and very few studies have been performed on monitoring the long-term pharmaceutical care of patients with multiple conditions. One Italian study has reported that almost half of the population aged 65 years and over received five different medications from their primary care doctor in 2005.

This means an increased risk of inappropriate prescribing – both with regard to medications that should not be prescribed simultaneously, as well as exceeding the maximum doses of certain substances. Moreover, different drugs may be prescribed by different doctors who are treating the same patient for different coexisting conditions.

This may cause an increase in the adverse side effects due to the number of medications used; this may then further reduce a patient’s quality of life.

Challenges for the Future

One of the main questions to consider is: which combinations of conditions occur most commonly – for example, are there particular conditions that occur more often than others in patients suffering from hypertension?

This could then lead to an implementation of a more standardized plan of treatment for certain co-morbidities, as well as more flexible guidelines for treatment and the drugs prescribed under this new model. It would enable general health practitioners to strike a balance between the treatment guidelines for specific conditions and the needs of a patient as a whole.

Further Reading

• All Multimorbidity Content
• Multimorbidity Epidemiology
• What is a Concomitant Illness?