A comparison of policies and guidelines related to multimorbidity in the UK, Australia and Sri Lanka

Chandraratne, Nadeeka; Pathirathna, Ravindra; Harrison, Christopher; Siriwardena, A Niroshan

doi:10.31128/afp-09-17-4346

Cited by 12 publications

(11 citation statements)

References 17 publications

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“…Countries such as the UK and Sri Lanka have developed clinical guidelines for multimorbidity that emphasise integration and patient-centred health-care services. 38 Our findings also provide new evidence on the growing financial burden of multimorbidity in China. Multimorbidity is costly to individuals and health systems.…”

Section: Discussionmentioning

confidence: 51%

Physical multimorbidity, health service use, and catastrophic health expenditure by socioeconomic groups in China: an analysis of population-based panel data

Zhao¹,

Atun²,

Oldenburg³

et al. 2020

The Lancet Global Health

225

219

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Background Multimorbidity, the presence of two or more mental or physical chronic non-communicable diseases, is a major challenge for the health system in China, which faces unprecedented ageing of its population. Here we examined the distribution of physical multimorbidity in relation to socioeconomic status; the association between physical multimorbidity, health-care service use, and catastrophic health expenditures; and whether these associations varied by socioeconomic group and social health insurance schemes. MethodsIn this population-based, panel data analysis, we used data from three waves of the nationally representative China Health and Retirement Longitudinal Study (CHARLS) for 2011, 2013, and 2015. We included participants aged 50 years and older in 2015, who had complete follow-up for the three waves. We used 11 physical non-communicable diseases to measure physical multimorbidity and annual per-capita household consumption spending as a proxy for socioeconomic status. Findings Of 17 708 participants in CHARLS, 11 817 were eligible for inclusion in our analysis. The median age of participants was 62 years (IQR 56-69) in 2015, and 5766 (48•8%) participants were male. 7320 (61•9%) eligible participants had physical multimorbidity in China in 2015. The prevalence of physical multimorbidity was increased with older age (odds ratio 2•93, 95% CI 2•71-3•15), among women (2•70, 2•04-3•57), within a higher socioeconomic group (for quartile 4 [highest group] 1•50, 1•24-1•82), and higher educational level (5•17, 3•02-8•83); however, physical multimorbidity was more common in poorer regions than in the more affluent regions. An additional chronic non-communicable disease was associated with an increase in the number of outpatient visits (incidence rate ratio 1•29, 95% CI 1•27-1•31), and number of days spent in hospital as an inpatient (1•38, 1•35-1•41). We saw similar effects in health service use of an additional chronic non-communicable disease in different socioeconomic groups and among those covered by different social health insurance programmes. Overall, physical multimorbidity was associated with a significantly increased likelihood of catastrophic health expenditure (for the overall population: odds ratio 1•29, 95% CI 1•26-1•32, adjusted for sociodemographic variables). The effect of physical multimorbidity on catastrophic health expenditures persisted even among the higher socioeconomic groups and across all health insurance programmes.Interpretation Concerted efforts are needed to reduce health inequalities that are due to physical multimorbidity, and its adverse economic effect in population groups in China. Social health insurance reforms must place emphasis on reducing out-of-pocket spending for patients with multimorbidity to provide greater financial risk protection.

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Section: Discussionmentioning

confidence: 51%

Physical multimorbidity, health service use, and catastrophic health expenditure by socioeconomic groups in China: an analysis of population-based panel data

Zhao¹,

Atun²,

Oldenburg³

et al. 2020

The Lancet Global Health

225

219

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“…Our study demonstrates that these patients consist of groups characterised by distinct disease patterns. Current treatment guidelines overwhelmingly focus on a single disease and the health system is fragmented and sub-specialised [ 64 ]. Poor patient-provider communication, limited standard consultation time, lack of care coordination and shared decision-making are important challenges for managing multimorbidity [ 65 , 66 ].…”

