How can healthcare providers alleviate the burden on patients with multiple chronic comorbidities (Co-existing Medical Conditions)?

From the Guidelines

Healthcare providers can alleviate the burden on patients with multiple chronic comorbidities by prioritizing therapies that address multiple conditions simultaneously, such as using ACEI/ARB for hypertension, heart failure, and chronic kidney disease, and focusing on patient-centered care that respects individual preferences and quality of life goals. This approach is supported by the most recent and highest quality study, which emphasizes the importance of identifying core values and health outcome goals, estimating baseline function, and ranking options to pick high-value areas to discuss with the patient 1.

When managing patients with multiple chronic comorbidities, it is essential to consider the following key points:

• Prioritize therapies that address multiple chronic conditions simultaneously with high impact
• Consider the use of medications that can treat multiple conditions, such as ACEI/ARB or SGLT2i
• Focus on patient-centered care that respects individual preferences and quality of life goals
• Use shared decision-making techniques to clearly explain treatment options and their benefits and risks
• Implement a team-based care model to reduce logistical burdens and improve coordination of care

The evidence suggests that a comprehensive approach that addresses the physical, emotional, and logistical burdens of managing multiple conditions can improve treatment adherence and quality of life 1. By prioritizing patient-centered care and simplifying treatment regimens, healthcare providers can help patients with multiple chronic comorbidities feel less burdened and improve their overall well-being.

Some key strategies for achieving this include:

• Conducting comprehensive medication reviews to eliminate unnecessary prescriptions and consolidate dosing schedules
• Implementing a team-based care model with a designated care coordinator to navigate appointments, tests, and referrals
• Using shared decision-making techniques to respect patients' priorities and quality of life goals
• Providing clear, simplified written instructions and medication schedules to enhance self-management
• Considering the use of telehealth and remote monitoring options to minimize unnecessary clinic visits.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Alleviating the Burden on Patients with Multiple Chronic Comorbidities

To alleviate the burden on patients with multiple chronic comorbidities, healthcare providers can consider the following strategies:

• Implementing problem-focused strategies, such as routinizing self-care, enlisting support of others, planning for the future, and using technology 2
• Providing emotion-focused coping strategies, like maintaining a positive attitude, focusing on other life priorities, and spirituality/faith 2
• Offering social support, including informational, tangible, and emotional assistance 2
• Fostering positive aspects of health care, such as coordination of care and beneficial relationships with providers 2
• Preserving autonomy/independence and being proactive with providers 2

Interventions for Improving Outcomes

Interventions that can improve outcomes for patients with multimorbidity include:

• Complex interventions, such as case management or enhanced multidisciplinary team work 3
• Patient-oriented interventions, such as educational or self-management support-type interventions 3
• Targeted interventions, such as those focusing on depression, diabetes, and cardiovascular disease 3
• Interventions that address interactions between chronic conditions and skills necessary to care for individual diseases 4

Barriers to Self-Care

Patients with comorbid chronic diseases experience a wide range of barriers to self-care, including:

• Physical limitations 4
• Lack of knowledge 4
• Financial constraints 4
• Logistics of obtaining care 4
• Need for social and emotional support 4
• Aggravation of one condition by symptoms of or treatment of another 4
• Multiple problems with medications 4
• Overwhelming effects of dominant individual conditions 4

Role of Health Psychology and Behavioral Medicine

Health psychology and behavioral medicine can play an important role in meeting the challenges posed by multimorbidity by:

• Studying the etiology of multimorbidity 5
• Developing prevention and self-management strategies 5
• Improving clinical care for patients with multimorbidity 5

Impact on Health Care Resources and Costs

Multimorbidity has a significant impact on health care resources and costs, including:

• Substantially greater health care costs and resource utilization 6
• Elevated rates of primary care and specialist physician occasions of service, medication use, emergency department presentations, and hospital admissions 6
• A need for cost-effectiveness information for chronic disease interventions originating from patient samples with multimorbidity 6