Section: Discussionmentioning

confidence: 99%

Complexity in disease management: A linked data analysis of multimorbidity in Aboriginal and non-Aboriginal patients hospitalised with atherothrombotic disease in Western Australia

et al. 2018

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BackgroundHospitalisation for atherothrombotic disease (ATD) is expected to rise in coming decades. However, increasingly, associated comorbidities impose challenges in managing patients and deciding appropriate secondary prevention. We investigated the prevalence and pattern of multimorbidity (presence of two or more chronic conditions) in Aboriginal and non-Aboriginal Western Australian residents with ATDs.Methods and findingsWe used population-based de-identified linked administrative health data from 1 January 2000 to 30 June 2014 to identify a cohort of patients aged 25–59 years admitted to Western Australian hospitals with a discharge diagnosis of ATD. The prevalence of common chronic diseases in these patients was estimated and the patterns of comorbidities and multimorbidities empirically explored using two different approaches: identification of the most commonly occurring pairs and triplets of comorbid diseases, and through latent class analysis (LCA). Half of the cohort had multimorbidity, although this was much higher in Aboriginal people (Aboriginal: 79.2% vs. non-Aboriginal: 39.3%). Only a quarter were without any documented comorbidities. Hypertension, diabetes, alcohol abuse disorders and acid peptic diseases were the leading comorbidities in the major comorbid combinations across both Aboriginal and non-Aboriginal cohorts. The LCA identified four and six distinct clinically meaningful classes of multimorbidity for Aboriginal and non-Aboriginal patients, respectively. Out of the six groups in non-Aboriginal patients, four were similar to the groups identified in Aboriginal patients. The largest proportion of patients (33% in Aboriginal and 66% in non-Aboriginal) was assigned to the “minimally diseased” (or relatively healthy) group, with most patients having less than two conditions. Other groups showed variability in degree and pattern of multimorbidity.ConclusionMultimorbidity is common in ATD patients and the comorbidities tend to interact and cluster together. Physicians need to consider these in their clinical practice. Different treatment and secondary prevention strategies are likely to be useful for management in these cluster groups.

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“…There is a need to redesign the healthcare system in accordance with local resources and demands focusing on the management of MCCs. Some high‐income countries such as the UK and Australia have established clinical guidelines and developed policies to address care of people with MCCs (Chandraratne, Pathirathna, Harrison, & Siriwardena, ). China, as a developing country with significant regional inequality, still lacks an effective healthcare model for people with MCCs.…”

Section: Relevance To Clinical Practicementioning

confidence: 99%

Patients' experiences of coping with multiple chronic conditions: A qualitative descriptive study

Cheng

Bai

Yang

et al. 2019

Journal of Clinical Nursing

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Objective To explore the experiences of how Chinese adults cope with multiple chronic conditions in everyday life. Background Having multiple chronic conditions is stressful, requiring people to make physical and mental adaptations. There is little evidence exploring how people cope with multiple chronic conditions, especially in an Asian context. Design A qualitative descriptive design was employed. The Consolidated criteria for reporting qualitative research (COREQ) was used to report this study. Methods This study was conducted in a tertiary referral and teaching hospital in Bengbu, Anhui, China, between August and October 2018. A purposive sample of 14 people with multiple chronic conditions, aged between 32 and 75 years, completed a demographic questionnaire and semi‐structured face‐to‐face interviews. The interviews were digitally recorded and transcribed verbatim. Qualitative content analysis guided data analysis. Results Four distinctive themes comprising subthemes were developed from participants' narratives pertaining to coping with multiple chronic conditions: (a) appraising multiple chronic conditions, (b) addressing multiple chronic conditions management, (c) maintaining psychological well‐being and (d) fulfilling a social role. Illustrative quotations were cited to support each theme. Conclusions This study underscores that people cope with multiple chronic conditions in everyday life by using a compendium of coping strategies. As one of the influencing factors, culture dominates the ways of coping at different levels among people with multiple chronic conditions. These findings expand the current literature on coping based on an Asian perspective and inform further cross‐culture research on this topic. Relevance to clinical practice Healthcare professionals should understand peoples' experiences of coping with multiple chronic conditions to provide more holistic and dynamic health care to address their actual needs. Healthcare professionals should be acquainted with how culture impacts individuals' coping and develops culture‐tailored supportive programmes such as family‐based interventions, to promote the health of people with multiple chronic conditions.

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A comparison of policies and guidelines related to multimorbidity in the UK, Australia and Sri Lanka

Cited by 12 publications

References 17 publications

Physical multimorbidity, health service use, and catastrophic health expenditure by socioeconomic groups in China: an analysis of population-based panel data

Physical multimorbidity, health service use, and catastrophic health expenditure by socioeconomic groups in China: an analysis of population-based panel data

Complexity in disease management: A linked data analysis of multimorbidity in Aboriginal and non-Aboriginal patients hospitalised with atherothrombotic disease in Western Australia

Patients' experiences of coping with multiple chronic conditions: A qualitative descriptive study

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